Tips for first rotation

[78222]

I start medicine on Monday and I am...well a little terrified. I have no idea how to study or to prepare and Medicine seems to be one of the toughest. Any tips on how to avoid making a complete fool out of myself and what books I should get? I really have no clue.

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[smq123]

I start medicine on Monday and I am...well a little terrified. I have no idea how to study or to prepare and Medicine seems to be one of the toughest.

Review how to write a good SOAP note. Organization in a SOAP note is KEY. Write headers to help clearly organize your note. (Ex: CV issues is new-onset a-fib, which we will manage with telemetry, coumadin, and daily INR checks. RENAL issue is ARF, which we will manage with IVF - NSS. PULM issues are...etc.] Compartmentalizing stuff will help you both with your pt. presentations, as well as your SOAP notes.

Keep track of the pt.'s meds as much as possible. What are they taking? What are they taking it for? What dosage? Are they good about taking their meds, or do they dose themselves with HCTZ prn?

In your A&P on your SOAP note, always include a diet (house? Cardiac prudent?), activity level (may shower; up ad lib; etc.) and prophylaxis (daily Lovenox? SCDs?)

Any tips on how to avoid making a complete fool out of myself and what books I should get?

Sorry. There's no way to avoid this. We could bombard you with advice...but then you'd find the ONE THING that we forgot to tell you, and do it, and look like a total idiot anyway.

It's okay to look like an idiot. It's temporary, and everyone (even the chairman of your dept.) looked like an absolute idiot at some point or another. Just shrug it off, and don't make the same mistake again.

You'll have to find which books work for you. I personally loved Case Files, but some people swear by PreTest. It's very individual.

Good luck.

 

[getunconcsious]

I'd definitely suggest Pocket Medicine to carry in your white coat. I don't know that I'd really read on anything yet just cuz you really have no idea what diagnoses your patients will carry. But pocket medicine is great for when you get some patient and have to present post-call early the next morning....you can read up on the main points for pimping. Other than that, relax. Medicine is a burden to be sure but it's not one of the high stress rotations (that would be surgery and OB/Gyn)

 

[group_theory]

I start medicine on Monday and I am...well a little terrified. I have no idea how to study or to prepare and Medicine seems to be one of the toughest. Any tips on how to avoid making a complete fool out of myself and what books I should get? I really have no clue.

First - let everyone on the team know it is your first rotation. Expectations are different for a student on his/her first clinical rotation versus expectations towards the end of the third year (where students are expected to be almost sub-I/AIs)

Use the first day to observe how the team functions, how patients are presented during rounds, etc. The senior resident on the team will then assign you a patient or two to follow (because you are not a sub-I/Acting Intern, expect the intern to also follow your patient). That afternoon, read up on the patient's H&P, and the previous progress notes. Read up on your patient's disease and the medications that he/she is on that night. The next day, look up lab and vitals on your patient, examine the patient, and then go over your notes with your senior. A quick mock-presentation with the senior is a good idea so that you will be ready to present to the attending.

 

[Kubed]

I'd definitely suggest Pocket Medicine to carry in your white coat. I don't know that I'd really read on anything yet just cuz you really have no idea what diagnoses your patients will carry. But pocket medicine is great for when you get some patient and have to present post-call early the next morning....you can read up on the main points for pimping. Other than that, relax. Medicine is a burden to be sure but it's not one of the high stress rotations (that would be surgery and OB/Gyn)

I 2nd that. Pocket medicine will set you free. It's perfect for the quick read on the major topics. I also recommend using its format for formal presentations and then supplementing with something more official.
http://www.amazon.com/Pocket-Medici...bs_sr_2?ie=UTF8&s=books&qid=1209901946&sr=8-2

Also, find yourself a maxwell and keep it close. Other than that be on time, keep quiet, and watch how things work on the first day. You'll be surprised at how quickly you pick it up.

 

[DingleBerry]

Congrats on finishing preclinical years and welcome to a whole new animal, one that I think is infinitely better.

You've gotten very good advice so far,
listen to kubed- the first rule of rotations is always be on time. There's not a whole lot that will be expected of you on your first rotation but you must be present, your absence will be noted.

Group-theory brings up a good point, observe the dynamics of the team and ask what your responsibilities are. You need to know what is expected of you and you can't always expect them to sit down and spell it out for you. House staff are very busy and if you're not assertive you may be ignored.

Lastly, pay attention as much as you can. When someone presents a topic or a patient listen, when you have an organized lecture grab some coffee and don't fall asleep. Passive learning was so helpful for me on my shelf exams, it made studying that much easier. Good luck, and have fun on the wards!

 

[doc20]

Crush, secrets, or case files are good
kaplan videos if you are a visual/audio person and also it helps preparing for step 2

 

[beastmaster]

We could bombard you with advice...but then you'd find the ONE THING that we forgot to tell you, and do it, and look like a total idiot anyway.

The trick is knowing when you've said or done something totally stupid. Then to minimize the number of times you repeat the infraction. 3rd year is truly a fun and unique learning process.

Just remember you can use "But, but... it's my first day/week/month/rotation" excuse. Oh how sweet that was!

Now for my one bit of small advice. If you're asked to do something, ie. IV line, find/bring medical supplies you've never seen/heard of before. Fight to do it with someone walking you through it. "No, NO... Don't do it for me. Let ME do that... you watch me and make sure I'm doing it properly." You learn by doing. SCUT is a priviledge. Offer to go down to radiology or the blood bank to bring the films or the bloods. You learn how different departments function and communicate. And make sure to ask your SCUTing resident, "is there anything else that I don't know that I need to know in order to get this done?" ... so when you return empty handed, at least you can say "but I asked you before going down there... why didn't you tell me I needed such and such... you know I'm new here, come on!"

 

[Mariah246]

Review how to write a good SOAP note. Organization in a SOAP note is KEY. Write headers to help clearly organize your note. (Ex: CV issues is new-onset a-fib, which we will manage with telemetry, coumadin, and daily INR checks. RENAL issue is ARF, which we will manage with IVF - NSS. PULM issues are...etc.] Compartmentalizing stuff will help you both with your pt. presentations, as well as your SOAP notes.

ehh...it's always best to check with your attending on the first day to see what they prefer

I was reamed out by a medicine attending for organizing my A/P in this manner (overreact much? )

She preferred clear listings (in order of priority of course) in the A/P

That is, not lumping in Afib under a subset of CV but actually writing out the

1) Afib
-
-
-

2) COPD exacerbation
-
-
-

etc... etc...

 

[smq123]

ehh...it's always best to check with your attending on the first day to see what they prefer

I was reamed out by a medicine attending for organizing my A/P in this manner (overreact much? )

Which, I think, is the best way to sum up third year: The only sure-fire rule is "Do what the attending wants you to do."

OP - This is what I meant by no one can tell you how to avoid looking like an idiot. One way or another, you're going to look stupid, through no fault of your own.

 

[tkim]

For the pocket: Maxwells, Pocket Medicine (comes in PDA form), Pharmacopeia

For the PDA: Epocrates (or Pharmacopeia) book, Diagnasaurus

For the backpack: Consult Manual of Internal Medicine, Step Up to Medicine

If you're entirely clueless to the wards, First Aid for the Wards is a good introduction.

And let's not forget Boards and Wards.

 

[78222]

Hey guys, thanks for the great info. Definitely at least gives me a starting point for going into the wards.

 

[had2piknowEM]

ehh...it's always best to check with your attending on the first day to see what they prefer

I was reamed out by a medicine attending for organizing my A/P in this manner (overreact much? )

She preferred clear listings (in order of priority of course) in the A/P

That is, not lumping in Afib under a subset of CV but actually writing out the

1) Afib
-
-
-

2) COPD exacerbation
-
-
-

etc... etc...

This is also patient dependent. If you have a patient with multiple medical problems that span several organ systems, then it may be better to list CV, Pulm, Renal, etc. On the other hand, some disease processes overlap, so in that case it may be easier to list the actual problem. For example, Pneumonia, which covers Pulm and ID can be listed as problem #1. But end the end, the attending's preference will ALWAYS rule. Which brings up another tip, remember every attending has his/her own peculiarities about presentations, H&P's, etc...so try not to take anything personal and don't keep saying, "well Dr. So and So had me do it like this..." cause they don't care. Have fun though, clinics >>>> class.

 

[MrBurns10]

I think the most important thing I can suggest, which has helped me tremendously throughout my rotations, is always ask for feedback after the first day, your first H&P, your first presentation, etc and in the middle of your rotation. And don't ask "how did I do?" or "how am I doing?" because inevitably the answer will be "fine!"...I would suggest asking "is there anything you would like me to do differently?" or "what specifically can I improve on for the rest of the rotation?" Those questions lend themselves to better feedback and make it seem like you actually care what they tell you are aren't just asking because you feel like you have to.

 

[vtucci]

Medicine resources for exam: USMLEWORLD 5+stars, Step Up 5 stars, Case Files 4.5 starts, First Aid 3.5 stars

Medicine resources for the wards: Care of the Medical Patient. I preferred this to Pocket Medicine

General advice:

1. ask for feedback early and often. You would be amazed at how many students drop the ball on this one. I asked on an almost daily basis or with any new experience. How was that- is there a way I can improve my H&P, oral presentation, SOAP note- whatever? If it was not exceptional in their opinion, what did I miss- need to list more pertinent positives, negatives? At least ask for feedback on a weekly basis, that way you can implement any changes. Asking also shows interest in your performance and being the best team member you can be. How can I help the team more? Give a formal feedback form each week- a copy of the final form you will hand in (or they will hand in). If you leave it informal, you will invariably be told you are doing fine because it is easier to say that than sit down and fill out a form or think critically about the matter and it is much easier to say that particularly if someone is not comfortable with confrontation and making people upset. Don't rely on that. Many a student has been slayed by this approach.

2. At the beginning of the rotation, make sure you understand the expectations of both your attending and residents (they are not always the same). Check copies of sample notes from the team. Review H&Ps and notes with the attending and residents if this is already not a requirement for your clerkship.

3. Make sure you understand how to d/c patients. One of the constant struggles of the medicine services is disposition. Preparing the paperwork and checking with consults and social work will help the team enormously.

4. Follow up with consults on your own. Do not say you are a third year medical student but that your name is so and so and you are with Dr. attending's medicine team and you are calling to follow up on__________. You will find that some consultants and some teams will not return the calls of students.

5. Enthusiasm. If you do not have it naturally for the discipline, fake it. Think about it-- no one wants to be around someone who is dragging *** or hating life or the service. For the most part, the residents and attending chose this field of medicine because they enjoy it. Looking bored, not paying attention is saying to them that what they love to do is not important to you.

6. Team work- this is not an option. Work with your fellow 3rd and 4th years. Under no circumstances should you try to show up the other students. Get their cell and beeper numbers in advance. Agree when you will show up together on the first day and in subsequent rotations. Few things are more annoying than a student showing up an hour early to look better than their teammates. You will need to rely on a fellow student at some time this year so don't be the one that everyone will end up talking about. Help the teammate out. IF they are sick, offer to shoulder some of the burden for them-- even if that is checking their patient's labs so they can lay down in the call room or get something to eat. You do not need to announce how great you are to the team. The residents will see that you are a team player and your eval will reflect this accordingly.

7. Never underestimate the power of candy and junk food when brought for the team during call. A twinkie or jolly rancher candy at 1 am can work wonders for everyone's disposition.

 

[Anka]

1. Don't make excuses. Ever. You will wind up peripheralized. Tell people your first day it is your first rotation, but after that, just start plugging away and don't use it as an excuse. Some examples:

EXAMPLE 1

Attending: "What, you don't know the eight causes of perdunkle syndrome?"
MS3: "Sorry, it's my first day" [LAME!!!! and an excuse. At best, the attending thinks you're just a dumb medical student; at worst, he looks down on you for not taking responsibility for your fund of knowledge]

--redo--
Attending: "What, you don't know the eight causes of perdunkle syndrome?"
MS3: "I'll look it up and get back to you tomorrow." [no excuse, but a plan of action to remedy your fault]

EXAMPLE 2

Resident: Can you get together Ms. D's discharge paperwork and scripts.
MS3: Uhh... I don't know how to do that, it's my first day. [Excuse.]
Resident: Oh, I totally understand. <smile> <procedes to do discharge summary while you watch... it's like watching paint dry... doesn't actually show you how to do it, however, because it's just faster if he does it>
[Congrads! You are now completely peripheral! And guess what, you still don't know how to do a discharge summary! AND, you made an excuse so the guy thinks you're just a dumb medical student at best, at worst that you're lame.]

--Redo---
Resident: Can you get together Ms. D's discharge paperwork and scripts.
MS3: Sure! <run off and find nearest RN, ask her where the discharge paperwork is... if she doesn't know, ask the intern where you can find the forms... fill in the blanks as best you can. Look up how to write a prescription on line and write them out. Then put it in a big pile and take it back to your resident>
MS3: Here you are. It's the first time I've done it, can you check it over for me?
Resident: <flips through scripts> Jeez, can't you even write a Rx? When I was a medical student...
MS3: Sorry, sir. <watch while he corrects your many mistakes>
Resident: Okay, now put that in the chart.
MS3: Thanks. <puts them in the chart>
Next time... "Hey, I already put the discharge paperwork together for Ms S who is going home today; could you check it over for me"
[Your resident now thinks you're a superstar.]

2. Be early, stay late. Be around when you're supposed to be around. Make sure you know who's 'in charge' of you (resident or intern), and make sure they know if you need to go to class.

3. Listen to what people are saying. Even if you don't understand exactly what is being said, you'll pick up a lot without realizing.

4. Silence is your best friend. Chime in every once in a while when you know the answer and it's obscure, but once people are convinced you're smart, just keep your mouth shut.

5. Count to ten before you ask a question. 9 times out of 10 you actually know the answer.

6. Mostly this year is a cross cultural experience. Try to fit in with the dominant culture of the rotation you're on. It'll make life easier for you, and more teaching/learning will occur.

7. Everything is your fault. The faster you internalize that, the less depressed you'll be. If nothing is your fault, you aren't responsible for anything, and you are at the mercy of fate and strange forces that run the hospital. You will go into learned helplessness mode and wind up depressed. If everything is your fault, sure you'll take an ego hit, and you'll wind up accepting responsibility for a lot that you really don't have any control over, but at the end of the day, you'll be in problem solver mode rather than learned helplessness mode. If you are responsible, things are your fault, but you also have control.

 

[Scaredshizzles]

1. Don't make excuses. Ever. You will wind up peripheralized. Tell people your first day it is your first rotation, but after that, just start plugging away and don't use it as an excuse. Some examples:

EXAMPLE 1

Attending: "What, you don't know the eight causes of perdunkle syndrome?"
MS3: "Sorry, it's my first day" [LAME!!!! and an excuse. At best, the attending thinks you're just a dumb medical student; at worst, he looks down on you for not taking responsibility for your fund of knowledge]

--redo--
Attending: "What, you don't know the eight causes of perdunkle syndrome?"
MS3: "I'll look it up and get back to you tomorrow." [no excuse, but a plan of action to remedy your fault]

EXAMPLE 2

Resident: Can you get together Ms. D's discharge paperwork and scripts.
MS3: Uhh... I don't know how to do that, it's my first day. [Excuse.]
Resident: Oh, I totally understand. <smile> <procedes to do discharge summary while you watch... it's like watching paint dry... doesn't actually show you how to do it, however, because it's just faster if he does it>
[Congrads! You are now completely peripheral! And guess what, you still don't know how to do a discharge summary! AND, you made an excuse so the guy thinks you're just a dumb medical student at best, at worst that you're lame.]

--Redo---
Resident: Can you get together Ms. D's discharge paperwork and scripts.
MS3: Sure! <run off and find nearest RN, ask her where the discharge paperwork is... if she doesn't know, ask the intern where you can find the forms... fill in the blanks as best you can. Look up how to write a prescription on line and write them out. Then put it in a big pile and take it back to your resident>
MS3: Here you are. It's the first time I've done it, can you check it over for me?
Resident: <flips through scripts> Jeez, can't you even write a Rx? When I was a medical student...
MS3: Sorry, sir. <watch while he corrects your many mistakes>
Resident: Okay, now put that in the chart.
MS3: Thanks. <puts them in the chart>
Next time... "Hey, I already put the discharge paperwork together for Ms S who is going home today; could you check it over for me"
[Your resident now thinks you're a superstar.]

2. Be early, stay late. Be around when you're supposed to be around. Make sure you know who's 'in charge' of you (resident or intern), and make sure they know if you need to go to class.

3. Listen to what people are saying. Even if you don't understand exactly what is being said, you'll pick up a lot without realizing.

4. Silence is your best friend. Chime in every once in a while when you know the answer and it's obscure, but once people are convinced you're smart, just keep your mouth shut.

5. Count to ten before you ask a question. 9 times out of 10 you actually know the answer.

6. Mostly this year is a cross cultural experience. Try to fit in with the dominant culture of the rotation you're on. It'll make life easier for you, and more teaching/learning will occur.

7. Everything is your fault. The faster you internalize that, the less depressed you'll be. If nothing is your fault, you aren't responsible for anything, and you are at the mercy of fate and strange forces that run the hospital. You will go into learned helplessness mode and wind up depressed. If everything is your fault, sure you'll take an ego hit, and you'll wind up accepting responsibility for a lot that you really don't have any control over, but at the end of the day, you'll be in problem solver mode rather than learned helplessness mode. If you are responsible, things are your fault, but you also have control.

My advice to the OP is to be him/herself, try your best, be willing to put in effort and use common social sense. Read something about your patients....the next day recite some of that newly gained information to residents and then find a way to formulate an intelligent question from it for your attending....they love to hear themselves talk (remember they chose to be a hospitalist for reasons other than $$$), but the question should reveal that you have a pretty strong basic understanding on the topic.

But definitely don't concern yourself with following these long lists of things to be done by some of the gunners on here....At least half of their effort is wasted, and some of their effort only makes them the ridicule of others. Don't be so willing to be **** on by everyone. Usually if you score well on exams (which means yo uneed the time to study) and do what is expected from you on the wards, you wind up doing well in the rotation. Even when they tell you only a small percentage of the score is based on the exam, course directors sometimes have a way of adjusting your clinical eval score to reflect your shelf/exam performance.