Third year tricks of the trade.

[melvindo]

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I thought it would be nice if we shared some tricks that we have learned through third year.

I'll go first:
A few weeks ago I was pimped on a subject and fell flat on my face. I had never heard of it. My attending I could tell was a little disappointed and sai, of course " why don't you look that up". What I did was decided to give my presenttion on that subject. At the beginning of my presentation I said that I had not known this etc blah blah and thought it was very important to know.
In my eval I was told that he really respected that and said " that I was a discoverer of knowledge".
for what it's worth.
now your turn.

 

[phoenixsupra]

Yes, like he said, go out of your way to suck up given any opportunity. 😉

 

[zxvanhilsen]

not suck up dude!
nobbody ever said that.
I bet you just sit around and do nothing for fear of being a brown noser right?
give me a break

 

[phoenixsupra]

not suck up dude!
nobbody ever said that.
I bet you just sit around and do nothing for fear of being a brown noser right?
give me a break

Nah, no fear. Just some dignity. But don't worry I'm chipping away at that. 😉 There's precious little of it left. Whatever. Just give me a hoop. watch me jump. 😀

 

[Febrifuge]

Just FYI, staff not only notice how hard and how well you work; they also notice where your focus seems to be. Are you doing the best work you can as a future doctor taking care of patients, or are you a student working to ace the rotation? There may be a difference at times. And they're a lot more aware of (and, in my experience, forgiving of) nerves. They've all been there.

 

[phoenixsupra]

Just FYI, staff not only notice how hard and how well you work; they also notice where your focus seems to be. Are you doing the best work you can as a future doctor taking care of patients, or are you a student working to ace the rotation? There may be a difference at times. And they're a lot more aware of (and, in my experience, forgiving of) nerves. They've all been there.

Ah Febrifuge stradles the fault line again. 🙂 I'm definately more of the former and don't much care for the bowing and scraping bs. But many attendings and chiefs at a snotty academic center are of the latter breed. You can see what that leads to. In any case I'm learning to bow and scrape. One foot in both worlds. Balance I think it's called. Anyway, I've got a vague deja vu feeling. Have I chewed this over with you before, Feb? 😕

 

[b&ierstiefel]

I'm with phoenixsupra here. When I was a 3rd year medical student, I was faced with two options:
(a) Learn the material, work hard/get the stuff done, and play the game.
(b) Learn the material and work hard/get the stuff done.

I chose option (b). Sure, I could have been like some of my classmates who at every opportune moment would put on a "bubbly" demeanor and express enthusiasm. These folks would do presentations, print journal articles. Clearly, they went above and beyond the call of duty and they were rewarded. They got honors on their rotations. And they deserved it! Am I bitter? No.

If you are picking a specialty where there is a huge emphasis on clinical grades, this is what you need to do--whether it agrees with your personality or not. Personally, I took a risk. I knew that if I pulled off average grades during 3rd year, other aspects of my residency application would compensate. Regardless, if you are going into something especially competitive, depending on the grading system at your school, I'm afraid that nowadays with uber-enthusiastic med students around, a student needs to pull him/herself to that level if he/she wants honors/A's.

 

[ginger_flower]

dude....the biggest lesson I learned - SHUT UP unless you're spoken to, esp. if you're naturally chatty and friendly....they don't like the friendly types.

Oh, and the hierachy is in full force. Respect it or get fried on your evals. Never try to achieve or perform at a higher level, and never, never contradict a higher up even if you're 100% sure that they're wrong.

 

[melvindo]

Nah, no fear. Just some dignity. But don't worry I'm chipping away at that. 😉 There's precious little of it left. Whatever. Just give me a hoop. watch me jump. 😀

This is what my presentation spawned from. I played the whole sit in the corner and don't speak unless spoken to thing. Turns out "I was not motivated to learn or interact with others." I think you have it right: balance. I refuse to jump like a monkey and I even hate being corrected on something a stupid attending said that was wrong when I was right.
I didn't mean that I spout off presentations at the drop of a hat, it was one I had to do anyway. I will work hard, and learn... but I will not sell my soul to my devil attending.
If that is not enough, then it will never be.

 

[Febrifuge]

Anyway, I've got a vague deja vu feeling. Have I chewed this over with you before, Feb? 😕

Yah, that does sound familiar. I think I'm biased because I'm a scut-monkey at a really cool program, and someday I'll be totally influenced by that, when I'm a student. Granted, I'm sure I will fall on my face a few times, at places that are not attuned that way.

Signs I'm posting too much on SDN: I'm repeating myself. Oops. 😉

 

[souljah1]

The best thing I've learned as I've gone through third year is as follows:
when getting pimped don't give anymore information in an answer than what they ask.

i.e. if they ask you what is achalasia? don't say achalasia is a esophageal dysmotility disorder caused by the lack of migration of neural crest cells (or whatever) destined for the myenteric plexus leading to an inability to relax the lower esophageal sphincter as well as finish a concerted swallow reflex.

that is too much info. it is easy to try and tell them all you know at once, but that will back fire b/c they will always ask you a back up question (atleast three in fact) so you will run out of answers real fast if you tell them all you know.

instead i would answer - it is an esophageal dysmotility syndrome.

then the attending will ask...what is the pathogenesis? then you can talk about the failure of migration during embryogenesis.

then he'll ask...where are those cells destined?

get the picture? after 4 questions with right answers the attending will think you know your ****.

hope that helps.
peace.

 

[phoenixsupra]

This is what my presentation spawned from. I played the whole sit in the corner and don't speak unless spoken to thing. Turns out "I was not motivated to learn or interact with others." I think you have it right: balance. I refuse to jump like a monkey and I even hate being corrected on something a stupid attending said that was wrong when I was right.
I didn't mean that I spout off presentations at the drop of a hat, it was one I had to do anyway. I will work hard, and learn... but I will not sell my soul to my devil attending.
If that is not enough, then it will never be.

I have to admire your defiance. But remember, no matter how dumb they are, every attending is God 😉 That won't change who you are or what you have to offer medicine. The only thing that will change is that you'll be less miserable and you'll get better grades which will help you obtain your goals. These days the skills I'm working on are restraint and patience. Good luck. 🙂

 

[phoenixsupra]

dude....the biggest lesson I learned - SHUT UP unless you're spoken to, esp. if you're naturally chatty and friendly....they don't like the friendly types.

Oh, and the hierachy is in full force. Respect it or get fried on your evals. Never try to achieve or perform at a higher level, and never, never contradict a higher up even if you're 100% sure that they're wrong.

👍 👍 Absolutely. Nice to hear from a kindred spirit. 😀

 

[merlin]

This is my thought on third year...
I know it really depends on how your rotation determines final grades, but in the end, you can be a total slacker who shows very little interest, but is smart and studies hard. Or you can be very hard working, put off studying to help with work and try to learn in the hospital and will do average on the shelf. Person #1 will wind up with honors and will get away with working as little as possible, and Person #2 will end up with either pass or high pass after recieving glowing evaluations and honors in everything else in the rotation due to an average shelf score....of course there are people in the middle.

 

[Febrifuge]

I have to admire your defiance. But remember, no matter how dumb they are, every attending is God 😉 That won't change who you are or what you have to offer medicine. The only thing that will change is that you'll be less miserable and you'll get better grades which will help you obtain your goals. These days the skills I'm working on are restraint and patience. Good luck. 🙂

👍 This is excellent advice.

 

[roach]

is it common for people to bring in articles and give presentations without being asked? i believe you'd get your a$$ kicked for doing something like that.."sounds like someone's got a case of the mondays". i never encountered this my third year and only once heard of an attending who expected this sort of crap.

i agree with phoenix and andy. do your work, learn something, but don't go overboard. if a resident tells you to go home, go- don't sit around on the wards with your thumb up your butt. it's a waste of lifeforce, and you'd be better served by studying/sleeping whatever. i found that taking care of my patients and doing well on shelves served me better than volunteering for optional night call or hanging around for scut.

one third year pearl- when asked to give a talk to your entire rotation or your floor team, pick something somewhat obscure yet clinically relevant.
you'll know the most about your topic and be pimp-proofed. don't be the schmo who talks about lap choles in front of the entire surgery rotation. you may get picked apart in front of your classmates.

 

[tega]

after medicine, ER, and almost done with surgery....no one ever brought in an article....and i have a feeling the residents here will laugh at u if u do.

dont bother arguing with a Gen Surg attending. IT is futile. Just say.......... "ok"...."ok"..and..OK..... i get the feeling surgeons hate anything that can be perceived as an excuse. No matter how justified or credible this "excuse" might be, they dont want to hear it. Once they come to the conclusion that u somehow f***** up, u might as well give up and just accept it.


But on a tangent....I am so happy surgery is done with in 5 more days....and i am even happier knowing my grade will primarily be determined by my shelf exam. this made surgery much more tolerable......so nice telling a surgery intern to f*** off....knowing that u can get away with it. Or telling ur chief "hell no!!!" when he tries to make u stay post call to retract for his long ass cases, when school policy forbids this.

 

[timtye78]

Guys, there is a really neat little book, that I had as a third/fourth year student that was incredible for me. It is titled, "How to be a Truly Excellent Third Year Medical Student." by Tarascon (same people who make the little pharmacopeia book). The title sounded so cheesy to me that I almost didn't look at it in the store, but curiosity got the better of me, I bought it, and I am so glad I did.

The book is great even for the ultimate overachievers, let alone normal medical students. The book is full of USEFUL material, easy to read, easy to add to your already bulging white coat pockets. I probably didn't achieve everything in this little book, but I did very well on my clinical rotations, to the point that I received many incredible letters and even impressed the Dean at the Dean's Interview.

It's pretty cheap too. I think it was less than $15.

Later!

 

[barone ROCKS]

I thought it would be nice if we shared some tricks that we have learned through third year.

I'll go first:
A few weeks ago I was pimped on a subject and fell flat on my face. I had never heard of it. My attending I could tell was a little disappointed and sai, of course " why don't you look that up". What I did was decided to give my presenttion on that subject. At the beginning of my presentation I said that I had not known this etc blah blah and thought it was very important to know.
In my eval I was told that he really respected that and said " that I was a discoverer of knowledge".
for what it's worth.
now your turn.

thats one of the funniest comments i have heard, thanks dude for making me smile

 

[Bo Hurley]

Just do your best at answering their pimp questions. If you get some of them wrong (which you are bound to since they ask them hoping you'll get it wrong) then periodically nod your head and give a couple of token "Oh I see/Mmmm.../Interesting..." verbal responses as they get on their high horse and explain why you were wrong. This will not only make it seem like you are interested in the esoteric question they posed but it will also make them feel important, which is why they probably asked the question in the first place (so they could talk down to you when you got it wrong).

 

[irlandesa]

one third year pearl- when asked to give a talk to your entire rotation or your floor team, pick something somewhat obscure yet clinically relevant.
you'll know the most about your topic and be pimp-proofed. don't be the schmo who talks about lap choles in front of the entire surgery rotation. you may get picked apart in front of your classmates.[/QUOTE]

This is completely true. On my GI rotation, I spent one week with a 3rd year student who barfed up brief reports (on topics fed to him by the attending on duty that week) on pancreatic cystic masses, primary biliary cirrhosis, etc. As someone who also wants to go into GI, he cleverly chose to spend his time watching colonoscopies and ERCPs while kissing up to the attendings in charge; didn't see any consults, and left early. I made the unfortunate mistake of choosing more Gen Med/GI topics for presentations like PPI v. H2 blockers, IBD, etc, and as a 4th year clerk, chose to see consults and try to help the team. I got nice evals (which unfortunately didn't get forwarded) from the fellows, but the attending who taught both the 3rd yr student and myself gave me an overall HP for the week with Pass marks grades in knowledge base and initiative. I am told that Mr. 3rd year pulled down pretty much straight H's for that week. Got to learn how to play the game..

 

[path2be]

Is there an "honors" grade available to us at OSU? I have not found that box on the eval form. Just letter grades and S or U. How do we compete with people with honors if we have letter grades only? is this an issue come residency application time? 🙂

 

[Pili]

I thought it would be nice if we shared some tricks that we have learned through third year.

I'll go first:
A few weeks ago I was pimped on a subject and fell flat on my face. I had never heard of it. My attending I could tell was a little disappointed and sai, of course " why don't you look that up". What I did was decided to give my presenttion on that subject. At the beginning of my presentation I said that I had not known this etc blah blah and thought it was very important to know.
In my eval I was told that he really respected that and said " that I was a discoverer of knowledge".
for what it's worth.
now your turn.

Lay low the first week or so and figure out the residents and attendings. Most of them are easy to figure out.

 

[Eme-RG-ency]

I thought it would be nice if we shared some tricks that we have learned through third year.

I'll go first:
A few weeks ago I was pimped on a subject and fell flat on my face. I had never heard of it. My attending I could tell was a little disappointed and sai, of course " why don't you look that up". What I did was decided to give my presenttion on that subject. At the beginning of my presentation I said that I had not known this etc blah blah and thought it was very important to know.
In my eval I was told that he really respected that and said " that I was a discoverer of knowledge".
for what it's worth.
now your turn.

Definately play the game. Learn the game. Love the game. If you see someone playing well... "dont hate, instead participate." Most physician do deserve respect. (Notice I said "most", trust me, there are some that are pieces of garbage and I wont even make eye contact with let alone talk to). But most attendings do deserve respect. Give it to them. If that means taking out a notebook and scribbling down sh** as they are talking, or looking up stuff they pimp you on for later. Whatever it is... they have a wealth of information for us as students to learn. I just give them the respect thats due. If plays into their ego trip, then just laugh it off and go with the flow.

 

[tom_jones]

I'm with phoenixsupra here. When I was a 3rd year medical student, I was faced with two options:
(a) Learn the material, work hard/get the stuff done, and play the game.
(b) Learn the material and work hard/get the stuff done.

I chose option (b). Sure, I could have been like some of my classmates who at every opportune moment would put on a "bubbly" demeanor and express enthusiasm. These folks would do presentations, print journal articles. Clearly, they went above and beyond the call of duty and they were rewarded. They got honors on their rotations. And they deserved it! Am I bitter? No.

If you are picking a specialty where there is a huge emphasis on clinical grades, this is what you need to do--whether it agrees with your personality or not. Personally, I took a risk. I knew that if I pulled off average grades during 3rd year, other aspects of my residency application would compensate. Regardless, if you are going into something especially competitive, depending on the grading system at your school, I'm afraid that nowadays with uber-enthusiastic med students around, a student needs to pull him/herself to that level if he/she wants honors/A's.

Thank god for boards

 

[csmith1]

Here are some tips...

I like to get in very early and see other students' patients in addition to my own. Doing this, I can help point out inconsistencies or forgotten facts during presentations to the attendings.

I also think attendings like it when we students pimp each other during morning rounds. They also like it when we students answer questions directed to the attending by other students or residents. Attendings don't like to be bothered with this, and I feel I am helping out quite a bit when I do this.

Finally, I make it a point to take extra call to better 'help out'. Even though I'm not on the schedule and even though other team members are actually there in the hospital as they should be, I like to stay and help out however I can.

 

[Febrifuge]

Like Michael Stipe says, "irony is the shackles of youth, ah hah."

 

[DrMom]

Is there an "honors" grade available to us at OSU? I have not found that box on the eval form. Just letter grades and S or U. How do we compete with people with honors if we have letter grades only? is this an issue come residency application time? 🙂

honors/high pass/pass are used in lieu of grades & are roughly equivalent to A/B/C

 

[Coach]

Don't be a tool

 

[franktif]

Getting pimped sucks. Basically, when your doc is jerk, you have kiss his ass even more to get a good grade. Just think, there is a reason why the doc hates like so much, they most likley hate their spouse!

 

[Pili]

Here are some tips...

I like to get in very early and see other students' patients in addition to my own. Doing this, I can help point out inconsistencies or forgotten facts during presentations to the attendings.

I also think attendings like it when we students pimp each other during morning rounds. They also like it when we students answer questions directed to the attending by other students or residents. Attendings don't like to be bothered with this, and I feel I am helping out quite a bit when I do this.

Finally, I make it a point to take extra call to better 'help out'. Even though I'm not on the schedule and even though other team members are actually there in the hospital as they should be, I like to stay and help out however I can.

Too funny

 

[tx oms]

dude....the biggest lesson I learned - SHUT UP unless you're spoken to, esp. if you're naturally chatty and friendly....they don't like the friendly types.

Oh, and the hierachy is in full force. Respect it or get fried on your evals. Never try to achieve or perform at a higher level, and never, never contradict a higher up even if you're 100% sure that they're wrong.

THIS IS THE BEST ADVICE ANYONE CAN GIVE

 

[AwesomeO-DO]

I want to spend a lot of my 3rd year in Urbana/Champaign, IL (girlfriend lives there) but since it is a university city, I figure most of all the non-primary care clerckships will be filled by IL students. I don't have any special contacts at any of the 4 hospitals there, but I still want to try to rotate in some specialty areas. Is it cool to just pick docs out of the phone book and straight out ask if they take students, or is there some better way to get my foot in the door and increase my chances of a rotation spot?

 

[Idiopathic]

Is there an "honors" grade available to us at OSU? I have not found that box on the eval form. Just letter grades and S or U. How do we compete with people with honors if we have letter grades only? is this an issue come residency application time? 🙂

Stay away from the 'U' and you should be fine 😉

 

[Cpt.Hook Hamate]

Here is what I found to be helpful:

1. Never ask straight out if you can leave for the day... even if you know that your team is caught up in their work and you have been there all day. Ask if there is anymore work to be done for now or if you can go and study for a bit. Attendings will take your asking to leave as a non-interest in their field and will evaluate accordingly.

I overheard one of my attendings discussing another student and my grades over the phone with the Chief Resident while walking through the office one day. He didn't know I was there. I specifically heard him bring up the point that I showed more interest and deserved just as good as marks as he even though I know he took on much more work, especially scut work. But the other student often pages the the Senior or Attending around 5-6pm everyday to ask if it was okay to leave. I did this during my Family medicine clerkship and my attending would always get the same look on his face( the "of course you can leave" look) He gave me average marks across the board and left absolutely no comments on the evaluation. I knew he couldn't say anything negative about me so he just left it blank even though I have consistently received outstanding marks thus far in certain areas of all of my clerkships. Matter-of-fact, after the first week of the clerkship and me doing this, he told me he had already evaluated me. I still had a few more weeks to go!


2. Show your appreciation with frequent "thanks" for a resident or Attending who takes time out of their busy schedule to sit and teach you stuff. We know it is supposed to be their job but we also know that a lot of them don't do it and they really appreciate your gratitude. Being specific is even better. If it ain't genuine, forget it! These people are smart and know the game better than you since they have livED it while you are livING it.

 

[Heeed!]

Here are some tips...

I like to get in very early and see other students' patients in addition to my own. Doing this, I can help point out inconsistencies or forgotten facts during presentations to the attendings.

I also think attendings like it when we students pimp each other during morning rounds. They also like it when we students answer questions directed to the attending by other students or residents. Attendings don't like to be bothered with this, and I feel I am helping out quite a bit when I do this.

Finally, I make it a point to take extra call to better 'help out'. Even though I'm not on the schedule and even though other team members are actually there in the hospital as they should be, I like to stay and help out however I can.

 

[scootad.]

I wouldnt laugh I know more than a couple students who have done those things

 

[SOUNDMAN]

I think a key thing is to know when to say "I don't know". Don't make crap up or guess for hours on end. A lot of the times being a good physician is knowing your limitations, and knowing what you DON'T know.

 

[Doc Oc]

1) Don't ask to leave.

2) Volunteer to do RELEVANT things, like calling an outside hospital for test results, calling a patient's PCP, looking for the stupid portable ultrasound machine, etc. Don't say "Do you want me to do that", say, "I can take care of that."

3) Have stuff, like extra pens, flashlight, tongue depressors, guiac cards and developer, etc. in your pocket and pull them out and just hand them to your attending/resident when you can tell they need it (and only if you are sure they need it then). Also, if you're a clipboard carrier, have an order sheet and progress note paper with you so you can have that ready too. Anything that helps your attending not get out of their seat or look disorganized for a second instead of a patient wins you points, even if you're the biggest schmoe in the world.

4) Ask nurses how your patients did overnight, then include this in your presentation of your patient at bedside rounds. It is easy to do and makes you look resourceful.

5) Always know your patient's lab results before your attending, and dont' wait until they ask for them. Tell them, the labs are back on so and so, do you want to see them right now?

 

[SmallTownGuy]

Three things will take you a long way:

#1 Know everything about your patient

#2 Know everything about your patient

#3 Show at least some interest (ie don't look miserable even when you are)

 

[Gibby Haynes]

Pray for 4th year to hurry. Then once its hear, pray that you never have to start internship. 😱

 

[tupac_don]

Here are some tips...

I like to get in very early and see other students' patients in addition to my own. Doing this, I can help point out inconsistencies or forgotten facts during presentations to the attendings.

I also think attendings like it when we students pimp each other during morning rounds. They also like it when we students answer questions directed to the attending by other students or residents. Attendings don't like to be bothered with this, and I feel I am helping out quite a bit when I do this.

Finally, I make it a point to take extra call to better 'help out'. Even though I'm not on the schedule and even though other team members are actually there in the hospital as they should be, I like to stay and help out however I can.

\

Yea you might be helping out attendings. But students probably hate you. I know I wouldn't want you meddling with my patients. And you are doing not to help students out, but to show off to an attending. Smart to suck up to attending, but a ruthless strategy that will get other students to hate you.

 

[Hawk22]

\

Yea you might be helping out attendings. But students probably hate you. I know I wouldn't want you meddling with my patients. And you are doing not to help students out, but to show off to an attending. Smart to suck up to attending, but a ruthless strategy that will get other students to hate you.

Tupac,
I really hope you didn't miss the sarcasm in the post from csmith......

 

[csmith1]

tee hee hee

 

[tum]

\

Yea you might be helping out attendings. But students probably hate you. I know I wouldn't want you meddling with my patients. And you are doing not to help students out, but to show off to an attending. Smart to suck up to attending, but a ruthless strategy that will get other students to hate you.

pretty funny

 

[mellow yellow]

I think the most important assets to have as a third year medical student include having a good personality and strong base of knowledge. As far as having a good personality goes, I think it's important to be enthusiastic, outgoing, and friendly toward residents, attendings, and patients. If you are irritating toward the residents or attendings, there is no way in hell you'll ever get a top notch eval even if you're a genious. Even if you're not the sharpest tool in the shed, usually you can secure an above average eval simply for being a pleasure to work with. Having a strong grasp of clinical medicine is extremely important, but if you don't speak up and let others know what you're thinking, people will think you don't know anything. Examples of ways to show your knowledge w/o coming across as a know-it-all include participating in morning rounds with useful comments. Additionally, if you're in the examining room with your attending/resident and the senior is counseling the patient, speak up and explain what's going on to the patient or ask useful questions. Your attendings and residents realize that you're a student and that you need practice talking to/counseling patients and by speaking up, it offers the chance to show others what you know. And have some confidence when pimped by others or explaining things to patients that know know/understand. But don't be afraid to say "I don't know" when you don't know the answer. People will respect your confidence and that you recognize your limitations as well. The best way to accumulate knowledge is to work hard your second and third years and to regularly read journal articles (if you're interested). Don't just read journals so you can impress/show off. Find certain aspects of medicine that you're interested in and read up on it and offer to relay new information to your team when new and relevant articles arise. Your enthusiasm and interest will be evident to your team. As far as working hard is concerned, as long as you're working hard during regular hours, there's no reason to come in when you're not asked to. No one will really give much of a rat's ass that you came in on your day off if you're not contributing meaningfully during your regular working days.

So in summary, work hard while you're there, contribute meaningfully, have enthusiasm, and be friendly toward all those around you. If you display these assets, you should nearly always do well. Oh yeah, and don't be a ******* by pimping other med students on your team or making them look dumb. When pimped as a group, speak up if you know the answer but don't monopolize the pimp sessions! Let your fellow students respond as well! Just be cool!!!