Nephronlearner

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Hello everyone.
I would like a bit of an advice on studying on rotations. I am European and attend medical school here. That's why the schedule and organisation is a bit different. Passing the rotations (both written test and OSCE) isn't much of a challenge but since I plan on applying for American residencies (and electives in the final year), I'd like to do what I can to be as ready as possible.

My 1st placements will be in internal medicine (and since I have 3 years of clinicals - I will spend somewhat more time on that rotation compared to American students so I will also have more time to study.

I bought Step Up to Medicine and MKSAP and I suppose that is the general level of knowledge expected? Reading the whole Cecil Essentials is probably waste of time?
Should I attempt to read any of Case Files?

What about learning about your patients? I have CMDT, Harrison online, Cecil Essentials, UpToDate (and there is free eMedicine). How exactly do you do it? Let's say I have patient with ascites. Do I just open CMDT or UpToDate and find "ascites assessment and diagnosis" and read about it and write a plan without trying to memorise everything? Or do I actually try to learn everything? That sounds like an impossible task (since all those resources are extremely detailed and most of the topics are ~20-50 pages long and it would take hours to just read it properly). And then when the cause of ascites is discovered (say cirrhosis) do I just move on to cirrhosis in one of those resources and read (or try to learn?) everything about that?

I also have Pocket Medicine - what to do with that? Should I just use it to look up a condition while on wards? Or use it to study anything (for example during a boring lecture)?
Of should I read about my patient in pocket medicine and learn that?

I know that is a lot of questions but I tried finding the specifics and failed. Can someone please shed some light on how exactly you use those resources?

Thank you all very much in advance :)
 

Wolverines83

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Find your favorite book whether Cecil's, Harrison's or step up to medicine and read all about every patient you have. I'd say step up to medicine plus Harrison's manual is solid. Step up to medicine has the added benefit of helping study for the shelf and usmle.

Do u works questions too, they'll solidify your knowledge... At least for the exams.

Cecil's is too long and wordy. Big Harrison's is insane for a med student.

Picket medicine is useful while in the hospital to remind you what tests to order, what treatment, etc. It's not really a study tool
 

mimelim

Vascular Surgery
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Sep 19, 2011
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Hello everyone.
I would like a bit of an advice on studying on rotations. I am European and attend medical school here. That's why the schedule and organisation is a bit different. Passing the rotations (both written test and OSCE) isn't much of a challenge but since I plan on applying for American residencies (and electives in the final year), I'd like to do what I can to be as ready as possible.

My 1st placements will be in internal medicine (and since I have 3 years of clinicals - I will spend somewhat more time on that rotation compared to American students so I will also have more time to study.

I bought Step Up to Medicine and MKSAP and I suppose that is the general level of knowledge expected? Reading the whole Cecil Essentials is probably waste of time?
Should I attempt to read any of Case Files?

What about learning about your patients? I have CMDT, Harrison online, Cecil Essentials, UpToDate (and there is free eMedicine). How exactly do you do it? Let's say I have patient with ascites. Do I just open CMDT or UpToDate and find "ascites assessment and diagnosis" and read about it and write a plan without trying to memorise everything? Or do I actually try to learn everything? That sounds like an impossible task (since all those resources are extremely detailed and most of the topics are ~20-50 pages long and it would take hours to just read it properly). And then when the cause of ascites is discovered (say cirrhosis) do I just move on to cirrhosis in one of those resources and read (or try to learn?) everything about that?

I also have Pocket Medicine - what to do with that? Should I just use it to look up a condition while on wards? Or use it to study anything (for example during a boring lecture)?
Of should I read about my patient in pocket medicine and learn that?

I know that is a lot of questions but I tried finding the specifics and failed. Can someone please shed some light on how exactly you use those resources?

Thank you all very much in advance :)
http://forums.studentdoctor.net/threads/how-to-not-look-like-an-incompetent-fool-on-rotations.988111/#post-13752337

My only addendum is, get really really good at your H&P. I don't mean "learn how to take a super detailed hour long H&P". I mean learn how to get information efficiently and accurately from patients. It doesn't matter what you go into. Your H&P is your bread and butter. Don't be the intern that half-asses it because they can't do any better.
 
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operaman

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How I did medicine:
1) Get through all the UWorld medicine questions
2) If time, do pre-test or something like that
3) If your knowledge base sucks, then step up to medicine or the like
4) Big Harrisons -- read the chapter for each MAJOR condition that IM docs see. The whole thing is too much, but you should know all the ins and outs of DM, CAD, CHF, etc.
5) Big Harrisons -- read ALL of those first mini chapters about presenting symptoms of disease. I used to print these suckers out. Just golden.

Wholeheartedly agree with mimelim about your H&P. Nobody really did any direct teaching for us so I googled examples of H&Ps and tried to pattern mine after ones that I liked. There were some really great free sites out there from various institutions detailing the do's and don'ts of an H&P. Ended up with comments from multiple attendings and residents about how good they were, so it was noticed.

As to your example with the pt with ascites, I would say read whatever you need to read. From the preclinical years you should already understand the pathophysiology of ascites and be able to start thinking through a differential before you even walk in the room. Obviously your history and physical will determine how your ideas sort out and determine if your patient even has ascites to begin with. Management will depend on what the underlying etiology is. Ascites 2/2 alcoholic cirrhosis is managed very differently than pseudomyxoma peritonei. Even once you know what it is, understanding the story will greatly impact management (ie. new-onset ascites without obvious etiology gets a different workup than "hi doc, I'm here for my monthly paracentesis").

Once you have a good H&P, and you have a decent ddx, it's fairly intuitive what tests you need to order. If it isn't, this is a good thing to look up; UTD has a nice 'diagnosis' section that will help. Management too is fairly intuitive if you understand the pathophysiology at play. This is usually a good place to start and I will read briefly to confirm my thinking; sometimes the intuitive thing is wrong and understanding why will help me remember. Pocket Medicine is a great resource for this stuff.

Really there's no substitute for time with patients. Learning the natural history of disease and seeing and touching it was everything to me. This is the stuff you can't really find in books. It's also the critical part of USMLE Step 2 questions. They won't tell you its ascites; they will give a history and describe exam findings. From that you will need to construct your differential and use that to answer the question.
 
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Nephronlearner

5+ Year Member
Sep 19, 2013
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Medical Student
Find your favorite book whether Cecil's, Harrison's or step up to medicine and read all about every patient you have. I'd say step up to medicine plus Harrison's manual is solid. Step up to medicine has the added benefit of helping study for the shelf and usmle.

Do u works questions too, they'll solidify your knowledge... At least for the exams.

Cecil's is too long and wordy. Big Harrison's is insane for a med student.

Picket medicine is useful while in the hospital to remind you what tests to order, what treatment, etc. It's not really a study tool
Thank you. So you recommend using Step Up only to read about my patients? And there is a huge difference in details between Step Up and Harrison's. Learning one condition from Harrison's takes almost as much time as learning a chapter in Step Up. UpToDate seems even more detailed. So if I get a CHF patient - is it enough to know the info in Step Up about CHF in your opinion?

How I did medicine:
1) Get through all the UWorld medicine questions
2) If time, do pre-test or something like that
3) If your knowledge base sucks, then step up to medicine or the like
4) Big Harrisons -- read the chapter for each MAJOR condition that IM docs see. The whole thing is too much, but you should know all the ins and outs of DM, CAD, CHF, etc.
5) Big Harrisons -- read ALL of those first mini chapters about presenting symptoms of disease. I used to print these suckers out. Just golden.

Wholeheartedly agree with mimelim about your H&P. Nobody really did any direct teaching for us so I googled examples of H&Ps and tried to pattern mine after ones that I liked. There were some really great free sites out there from various institutions detailing the do's and don'ts of an H&P. Ended up with comments from multiple attendings and residents about how good they were, so it was noticed.

As to your example with the pt with ascites, I would say read whatever you need to read. From the preclinical years you should already understand the pathophysiology of ascites and be able to start thinking through a differential before you even walk in the room. Obviously your history and physical will determine how your ideas sort out and determine if your patient even has ascites to begin with. Management will depend on what the underlying etiology is. Ascites 2/2 alcoholic cirrhosis is managed very differently than pseudomyxoma peritonei. Even once you know what it is, understanding the story will greatly impact management (ie. new-onset ascites without obvious etiology gets a different workup than "hi doc, I'm here for my monthly paracentesis").

Once you have a good H&P, and you have a decent ddx, it's fairly intuitive what tests you need to order. If it isn't, this is a good thing to look up; UTD has a nice 'diagnosis' section that will help. Management too is fairly intuitive if you understand the pathophysiology at play. This is usually a good place to start and I will read briefly to confirm my thinking; sometimes the intuitive thing is wrong and understanding why will help me remember. Pocket Medicine is a great resource for this stuff.

Really there's no substitute for time with patients. Learning the natural history of disease and seeing and touching it was everything to me. This is the stuff you can't really find in books. It's also the critical part of USMLE Step 2 questions. They won't tell you its ascites; they will give a history and describe exam findings. From that you will need to construct your differential and use that to answer the question.
Wow, thanks for the detailed response.
This seems like a huge task (since reading all those chapters would result in reading 1500 pages of Harrison's which seems incredibly hard). Would Cecil's Essentials maybe be a more suitable book for those conditions? Or CMDT? Or maybe picking some book like Davidson (British book) which is probably more suitable for a med student than CMDT; but heavier on management than baby Cecil's?

And yeah I do know the pathophysiology of most conditions and I can generally make a decent differential based on it. But my question was - when seeing a patient with a condition (ascites, cough, whatever) do I go to UpToDate/Harrison/CMDT and read and try to learn ALL of it or do I just use it to help with A&P part of notes?

Thanks again :)
 

Wolverines83

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When I say Harrison's I really mean the Harrison's Manual (http://www.amazon.com/Harrisons-Manual-Medicine-18th-Edition/dp/007174519X/ref=sr_1_1?ie=UTF8&qid=1410616757&sr=8-1&keywords=harrison manual) which is a condensed version closer in size to washington manual. I agree, Big Harrison's is insane for a student. Rotations are all about being efficient with your time. Big Harrison's is not efficient; you have residency to read that. To me, at least, the manual was the perfect amount of information for a med student. It's written like an actual book unlike SUTM which can be annoying to read sometimes because it's outline form. That being said, SUTM is nice because it just cuts right to the point and is geared more towards shelf exams / USMLE. I usually used SUTM and then if I didn't like the explanation or thought something was off, I'd go to the small harrison's to clarify.

I don't like UpToDate, actually. It's too wordy. Looking up a condition quickly when you don't have a book or when the condition is some obscure thing not mentioned in most books is one thing, but I'd never in a million years use it as a primary resource. Likewise I don't like Cecil's. It's a lot of reading but at the end I always felt like it was an academic, not clinical book. Maybe it's just me.

Use Pocket medicine to remind you to order a CPK on that old lady who was on the ground for four days...not to study from.

TL;DR --> Be efficient with your time. Use SUTM, small Harrison's (maybe), UWorld and Pocket Medicine. You'll figure out what parts of the SO of SOAP you're missing when you give your presentation and the attending says "what about x?"
 
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Nephronlearner

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When I say Harrison's I really mean the Harrison's Manual (http://www.amazon.com/Harrisons-Manual-Medicine-18th-Edition/dp/007174519X/ref=sr_1_1?ie=UTF8&qid=1410616757&sr=8-1&keywords=harrison manual) which is a condensed version closer in size to washington manual. I agree, Big Harrison's is insane for a student. Rotations are all about being efficient with your time. Big Harrison's is not efficient; you have residency to read that. To me, at least, the manual was the perfect amount of information for a med student. It's written like an actual book unlike SUTM which can be annoying to read sometimes because it's outline form. That being said, SUTM is nice because it just cuts right to the point and is geared more towards shelf exams / USMLE. I usually used SUTM and then if I didn't like the explanation or thought something was off, I'd go to the small harrison's to clarify.

I don't like UpToDate, actually. It's too wordy. Looking up a condition quickly when you don't have a book or when the condition is some obscure thing not mentioned in most books is one thing, but I'd never in a million years use it as a primary resource. Likewise I don't like Cecil's. It's a lot of reading but at the end I always felt like it was an academic, not clinical book. Maybe it's just me.

Use Pocket medicine to remind you to order a CPK on that old lady who was on the ground for four days...not to study from.

TL;DR --> Be efficient with your time. Use SUTM, small Harrison's (maybe), UWorld and Pocket Medicine. You'll figure out what parts of the SO of SOAP you're missing when you give your presentation and the attending says "what about x?"
Thank you again. It makes sense. So small Harrison and Step Up is enough for "my" patients as well?

That is encouraging because going through SDN, I felt as if everyone here was memorising everything on UpToDate about everything their patients had... just never figured how anyone could have enough time for that. And Pocket Medicine really does seem like a nice little book to find info about management (most books aren't as clinical).
 

Wolverines83

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Thank you again. It makes sense. So small Harrison and Step Up is enough for "my" patients as well?
I think so. Of course some people are going to think you need to be a board certified internal medicine physician by the end of third year but I don't think that's necessary. There's other, better, stuff you can do with your time outside of the hospital. But if you find yourself actually wanting to learn/read more, then don't fight it; go for it.

SDN is a super small sample size; it's not representative of students or physicians as a whole...take it all with a grain of salt.
 
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Nephronlearner

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Thanks a lot for the useful advice, and sorry I am responding late (a bit busy with clinical placements).

I will try and see how it goes. Thanks again!
 
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Nephronlearner

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make sure to do medicine part of USMLE world. it is vital to filling in knowledge gaps
it's quite expensive and I plan on taking Step 1 after the 1st year of clinical placements (curriculum is a bit different so I still haven't covered some Step 1 stuff). Is it still worth it? That much better than cheaper alternatives such as pre-test, MKSAP, Kaplan Qbook etc?
 

django7

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oh well i don't think its worth it if you still have to cover USMLE world step 1. but just saying Uworld for step 2 is really good. like really