Third year tips from a newly minted fourth year

[NNguyenMD]

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A few rules you should adhere to if you want to ensure success

Rule 1: Never say no to anything your resident asks you to do. What I mean by that is, if its 4:30pm and signout is suppose to be a 5:00pm, and your resident tells you there's a new admission or consult in the ER, guess what? If you want to show you're a hard worker you had best race your buddy down to the ER to see this guy.

Rule 2: KNOW YOUR PATIENTS!!! Know them cold. Know every med they've been on since their admission, know what they were on before that, know every line thats in them and know how many days each line has been in. You should know your patient better than anyone else on the team, no questions asked.

Rule 2A: Know the fundamentals about the other patients on your sign out, what they're in the hospital for, what the gameplan is for them day for their treatment.

Rule 3: Never complain, realize that no matter how crappy you think your life is going during the third year, I gurantee you that your resident's is infinitely worse off than you are.

Rule 4: Never ask if you can leave, and what I mean by that is if its your call night and you haven't done anything physically for the last 2 hours and think your resident was going to dismiss you for the evening but just forgot about you? Guess again, he knows you're there never forget that he knows you're still there. You stay until they tell you you can leave.

Rule 5: READ READ READ READ READ. Always keep reading, always show that you're motivated to learn new things. You should be reading at least one topic per evening, its about a one hour committment. I breakdown topics into the following points if I get asked about them the next morning. "Physiology/Anatomy, Pathophysiology, Clinical Presentation, Diagnostic Criteria, Treatment (nonsurgical then surgical)"


Rule 6: Always try to make the team look good in front of the attending, never try to make your resident look bad unless you know for a fact that they're being grossly negligent.

Rule 7: The 30 sec pimping rule, if the other 3rd or 4th year on the team is asked a pimping question by the attending or resident, they have 30 seconds to answer if before you're free to blow them away with your knowledge. Attendings hate it when one med student can't answer a pimping question, they hate it more when both of the team med students can't answer. Never answer a pimp question when the attending asks the resident, unless maybe in the OR in which case the 30 sec rule applies.

Goodluck guys! 3rd year is fun as long as you're constantly learning, work hard, and stay motivated

 

[pillowhead]

Rule 4: Never ask if you can leave, and what I mean by that is if its your call night and you haven't done anything physically for the last 2 hours and think your resident was going to dismiss you for the evening but just forgot about you? Guess again, he knows you're there never forget that he knows you're still there. You stay until they tell you you can leave.

I have to disagree slightly with this. I have made all As in my 3rd rotations and have definitely asked (even if not outright) if I can leave. You just don't ask it like that. You say one of the following--

1. Is there anything else I can do to help you out?/Is there anything
I can do to help the team get out faster?
2. Is it all right if I go to try and get some good reading done tonight (if the shelf is coming up soon)?/Is it okay to go and read up Mr. Z's condition that we just found out about? (go home and find some random article, memorize the abstract and present it tomorrow. It doesn't take long.)

And sometimes residents DON'T know that you're still there. Once or twice I've paged a resident only to have them say, "Why are you still here?" And once on a post-call day, my resident AND intern actually left without ever telling me they were leaving or telling me to go. And no, I wasn't hiding in the library or a call room. I was very pissed. No reason to keep a med student hanging out in the hospital longer than necessary on a post-call day. That's just freaking rude and it puts the student in a very awkward postion.

 

[NNguyenMD]

I have to disagree slightly with this. I have made all As in my 3rd rotations and have definitely asked (even if not outright) if I can leave. You just don't ask it like that. You say one of the following--

1. Is there anything else I can do to help you out?/Is there anything
I can do to help the team get out faster?
2. Is it all right if I go to try and get some good reading done tonight (if the shelf is coming up soon)?/Is it okay to go and read up Mr. Z's condition that we just found out about? (go home and find some random article, memorize the abstract and present it tomorrow. It doesn't take long.)

And sometimes residents DON'T know that you're still there. Once or twice I've paged a resident only to have them say, "Why are you still here?" And once on a post-call day, my resident AND intern actually left without ever telling me they were leaving or telling me to go. And no, I wasn't hiding in the library or a call room. I was very pissed. No reason to keep a med student hanging out in the hospital longer than necessary on a post-call day. That's just freaking rude and it puts the student in a very awkward postion.

I agree its one of the weaker rules, but I think it depends a lot on the service that you're on. Medicine maybe more ammendable to letting you go, but for the 8 weeks I was on the surgery service, they pretty much dictacted when and where you're suppose to be.

 

[bulldog]

A few rules you should adhere to if you want to ensure success

Rule 4: Never ask if you can leave, and what I mean by that is if its your call night and you haven't done anything physically for the last 2 hours and think your resident was going to dismiss you for the evening but just forgot about you? Guess again, he knows you're there never forget that he knows you're still there. You stay until they tell you you can leave.

so what field r u planning to go into? i'd disagree w/ the comments. when i was on ob, the residents would sneak off to go to sleep when it was slow. i actually stayed around and did nothing. on other hand, some students sneeked off into our louge to sleep. did the residents even care? no... i don't think they even remember when the next day came around.

 

[loveumms]

I disagree with lots of the statements

- If you have been sitting around for two hours doing nothing I would definitely ask my resident if there is anything else I can do. This is your education ... you are NOT there to sit in the hospital and waste your life away.

- If you wait 30 seconds to answer a pimp questions, it is likely that the resident or intern has already answered it for you. I have a general rule of thumb that if the attending is looking around at everyone to answer it is fair game but, I would never answer an obvious question that one of my colleagues didn't know (sometimes you totally freeze in front of the attending and you know the answer but it just won't come out). I truly believe that med students should NEVER make each other look bad, no matter how good it makes you look as an individual.

- Of course I agree to know your patient and the other patients on the team. Thats what you are there for - learning is done best when you are correlating it to a real live human. Read up on all the patients on the team, if you have time of course.

One thing I would add - don't wait to be asked to do something ... if you are rounding and the attending doesn't have the chart for the next room, go get it before you are asked. You will really look like you are on top of things and the team will be very appreciative that rounds took less time. If you have a good back and can handle carrying around lots of materials in your pockets - carry the essentials ... especially on surgery (gauze, tape and whatever else is needed to take down dressings).

I think third year was half - half. Half was great and half really sucked a**. But, it is now over 😉

 

[allylz]

so what field r u planning to go into? i'd disagree w/ the comments. when i was on ob, the residents would sneak off to go to sleep when it was slow. i actually stayed around and did nothing. on other hand, some students sneeked off into our louge to sleep. did the residents even care? no... i don't think they even remember when the next day came around.

no, these comments are right on. Remember, you are at the very bottom of the food chain. it doesn't matter what you see your residents doing, it doesn't matter what you see your attendings doing. Your residents can sleep all day, your attendings can call the patients 'fat ******s', but medical students have to maintain the highest standards of behavior. I'm not kidding here, people will absolutely screw you on your evals if you don't put your best foot forward and get perkified and help out the team. You have no say in evaluating your residents, but they are dictating whether you get your future career by giving you some crap eval. It's completely unfair but I certainly wouldn't be willing to bet that 'the residents are slacking off too, so why shouldn't I?' Sometimes yes, the residents are sympathetic rather than jerks and will let you go early or tell you not to do work, or whatever. But you cannot just assume these things. My experience is just my experience, but it has shown on every rotation that people really are watching you. And if you slip, they will jump on you and report you to your dean for being unprofessional (at least at my school), and then you'll wish all you had to worry about was your grade.

 

[allylz]

- If you have been sitting around for two hours doing nothing I would definitely ask my resident if there is anything else I can do. This is your education ... you are NOT there to sit in the hospital and waste your life away.

I totally agree with this - people will either forget you exist or they will forget that this is your education and not your job, so you actually don't have to be there. And some people think you will learn just by standing around near them. My surgery clerkship director called this "being Mini-Me'ed" which I think is really appropriate, and it happens the most on surgery!

Lots of times it helps to ask them in such a way to remind them, like "so, I've been hanging out for a while.... I'm getting a little nervous because the shelf exam is coming up and I could use some study time. Is there anything else I can do?".... which of course should be followed up by: "What would you like me to do tomorrow morning? When should I be here?"

it does suck! I am so sick of being a third year. This is why my entire fourth year is rotations like 'PBL facilitation' and 'research'.... 🙂

 

[njbmd]

Hey Guys,
I always sent the medical students home when it wasn't busy (unless the attending specifically told me not to do so). If the service is slow, you can get more out of reading and studying for your shelf than sitting around the hospital taking up space.

If I am going off to sleep, you should try to get some rest too if you are on overnight. If there was something interesting, I would page otherwise, you could sleep. You really do not need to see me admit non-operative patients but I would awaken the medical student if there was an operative case in the middle of the night.

I always tried to make sure that the students got a good educational experience on my service. I would generally talk you through things like central lines and the like. As your chief resident, I am not there to torture you but to help with your education. If it isn't busy and it's early evening, I don't mind answering questions or discussing cases but after dinner, I would try to sleep if I could (and you should be doing the same).

Read up on your patient's problems. Follow along with the intern and try to learn a few procedures as you go. If you are not interested in surgery, don't tell me that you are (because you think you will get a better grade). If I know you are interested in medicine, I try to tailor your experience so you will be a better medical resident or pediatric resident or ob-gyn resident etc. If you are interested in surgery, I would probably let you do more if you wanted the experience.

I had a great third year from start to finish. I was never scutted or abused by any resident or attending and I try to provide the same experience for the medical students that rotate with me. I will not allow the residents under me on my service to scut or abuse medical students in any way. If you pitch in and work with the team, then your get a better experience and things go more smoothly.

njbmd 🙂

 

[Zuwie]

I am another newly-minted fourth-year student and I have some rules of my own:
Rule 1: Go through the year with as little pain as possible, it will be over before you know it.
Rule 2: Study for the shelf exams, they will be your only objective grade.
Rule 3: No matter how hard you work there will be a couple of people who don't like you for whatever reason and give you a crappy eval. Refer to Rule 2.
Rule 4: No matter how much you think your life sucks, this guy has it infinitely worse than you (WARNING: strong language, take small children away from the screen):
http://media.putfile.com/Worst-Job-Ever
Which brings me to the last rule: always take time to relax and have a good laugh

 

[dynx]

Rule 1: Never say no to anything your resident asks you to do. What I mean by that is, if its 4:30pm and signout is suppose to be a 5:00pm, and your resident tells you there's a new admission or consult in the ER, guess what? If you want to show you're a hard worker you had best race your buddy down to the ER to see this guy.

Rule 3: Never complain, realize that no matter how crappy you think your life is going during the third year, I gurantee you that your resident's is infinitely worse off than you are.

Rule 4: Never ask if you can leave, and what I mean by that is if its your call night and you haven't done anything physically for the last 2 hours and think your resident was going to dismiss you for the evening but just forgot about you? Guess again, he knows you're there never forget that he knows you're still there. You stay until they tell you you can leave.

I agree with all of them but these three. This kind of "i'll suck a dick" attitude is why the 80 hour work week is not enforced well, its why residents get abused, its why doctors cant organize a bargaining group more cohesive than the AMA. If you need to leave at 5 for some reason and the rules say leave at 5 then guess what...leave at 5. If you have nothing to do and want to learn you should stay, but you shouldn't get looked down on (and you will) for leaving when you "can" and need to. I've done just this, got a crappy eval and im happy as hell cause at least my pride is still intact.

If something is crappy and needs fixing and nobody complains nothing changes...but your eval is the important thing right? Wrong. Speak up. Eventually you'll have to grow some balls unless you want to take crap for the rest of your life. Don't whine, don't start crying (which is what happens to med students when they take crap forever refusing to say anything and it all builds up). Just voice your grievence clearly and offer alternatives.

Ditto leaving if there is nothing to do. The point of third year is to learn...if you are learning something on the floor you should stay, its more important than anything you can learn in a book. If not, you should be reading, and to do that you probably have to go somewhere to sit down with a book..that means leaving. There are two steps to this whole leaving process that medical students dont seem to understand so I'll explain them:
1. Ask if there is anything you can help the resident/intern to do
2. Tell them you are going to go read (dont ask)
If you're sticking around just to stick around then you are a tool.

 

[sdnetrocks]

In my experience, the OB/GYNs took it as an insult when they "caught" you reading - even when this was an OB/GYN text, in plain sight at the board, no less...

They wanted you to be perky at attention always - NEIN READING!

 

[DrMom]

In my experience, the OB/GYNs took it as an insult when they "caught" you reading - even when this was an OB/GYN text, in plain sight at the board, no less...

They wanted you to be perky at attention always - NEIN READING!

Hmmm. I had a very different experience. I read a ton on OB when there was nothing going on. I read through all of my OB materials and then moved on to popular novels. Nobody had a problem at all. Of course, I don't know if any of the residents ever did much more than glance sideways at me whenever I was reading so maybe they just didn't notice. 😉

 

[jojo14]

in regards to leaving- just don't even utter the phrase "Can I leave?" or really anything with the word leave in it. Trick is to make the resident realize you really don't need to be there and you should go home. But if you bring it up, you look lazy. I have not had a resident make me stay for bs reasons. Usually they are just so busy they forget about you.

 

[DrJ105]

Hey Guys,
I always sent the medical students home when it wasn't busy (unless the attending specifically told me not to do so). If the service is slow, you can get more out of reading and studying for your shelf than sitting around the hospital taking up space.

If I am going off to sleep, you should try to get some rest too if you are on overnight. If there was something interesting, I would page otherwise, you could sleep. You really do not need to see me admit non-operative patients but I would awaken the medical student if there was an operative case in the middle of the night.

I always tried to make sure that the students got a good educational experience on my service. I would generally talk you through things like central lines and the like. As your chief resident, I am not there to torture you but to help with your education. If it isn't busy and it's early evening, I don't mind answering questions or discussing cases but after dinner, I would try to sleep if I could (and you should be doing the same).

Read up on your patient's problems. Follow along with the intern and try to learn a few procedures as you go. If you are not interested in surgery, don't tell me that you are (because you think you will get a better grade). If I know you are interested in medicine, I try to tailor your experience so you will be a better medical resident or pediatric resident or ob-gyn resident etc. If you are interested in surgery, I would probably let you do more if you wanted the experience.

I had a great third year from start to finish. I was never scutted or abused by any resident or attending and I try to provide the same experience for the medical students that rotate with me. I will not allow the residents under me on my service to scut or abuse medical students in any way. If you pitch in and work with the team, then your get a better experience and things go more smoothly.

njbmd 🙂

Is it to late to transfer to your school/hospital? 🙂

 

[stebb]

3rd year sucks A$$, but you gotta do it...thats all i have to say on the matter

 

[Arginine]

I found it most effective to approach the senior resident with, "I've done X, Y, and Z. I helped Resident J do [fill in the blank] and checked labs and imaging studies for Patient G. I checked in with both of the interns and neither of them have any tasks/procedures left to do. All the consults are taken care of. Is there anything I can help you or the team with before I go?"

This way, the senior resident knows you've been working hard and that the tasks for your patient(s) have been completed. Only an absolute ogre would make you stay if there is nothing left to do.

 

[footcramp]

rules of 3rd year:
kiss ass until your attending gets a rectal prolapse.
be friendly and interesting.
study hard.
never argue with anyone because you are always wrong, even when you are right.
don't waste time with low yield bullcrap.
learn to be efficient.
don't listen to stupid cliche mantras like "know your patient better than anyone else" because that's not very realistic, since you don't get sign out from others, nurses don't page you about things overnight, etc. if you hear anyone say something like that, you know their advice is BS and they are merely regurgitating what others have told them.

 

[NNguyenMD]

rules of 3rd year:
kiss ass until your attending gets a rectal prolapse.
be friendly and interesting.
study hard.
never argue with anyone because you are always wrong, even when you are right.
don't waste time with low yield bullcrap.
learn to be efficient.
don't listen to stupid cliche mantras like "know your patient better than anyone else" because that's not very realistic, since you don't get sign out from others, nurses don't page you about things overnight, etc. if you hear anyone say something like that, you know their advice is BS and they are merely regurgitating what others have told them.

Its helpful to know everything about your patient on rounds, especially when presenting to your attending or resident. I've gotten signouts on every service I've been on except OB. Which I think majority of us feel is a pretty ****ty clerkship. Nurses page you if they have your pager number or you ask them to page you for any particular reasons.

 

[sdnetrocks]

I found it most effective to approach the senior resident with, "I've done X, Y, and Z. I helped Resident J do [fill in the blank] and checked labs and imaging studies for Patient G. I checked in with both of the interns and neither of them have any tasks/procedures left to do. All the consults are taken care of. Is there anything I can help you or the team with before I go?"

This way, the senior resident knows you've been working hard and that the tasks for your patient(s) have been completed. Only an absolute ogre would make you stay if there is nothing left to do.

This is BRILLIANT advice!!! It makes you look like a star, and by the rules of etiquette, makes it almost impossible for the senior to keep you any longer.

I LOVE IT!!!

 

[Zuwie]

Well, let's be realistic here. Your senior resident will love you if you sit with him/her during break and talk about football/baseball/shopping/restaurants/car buying and whatnot. Unless you helped them directly, they wouldn't care about what you've done in patient care. And make sure you are available to give them scissors, bandaids, go ask a nurse for some four-by-fours and to perform other highly educational activities. Regardless, if they don't like you from the beginning, they won't like you throughout no matter what you do.

 

[StudentDoc327]

Everything is so highly service/attending/resident specific. Ask a friend who has been on that service or a friend a year ahead of you. A lot of residents, at least where I go to school, agree that 3rd year is ~ 50% wasted time. Use that time to study, read, learn, sleep, eat, etc. Its your tuition. Also look at the breakdown of the grading. If you are a good test taker and can do well on the shelf, you dont need to kiss ass all the time (it is also really obvious). If there is nothing to do then dont waste your time. They will page you if they really need you (which from my experience is not often).

 

[signomi]

Allylz said:

no, these comments are right on. Remember, you are at the very bottom of the food chain. it doesn't matter what you see your residents doing, it doesn't matter what you see your attendings doing. Your residents can sleep all day, your attendings can call the patients 'fat ******s', but medical students have to maintain the highest standards of behavior. I'm not kidding here, people will absolutely screw you on your evals if you don't put your best foot forward and get perkified and help out the team. You have no say in evaluating your residents, but they are dictating whether you get your future career by giving you some crap eval. It's completely unfair but I certainly wouldn't be willing to bet that 'the residents are slacking off too, so why shouldn't I?' Sometimes yes, the residents are sympathetic rather than jerks and will let you go early or tell you not to do work, or whatever. But you cannot just assume these things. My experience is just my experience, but it has shown on every rotation that people really are watching you. And if you slip, they will jump on you and report you to your dean for being unprofessional (at least at my school), and then you'll wish all you had to worry about was your grade.

Ha Ha! Are you at PSU? I went there! You are so correct. There was a certain ped surg attending who yelled in the halls in front of patients and their families and threw charts and fired the whole team daily....and then he writes up the med students for "unprofessional behavior." Don't get me started on inpatient adolescent psych or ob-gyn. Remember that the people who will write the most on your evals (residents, interns) are the people who have an axe to grind. Do NOT do as the attendings/residents/interns do...you are held to a much higher standard of behavior! That goes for commentary as well. They can make crude/rude comments about patients, other services, nurses, etc but sweet weeping jesus you CANNOT!

 

[StudentDoc327]

Allylz said:

Ha Ha! Are you at PSU? I went there! You are so correct. There was a certain ped surg attending who yelled in the halls in front of patients and their families and threw charts and fired the whole team daily....and then he writes up the med students for "unprofessional behavior." Don't get me started on inpatient adolescent psych or ob-gyn. Remember that the people who will write the most on your evals (residents, interns) are the people who have an axe to grind. Do NOT do as the attendings/residents/interns do...you are held to a much higher standard of behavior! That goes for commentary as well. They can make crude/rude comments about patients, other services, nurses, etc but sweet weeping jesus you CANNOT!

omg im glad i went to a laid back medical school! I dont think anybody in our class has ever gotten written up to the dean. In fact that is just about the last thing that would ever happen to us. I guess it really is school-specific.

 

[MediCane2006]

Agree with the OP (these are good rules for internship too!) except for the thirty-second rule for pimp questions. Med students need to be a team, bottom line. No one (residents included) is going to like you if you get a reputation for making your fellow students look bad.

My strategy for this situation was to never immediately answer a question that was directed at another student or resident. If the student obviously couldn't answer the question, I'd wait until the questioner opened the question to the field, and then, if I knew the answer, I'd preface it by saying, "I'm not sure, but I think...." This way you answer the question while minimizing the other med student's lack of knowledge.

 

[p53]

Actually the rules are good but here are some suggestions.

1. If a resident asks you to do something. Say "Sure" with a good attitude. I've seen many students say they will do it but then they have a look on their face like they don't want to do it. HIDE THIS. Practice this if you can. Make it look like in your attitude you want to do it even if you don't want to do it. THIS IS ACTING BUT YOU HAVE TO MASTER THIS.

2. Analyze the daily preceedings of an intern or resident. Then, rather than ask if you can do something. DO IT. For example, if you notice the intern struggles to get the lab values for patients in the AM. Get the lab values for him/her. BE PROACTIVE. A 3rd year by definition is an observer. If you become proactive and anticipate things to help out the residents you will stand out.

3. Hang out with the residents if you have down time. Don't leave their side unless they tell you to go and study. If they complain about their day, use active listening techniques to console them. Don't use reciprocity to say "I know what you mean and then start complaining". Listen, paraphrase, and empathize. Be a good listener.

4. Reading. I agree with this. However, just keep in mind. You can read every night of the week and the attending might not know it if you are reading if you are the quiet type. Then again, you can say I read blah, blah, blah last night and that doesn't come across impressive either. The best technique is to tie a reading concept with something about your particular patient. Such as "I was reading about _______, last night and was wondering if we have to consider ________ for our patient. Don't do this in front of the residents and interns. Just with the attending.

5. Never blurt out facts to impress the attending during rounds. If a patient has pneumonia, and you blurt out would you consider a Legionella Urine antigen. This shows you might know your stuff, however if it isn't your patient and the resident hasn't ordered that test, you make the resident look bad. Bite your tongue. Only talk when someone is talking to you or if it if your patient. Believe it or not. If you studied hard for Step 1 you will know more than an attending on some things. The key is to not come across as someone that is trying too hard to impress. The time to show your knowledge is during oral presentations of patients, or a discussion of a topic during a research presentation. If an attending asks you a question during rounds you can answer the question. Don't blurt out the answer. Say something with some thought. If an attending asks you a question it is likely about your patient.

For example, if an attending asks what are some causes of a low sodium value. You can blurt out SIADH, Drug Induced, polydipsia etc. Or you can say the most common causes of hyponatremia on the wards is diuretics. He is currently on Lasix. But you have to consider other causes, with our patient he doesn't seem to be hypovolemic because his vitals are stable, mucuous membranes are moist and capillary refills are brisk. The patient doesn't appear to have edema to suggest hypervolemia. The LFT's rule out liver failure, BMP rules out renal failure and hyperglycemia. We could try water restriction to correct the problem, or we could modify the dose of lasix.

6. Never kiss a resident's butt with compliments. This is transparent. Impress them with actions by doing things, not with words. If you are sincerely impressed and want to give someone a compliment do it through a third party. This will eventually get to the target and it will payer greater dividends. Plus, you will not be in trouble for insincereity since you are not the one that told the target.

7. Show up early. Do your job. Smile with Patients. Help the team members. Don't complain. Read during down time. Never show frustration. Console the residents. Don't hang out with whining, complaining medical students, this will bring you down too. Have a beer after a hard day, and relax. Enjoy you day off by doing something fun.

A few rules you should adhere to if you want to ensure success

Rule 1: Never say no to anything your resident asks you to do. What I mean by that is, if its 4:30pm and signout is suppose to be a 5:00pm, and your resident tells you there's a new admission or consult in the ER, guess what? If you want to show you're a hard worker you had best race your buddy down to the ER to see this guy.

Rule 2: KNOW YOUR PATIENTS!!! Know them cold. Know every med they've been on since their admission, know what they were on before that, know every line thats in them and know how many days each line has been in. You should know your patient better than anyone else on the team, no questions asked.

Rule 2A: Know the fundamentals about the other patients on your sign out, what they're in the hospital for, what the gameplan is for them day for their treatment.

Rule 3: Never complain, realize that no matter how crappy you think your life is going during the third year, I gurantee you that your resident's is infinitely worse off than you are.

Rule 4: Never ask if you can leave, and what I mean by that is if its your call night and you haven't done anything physically for the last 2 hours and think your resident was going to dismiss you for the evening but just forgot about you? Guess again, he knows you're there never forget that he knows you're still there. You stay until they tell you you can leave.

Rule 5: READ READ READ READ READ. Always keep reading, always show that you're motivated to learn new things. You should be reading at least one topic per evening, its about a one hour committment. I breakdown topics into the following points if I get asked about them the next morning. "Physiology/Anatomy, Pathophysiology, Clinical Presentation, Diagnostic Criteria, Treatment (nonsurgical then surgical)"


Rule 6: Always try to make the team look good in front of the attending, never try to make your resident look bad unless you know for a fact that they're being grossly negligent.

Rule 7: The 30 sec pimping rule, if the other 3rd or 4th year on the team is asked a pimping question by the attending or resident, they have 30 seconds to answer if before you're free to blow them away with your knowledge. Attendings hate it when one med student can't answer a pimping question, they hate it more when both of the team med students can't answer. Never answer a pimp question when the attending asks the resident, unless maybe in the OR in which case the 30 sec rule applies.

Goodluck guys! 3rd year is fun as long as you're constantly learning, work hard, and stay motivated

 

[OMMFan]

I always tried to make sure that the students got a good educational experience on my service. I would generally talk you through things like central lines and the like.

Do students learn to put in central lines?

 

[lattimer13]

Do students learn to put in central lines?

yes you can, but ultimately it depends on the resident you're working w/ and whether or not anybody else needs higher up the ladder needs the line to get there numbers in and if the resident wants to take the time and is comfortable w/ you doing it.

i got to do lots of a-lines, intubations, ABGs, and almost got to do a chest tube on the trauma service until the EM intern walked in the door. attempted a central line, but watched lots and lots of them. anesthesia rotation was where i got to do a ton of stuff.


make sure to let people know that you're interested in doing procedures otherwise they might never think about asking you if you want it.

 

[KidDr]

Actually the rules are good but here are some suggestions.

1. If a resident asks you to do something. Say "Sure" with a good attitude. I've seen many students say they will do it but then they have a look on their face like they don't want to do it. HIDE THIS. Practice this if you can. Make it look like in your attitude you want to do it even if you don't want to do it. THIS IS ACTING BUT YOU HAVE TO MASTER THIS.

2. Analyze the daily preceedings of an intern or resident. Then, rather than ask if you can do something. DO IT. For example, if you notice the intern struggles to get the lab values for patients in the AM. Get the lab values for him/her. BE PROACTIVE. A 3rd year by definition is an observer. If you become proactive and anticipate things to help out the residents you will stand out.

3. Hang out with the residents if you have down time. Don't leave their side unless they tell you to go and study. If they complain about their day, use active listening techniques to console them. Don't use reciprocity to say "I know what you mean and then start complaining". Listen, paraphrase, and empathize. Be a good listener.

4. Reading. I agree with this. However, just keep in mind. You can read every night of the week and the attending might not know it if you are reading if you are the quiet type. Then again, you can say I read blah, blah, blah last night and that doesn't come across impressive either. The best technique is to tie a reading concept with something about your particular patient. Such as "I was reading about _______, last night and was wondering if we have to consider ________ for our patient. Don't do this in front of the residents and interns. Just with the attending.

5. Never blurt out facts to impress the attending during rounds. If a patient has pneumonia, and you blurt out would you consider a Legionella Urine antigen. This shows you might know your stuff, however if it isn't your patient and the resident hasn't ordered that test, you make the resident look bad. Bite your tongue. Only talk when someone is talking to you or if it if your patient. Believe it or not. If you studied hard for Step 1 you will know more than an attending on some things. The key is to not come across as someone that is trying too hard to impress. The time to show your knowledge is during oral presentations of patients, or a discussion of a topic during a research presentation. If an attending asks you a question during rounds you can answer the question. Don't blurt out the answer. Say something with some thought. If an attending asks you a question it is likely about your patient.

For example, if an attending asks what are some causes of a low sodium value. You can blurt out SIADH, Drug Induced, polydipsia etc. Or you can say the most common causes of hyponatremia on the wards is diuretics. He is currently on Lasix. But you have to consider other causes, with our patient he doesn't seem to be hypovolemic because his vitals are stable, mucuous membranes are moist and capillary refills are brisk. The patient doesn't appear to have edema to suggest hypervolemia. The LFT's rule out liver failure, BMP rules out renal failure and hyperglycemia. We could try water restriction to correct the problem, or we could modify the dose of lasix.

6. Never kiss a resident's butt with compliments. This is transparent. Impress them with actions by doing things, not with words. If you are sincerely impressed and want to give someone a compliment do it through a third party. This will eventually get to the target and it will payer greater dividends. Plus, you will not be in trouble for insincereity since you are not the one that told the target.

7. Show up early. Do your job. Smile with Patients. Help the team members. Don't complain. Read during down time. Never show frustration. Console the residents. Don't hang out with whining, complaining medical students, this will bring you down too. Have a beer after a hard day, and relax. Enjoy you day off by doing something fun.

This is very VERY good advise!!!

 

[OMMFan]

yes you can, but ultimately it depends on the resident you're working w/ and whether or not anybody else needs higher up the ladder needs the line to get there numbers in and if the resident wants to take the time and is comfortable w/ you doing it.

Thanks for the tips. I just read an old New Yorker article about training surgeons. The author discusses how he learned to insert a central line as an intern. He makes it sound really difficult to learn but fairly simple after enough practice. I'll try to get through my first two years of med school before I start to worry about putting in central lines, but it's nice to know I may be able to learn how to put one in before I start residency.

 

[Pinner Doc]

I just finished the first week of my first rotation-- surgery. The thing that I am finding the hardest to figure out is the delicate balance between trying to look like a totally on-top-of-things med student, and not showing up your superiors. I'm not even sure what constitutes showing up ones superiors... here, I'll give you an example...

Setting -- Afternoon rounds, with me, 4th yr resident, and attending.

Attending: I'll need some gauze to clean up this patient's wound.

Resident turns towards the table to see what she can scrounge up. I happen to have some gauze in my jacket pocket for such occasions, so I hand one to the attending as the resident returns to the bedside with gauze she found across the room.

Is this poor form? Was I "showing up the resident?" I'm so confused.

Also, I've heard of a resident on a friend's team giggling behind her hand noticeably as my fellow classmates were presenting their first patients (EVER) to the chief attending of their department. Are these sorts of things pretty standard during third year? Sigh... these rotations can be so demoralizing!!

Don't get me wrong, though. At the same time, I am having a BLAST.

 

[footcramp]

I just finished the first week of my first rotation-- surgery. The thing that I am finding the hardest to figure out is the delicate balance between trying to look like a totally on-top-of-things med student, and not showing up your superiors. I'm not even sure what constitutes showing up ones superiors... here, I'll give you an example...

Setting -- Afternoon rounds, with me, 4th yr resident, and attending.

Attending: I'll need some gauze to clean up this patient's wound.

Resident turns towards the table to see what she can scrounge up. I happen to have some gauze in my jacket pocket for such occasions, so I hand one to the attending as the resident returns to the bedside with gauze she found across the room.

Is this poor form? Was I "showing up the resident?" I'm so confused.

Also, I've heard of a resident on a friend's team giggling behind her hand noticeably as my fellow classmates were presenting their first patients (EVER) to the chief attending of their department. Are these sorts of things pretty standard during third year? Sigh... these rotations can be so demoralizing!!

Don't get me wrong, though. At the same time, I am having a BLAST.

give the gauze to the resident. btw that's not really showing up.

remember the chain of command.

 

[seansoutherland]

Greetings. I just thought I would let p53 know that I have been reading posts about Step I strategies and ventured into this topic to think ahead. I have as of yet to read a post that is not insightful and valuable. Thanks. (I'd compliment you indirectly through someone else, but whatever, it needs to be stated.)