Studying for residency

[TypeADoctor]

I'm now in my 4th year of medical school and will have a few months during and a couple of months after my 4th year in which I would like to do some studying in preparation for residency. Any suggestion on how or what to study in preparation for my first year of FM residency?

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[GoodmanBrown]

I'm now in my 4th year of medical school and will have a few months during and a couple of months after my 4th year in which I would like to do some studying in preparation for residency. Any suggestion on how or what to study in preparation for my first year of FM residency?

I dunno. I'm only in med school myself, but everyone I've ever talked to or heard advice from says you should enjoy those last few months of freedom.

 

[JustPlainBill]

I made the mistake of taking those last months of freedom --- and promptly fell on my glutes royally during intern year and am still trying to shake the perception (not without a grain of truth) that I don't know WTF I'm doing......

So, what would I do differently?

1) I'd make it a point to read the AAFP journal, if not cover to cover, then at least the 3 major articles they have in each edition -- and now you need to focus mainly on workup and treatments...esp. treatments...know the names, dosages, course and options...

2) I'd know the general workup/treatments for major things in IM -- like CHF exac, COPD/asthma exac, DKA/hyperglycemia, ascites, cellulitis, osteo, MI, intractable diarrhea, pancreatitis....and I'm sure there's some others I'm missing....again, know the lab/imaging workups and treatments...more importantly, know/understand discharge planning...what are the criteria to get these people the heck out of the hospital?

3) Review OB, peds, surgical knot tying, suturing, electrolytes, blood gases......

That should be enough to keep you up at night for a while.....and then start getting some dedicated sleep time...figure out what you NEED to stay fresh, what you can get away with for a day or two with 'catch up' in a few days....tone down the caffeine, you'll ramp back up later....if you're overweight, lose it now, go in aerobically fit so you can keep moving....

Good luck....everyone, some more than others, cries like a little girl....but everyone, with few exceptions, makes it through....

Also, practice your presentations before the mirror -- it's no longer about reporting/droning on about information that you've discovered...now it's about -- the patient has X based on this, I'm presenting this information to let the attending know I've thought about/ruled out other big bad stuff and since I'm reasonably sure it's this, here's WTF I'm going to do.....practice that until you can present it with confidence and keep it 'tight'.....stumbling around, skipping around, answering, "I didn't think about that" or "I don't know" will get you hammered and shark attacked...for quite a while.....don't ask me how I know....

Also, the Shark Talk --- If one of your colleagues has attendings/upper levels/fellows circling them like sharks, either verbally or whatever, everyone else stay the hell away so to speak. If you get involved, you'll get bit also....it's over faster...once they smell chum in the water, the feeding frenzy is vicious.....and you'll bear the scars.....

Good luck....

 

[TypeADoctor]

I appreciate the advice. I am choosing FM not because I am a poor student but because it is what I believe in. I don't just want to get by or waist my 4th year and figure if I prepare even a little now it will only better prepare me for later on...when the **** hits the fan!

 

[BrickHouseMD]

I made the mistake of taking those last months of freedom --- and promptly fell on my glutes royally during intern year and am still trying to shake the perception (not without a grain of truth) that I don't know WTF I'm doing......

So, what would I do differently?

1) I'd make it a point to read the AAFP journal, if not cover to cover, then at least the 3 major articles they have in each edition -- and now you need to focus mainly on workup and treatments...esp. treatments...know the names, dosages, course and options...

2) I'd know the general workup/treatments for major things in IM -- like CHF exac, COPD/asthma exac, DKA/hyperglycemia, ascites, cellulitis, osteo, MI, intractable diarrhea, pancreatitis....and I'm sure there's some others I'm missing....again, know the lab/imaging workups and treatments...more importantly, know/understand discharge planning...what are the criteria to get these people the heck out of the hospital?

3) Review OB, peds, surgical knot tying, suturing, electrolytes, blood gases......

That should be enough to keep you up at night for a while.....and then start getting some dedicated sleep time...figure out what you NEED to stay fresh, what you can get away with for a day or two with 'catch up' in a few days....tone down the caffeine, you'll ramp back up later....if you're overweight, lose it now, go in aerobically fit so you can keep moving....

Good luck....everyone, some more than others, cries like a little girl....but everyone, with few exceptions, makes it through....

Also, practice your presentations before the mirror -- it's no longer about reporting/droning on about information that you've discovered...now it's about -- the patient has X based on this, I'm presenting this information to let the attending know I've thought about/ruled out other big bad stuff and since I'm reasonably sure it's this, here's WTF I'm going to do.....practice that until you can present it with confidence and keep it 'tight'.....stumbling around, skipping around, answering, "I didn't think about that" or "I don't know" will get you hammered and shark attacked...for quite a while.....don't ask me how I know....

Also, the Shark Talk --- If one of your colleagues has attendings/upper levels/fellows circling them like sharks, either verbally or whatever, everyone else stay the hell away so to speak. If you get involved, you'll get bit also....it's over faster...once they smell chum in the water, the feeding frenzy is vicious.....and you'll bear the scars.....

Good luck....

This is all outstanding advice!! Also remember, these are no longer just fellow students that you're competing with or don't even really care about. These are your colleagues, and more importantly, these are now YOUR patients. So when it comes to notes or scut work, if you absolutely can, do it yourself and don't leave it for others. If you are known for leaving everyone else a pile of caca to clean up, guess what they'll do for you. If YOUR patient needs something done, go the extra mile. If your COWORKER'S patient needs something done, also go the extra mile. They'll be more likely to reciprocate.

 

[TypeADoctor]

Does anyone know of a good FM textbook that is generally used by PGY1's??

 

[Shinken]

Any suggestion on how or what to study in preparation for my first year of FM residency?

Actually I'm with the poster that recommended to relax and enjoy your time off before residency starts. That's good advice.

I don't want to sound like a smartie pants, but if you dont' know the basic work-up and treatment for common inpatient conditions then you probably didn't pay enough attention in 3rd and 4th year of medical school.

[Also, just a piece of friendly advice: There are weird people out there, like myself, who love Family Medicine and chose it over any other specialty. I had great board scores and did very well in medical school too (honest!). We come to this forum to read topics of interest to family docs. You don't really need to justify yourself by saying "I am choosing FM not because I am a poor student but because it is what I believe in."]

As far as your question about textbooks, it depends on what you're looking for. For inpatient medicine, most of us used a basic text like The Washington Manual of Medical Therapeutics or Ferri's. Also, many people had a pocket book on hospital admission order samples (for example Hospital Admissions or Current Clinical Strategies Family Medicine).

For outpatient medicine then any basic textbook (or even the AFP journal) is fine. My favorite is Primary Care Medicine by Goroll/Mulley simply because it's a textbook that teaches the approach to physical complaints instead of simply being a catalog of diseases (like Harrison's or Cecil's).

To be honest, though, other than a pocketbook with sample orders, most of us used the internet to read up on medicine. Our main websites were UptoDate and eMedicine.

 

[JustPlainBill]

I don't want to sound like a smartie pants, but if you dont' know the basic work-up and treatment for common inpatient conditions then you probably didn't pay enough attention in 3rd and 4th year of medical school.

To be honest, though, other than a pocketbook with sample orders, most of us used the internet to read up on medicine. Our main websites were UptoDate and eMedicine.

Or you did what most of us have done -- decided that the last 6 months of 4th year were 'cruise mode' elective time...I essentially stopped thinking 6 month from graduation....and that bit me....It all comes back, but my medical school experience wasn't that great in the first place in terms of training on assessment/plan. My fault for not pursuing it harder though.

UptoDate and eMedicine are great. Most of your 'learning' will be in the 5 minutes or so you have to read one topic which you are currently dealing with.....

 

[MeowMix]

What will you really learn and retain from reading books?

if you can do so, I would fill that time with clinical electives that will really help you in FM. Derm is always great IF you can do procedures. ID. ER. Radiology. Anesthesia. Peds urgent care. Sports Med. I am so glad I did extra time on all of these, because even though you have to do electives in residency, you will never have as much time as you will as a med student. Find out the best electives available to you, and take advantage of them.

And above all, MORE SPANISH.

 

[senseiturtle]

I'd say to keep yourself rested and 100% prepared mentally. Just like studying before entering medical school, it's all akin to urinating in a tornado.

Basics I WOULD do:

1) Familiarize yourself with basic ordersets and rotation-specific testing, if your school hasn't done it. Admit/discharge, progress notes, NST's for OB, EKG, etc. Tie at least 20 knots per day (two-handed and one-handed, left-handed and right-handed), while watching TV. Everything just moves so much more smoothly in the OR / ER / procedure clinic when you don't have to be shown how to do basic knots.

2) Learn some pain management, since that's most of the crap calls you'll get at night. Memorize some very rough equivalencies, such as:

Morphine 4mg IV = ~15mg hydrocodone PO, or about 5mg oxycodone PO.
Dilaudid 1mg IV = ~ Morphine 7mg IV
Never give demerol or stadol (personal opinion)

3) Learn your basic tuck-in orders. Give your nurses freedom to be nurses, and they'll give you freedom to sleep. They hate calling you for the 3am tylenol as much as you hate answering it.

4) If you're really bored, learn spanish off of Rosetta stone. This alone will EASILY be the most useful thing you could do. Don't underestimate the sheer numbers of spanish there are in the US, and they WILL show up in your clinic every single day.

 

[TypeADoctor]

Thank you for the advice. I def have to go back and relearn how to tie knots!

 

[WanderingDave]

This thread is pure gold. Much appreciated, everyone.

I will have gotten all my rotation requirements completed by January, and I was pondering filling in five fluffy rotations to round out my medical education. Not anymore.

 

[Sportdoc]

I wouldn't focus too much on overall management of diseases after all that what you are in residency to learn. Some little things that will make your life a lot easier are:

As someone mentioned above pain control, what to do for a fever, constipation, Shortness or breath, how to take care of high glucose, chest pain, decrease urine output, insomnia, agitation, what to do about a fetal heart tone deceleration, ob triage that comes in for "back pain", OB triage for contractions, vomiting, correcting low K, Mg, and Phos, learning when you need and don't need CT contrast, learning general antibiotic use for pneumonia, mrs a, abd infections etc

 

[DaveinDallas]

I'd say to keep yourself rested and 100% prepared mentally. Just like studying before entering medical school, it's all akin to urinating in a tornado.

Basics I WOULD do:

1) Familiarize yourself with basic ordersets and rotation-specific testing, if your school hasn't done it. Admit/discharge, progress notes, NST's for OB, EKG, etc. Tie at least 20 knots per day (two-handed and one-handed, left-handed and right-handed), while watching TV. Everything just moves so much more smoothly in the OR / ER / procedure clinic when you don't have to be shown how to do basic knots.

2) Learn some pain management, since that's most of the crap calls you'll get at night. Memorize some very rough equivalencies, such as:

Morphine 4mg IV = ~15mg hydrocodone PO, or about 5mg oxycodone PO.
Dilaudid 1mg IV = ~ Morphine 7mg IV
Never give demerol or stadol (personal opinion)

3) Learn your basic tuck-in orders. Give your nurses freedom to be nurses, and they'll give you freedom to sleep. They hate calling you for the 3am tylenol as much as you hate answering it.

4) If you're really bored, learn spanish off of Rosetta stone. This alone will EASILY be the most useful thing you could do. Don't underestimate the sheer numbers of spanish there are in the US, and they WILL show up in your clinic every single day.

Excellent advice -- took one or two calls before I started being proactive and ordering PRN x 1 pain meds...but you have to be careful about your nurses...Explain the case and treatment plan to them so they know when they should call before giving and when it's ok to give without calling (that's why it's PRN x1).

but you can't learn this without doing it or by reading....Use your remaining med school time wisely and PAY ATTENTION to patient management and you'll be ok....