Three months left of PGY-1, what should I start working on?

[deleted1208015]

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I have three months left of Internal medicine. Luckily my IM schedule was heavily front-loaded with the insane rotations, so these next three months I will have a lot of free time and down time. Six of these weeks are outpatient clinic where I am seeing 7-8 patients a day for relatively straightforward problems. I will have enough time to come home and spend 1-2 hours towards getting ready for PGY-2.

What should I focus on? I was thinking that I should start off with improving my neuro physical exam skills and working on neuroanatomy and understanding the basics of CT and MRI. If anyone has any free or low cost resources to work on these things (especially for CT/MRI) I would really appreciate it!! Unfortunately I already used up my entire PGY-1 educational budget on taking Step 3 so I can’t buy anything too expensive until July 1st!

 

[s5260205]

I find the best way to study during residency is through reading up extensively on patients you encounter. This may include reading UpToDate or guideline on the particular condition, or looking at the radiographic images pertinent to the patients. It is really difficult to retain what you've studied simply by reading them without encountering the patients clinically. If the clinics are all IM subspecialty, sometimes it can be helpful to learn about them as you will likely encounter these same conditions in your practice.

If you don't mind sitting down and reading though, then refreshing your memory on neuroanatomy can be a good start, specifically on different anatomic pathway as it relates to each symptom/function (e.g., cranial nerves, sensation, motor) as they will be quite relevant when you need to think about localization in the future. Imaging is another consideration. You should have an approach or system to reading CT and MRI first (refer to the template radiologists use), and afterwards it's all about being able to name the lesion and surrounding structure and finally having a potential differential. After getting down the basics of approach to MRI/CT, you just need an atlas. There are several online atlas including Radiopaedia. I personally find Imaging Anatomy Brain and Spine and Osborn's Brain to be the best resource for neuroanatomy (there are online free "samples" you can look at before purchasing in the future).

 

[Aldertonghen]

Radiopedia is great for neuroradiology (even for normal findings like learning circle of Willis variations). The continuum neuroradiology edition that came out in Feb 2024 is a goldmine.

Those, along with a solid book for clinical neuroanatomy (Blumenfeld and Berkowitz are both easy books to go through that don’t focus on hardcore neuroanatomy but gives important clinical correlates and helpful exam tips) prepares you for most of core neurology.

In addition to this- you want to pickup emergency neurology skills- the ENLS neurocritical care guidelines are great for status, subarachnoid, IPH, ischemic strokes etc. And you want to have a USMLE first aid style book for an overview- pocket neurology (pdf), practical neurology (website) and uptodate get me started for basics.

By doing the above + nowyouknowneuro (for RITE+ boards) I was able to achieve 98% for my second year RITE and be a solid second year neurologist even in early pgy2. RITE is important for non-neurology fellowships like neuroIR and pain (useless for neuro fellowships like stroke/epilepsy/movement etc).

Everything else- like advanced exam skills (dejong), EEG (Rowan), EMG (Preston/Shapiro) you can pick up during your respective outpatient/eeg/EMG rotations in residency.