To 3rd years, question!?

[PreMedAdAG]

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So.... i'm not on the wards, but i just got torn a new one during my last preceptorship visit in the hospital. I have a really tough preceptor who teaches me sooooo much and I'm super thankful, but when I present to him, I totally suck. It's like, I can make it through the HPI and ROS but when I get to PE, it's like I can hardly talk. Most of it is b/c I don't have clinical skills and I don't really know how to describe things at the level he wants me to describe... I'd like to know if there are any books bedsides Bates that can help me put together a good presentation with words that are correct. I find myself laboring to try to find the right words to describe "normal"

For example, instead of saying "the lungs were resonant and clear to auscultation" he prefers that I say "the lungs were resonant in all fields and upon auscultation, no adventitious sounds were heard"

He corrects every little thing that comes out of my mouth and I really want to fix it, so are there any good resources to practice the "lingo"?

I'm struggling with this... it's not like First Aid or Robbins is going to offer a second year like me any insight! Ideas so I don't keep getting killed everytime I go in to see him?

But regardless, funny moment of the year.. he ripped me soooo bad that as a sensitive woman, in my head I was thinking, "holy crap, I might actually cry... dude.. pull yourself together, what are you doing?" Sure enough I got a little wellage going on in both eyes which I'm sure he totally saw... can you blame me.. my first humiliating medical school experience.... glad I wrote it down, I should start a little collection 🙂

 

[Adcadet]

He sounds like a dick. You're trying hard, and probably doing a nice job to boot. The experience should not be described as humiliating. It's great that he corrects so many things, as it shows you what you need to work on. I wish in my third and fourth year I got feedback that is that detailed. But it sounds like he's being super picky over trivial details. There's a huge range in how to do things, even routine things like a general PE. Everybody likes things done a certain way, and there are some really good teachers who can tolerate and adapt to a wide range of acceptable approaches, descriptions, etc. He does not sound like one of them. My guess is that you'll get a similar response from him until you end up memorizing his specific style...but by then you'll be on a different rotation most likely, and the new person won't appreciate his style. Learn what you can, don't take it personally, and move on.

 

[raidermedic]

For example, instead of saying "the lungs were resonant and clear to auscultation" he prefers that I say "the lungs were resonant in all fields and upon auscultation, no adventitious sounds were heard"

Sounds a bit too picky to me. Personally when I have those findings I just say "Lung exam was negative" or I don't bring it up unless the pt is being worked up for a respiratory problem. Part of it though is projecting confidence. When asked I say it with a stern confident face as in "yes I checked for everything. What do you think I mean by negative?" When I first started third year I couldn't get away with this because I was too nervous and the attendings could sense this and would not trust my findings. Confidence goes a long way in doing well on the wards. The way I learned this was by watching some of the residents. They were confident and didn't take any crap. One example that I always got ripped for was the attendings asking "Did you ask about blah blah blah." Well in the beginning of third year I would say no and be apologetic for it. This got me a lot of dirty looks and poor evals (so much for honesty and being humble). Then I watched some of the residents present. When posed with the same question they would say "The patient did not bring that up or it was not significant concern. However she did say that blah blah blah." I started using that line and in the same tone as the residents. All of a sudden I went from a ******* to a genuiss (ok maybe just good knowledge level) in the eyes of my attendings.
On the flip side if the attendings sense your insecurity they will pounce. I swear that there are some attendings who live for bullying around med students and residents. If you let them they will do everything short of steal your lunch money.

Oh I would check out "How to be a truly excellent junior medical student" by Tarcanson. Has everything you need to write a note and make a presentation and it fits in your pocket.

 

[excalibur]

I don't know why this guy ripped you a new one, you're not even a third year. You have no clinical experience. You're not supposed to know how to do this.

Best advice is just do it however he wants it. This will go for every rotation. Through rotations you'll learn the basic set up, but then you'll realize each attending is different and wants things presented a certain way. You'll be constantly changing your presentation format based on who's your attending.

This guy sounds like a pulmonary guy. Lungs are CTAB is usually all I had to say. Do you mind sharing with us what he said when he chewed you out.

BTW, this will probably not be the first time you get chewed out for something trivial. It's the life. Don't take it personally. Some people are just jerks.

 

[oompaloompa]

Welcome to the highly subjective and contradictory world of medicine!

Just my .02, but I think the lesson to bring away from this is to come up with your own "style" of organizing the clinical information that makes the most sense to YOU, because that way you'll understand it better and be less likely to miss something.

That being said, whenever presenting just modify the terminology and organization according to the the attending-du-jour. Once you're in your clinical years you'll begin to realize there is an adjustment period at the beginning of every rotation where everyone has to figure out the the new attending "style." Every once in a while someone will offer some truly helpful or profound way of organizing/describing the clinical info, but most of the "corrections" you'll get regarding this are just personal preference.

Just like everyone else, you'll pick and choose from your various mentor's terminology. In some instances, people will be able to tell who you trained under based on the way you describe things.

Good luck!

 

[efex101]

God I hate that too...yup come the first day of the new rotation we all have to read minds.....

 

[Dr. Will]

Wow, I've never heard of anyone being THAT picky. Regardless...what everyone else has already said is true. You've got to develop your own style, and that takes practice. It sounds like he's expecting a little more out of you than you're ready for. Also, it is attending and rotation dependent. Some attendings want everything, while others want the short and sweet version. As I said, you'll learn with experience. Even as a 4th year, I don't have it fully right yet (although it seems to have gotten worse now that senioritis has set in).

 

[8744]

So.... i'm not on the wards, but i just got torn a new one during my last preceptorship visit in the hospital. I have a really tough preceptor who teaches me sooooo much and I'm super thankful, but when I present to him, I totally suck. It's like, I can make it through the HPI and ROS but when I get to PE, it's like I can hardly talk. Most of it is b/c I don't have clinical skills and I don't really know how to describe things at the level he wants me to describe... I'd like to know if there are any books bedsides Bates that can help me put together a good presentation with words that are correct. I find myself laboring to try to find the right words to describe "normal"

For example, instead of saying "the lungs were resonant and clear to auscultation" he prefers that I say "the lungs were resonant in all fields and upon auscultation, no adventitious sounds were heard"

He corrects every little thing that comes out of my mouth and I really want to fix it, so are there any good resources to practice the "lingo"?

I'm struggling with this... it's not like First Aid or Robbins is going to offer a second year like me any insight! Ideas so I don't keep getting killed everytime I go in to see him?

But regardless, funny moment of the year.. he ripped me soooo bad that as a sensitive woman, in my head I was thinking, "holy crap, I might actually cry... dude.. pull yourself together, what are you doing?" Sure enough I got a little wellage going on in both eyes which I'm sure he totally saw... can you blame me.. my first humiliating medical school experience.... glad I wrote it down, I should start a little collection 🙂

You need to grow a pair of gonads. He's being a dickhead. You will learn the lingo easily once you start rotations. By intern year you'll be speaking like House and every now and then you'll speak normally just for the fun of it.

I don't know how you can keep from geting ripped in public but you might try laughing at him when he's ripping you. Or you might jsut talk to him and tell him to save his bull**** for somebody who will take it, that somebody not being you. Seriously, it either bothers you or it doesn't. The solution is not to play his game and waste your time trying to learn something that will only come with experience.

If there's one thing your Uncle Panda can't stand it's condescending attendings and residents.

 

[Paws]

... Part of it though is projecting confidence. When asked I say it with a stern confident face as in "yes I checked for everything. What do you think I mean by negative?" When I first started third year I couldn't get away with this because I was too nervous and the attendings could sense this and would not trust my findings. Confidence goes a long way in doing well on the wards. The way I learned this was by watching some of the residents. They were confident and didn't take any crap. One example that I always got ripped for was the attendings asking "Did you ask about blah blah blah." Well in the beginning of third year I would say no and be apologetic for it. This got me a lot of dirty looks and poor evals (so much for honesty and being humble). Then I watched some of the residents present. When posed with the same question they would say "The patient did not bring that up or it was not significant concern. However she did say that blah blah blah." I started using that line and in the same tone as the residents. All of a sudden I went from a ******* to a genuiss (ok maybe just good knowledge level) in the eyes of my attendings.
On the flip side if the attendings sense your insecurity they will pounce. I swear that there are some attendings who live for bullying around med students and residents. If you let them they will do everything short of steal your lunch money.

Sister Paws agrees with this one, and I am saddened to admit it. Most attendings are really pretty normal and just want you to read the info, and that's about that. But some are really like this, and I don't know why. If they sense that you're nervous or whatever, they just go all over you and start asking things like: and did you know the lab value for this lab that was never drawn? and if it wasn't drawn, then why not? 😕 I mean, we'll all learn how to do presentations eventually, it's really not that hard. I don't see why tormenting begining students with minor inflections is going to make things better for them, and in fact it ussually makes things worse. Especially when you make them cry. Not that Paws ever cried ... altho like the OP I sure wanted to. I am only human.

I feel like I am getting my old attitude back where I am more likely to start with a good offense, so as to preclude any side tackles. We're like little puppies in the begining of third year, so vulnerable and willing to please. But by the third rotation I feel more like a junk yard dog, ready for a good fight. 😉

 

[pristine21]

From a lowly second year nothing do do with clinical stuff, but u guys dont visit the USMLE I site anymore 🙁

I have heard some new info from two separate 3rd years. Are they are dropping their number of classic clinical cases for questions involving:

1.)research articles and how to apply new research to a patient.

2.)Info that we wouldn't know, but can deduce based on our scientific knowlege learned from first year

How true is this?

I have a feeling that theese questions may have been the experimental questions we will all encounter, because from what I know USMLE wont make major changes without making it public, but I was wondering if anyone else has experienced anything like this

 

[Richie Truxillo]

Brother Richie agrees with Uncle Panda and Sister Paws. However, even though the guy is being a jackarse, just remember that you can learn something from everyone...including those who belittle us for the hell of it. Still, 3rd year has been worlds better than my first two years thus far. It just takes awhile to develop a thick skin out on clinical rotations.

On rotations you'll pick up the terminology without even knowing you are doing so. One day you'll wake up and it will start rolling out without you having to think about it. Not that I present cases perfectly but I was surprised at how quickly I started picking up the clinical terminology. 🙂

But for now, keep your chin up! Your heart is in the right place. I see you are a second-year student currently so study up and go rock those boards! 😎

And now that my 12 hour ER shift is over... I am going to crash! Good luck to ya! 👍

-Richie

 

[werd]

a good place to start is to insert some of the common abbreviations into your vocabulary, ie CTAPB (clear to auscultation and percussion bilaterally), RRR no MRG (regular rate and rhythm, no murmurs rubs or gallops), WWP (warm and well-perfused), 2nd ICS LSB (2nd intercostal space, left sternal border)... if you can get your hands on a list of common abbreviations like that you'll get a feel of how basic findings are verbally described.
i wouldn't worry about learning all of the linguo that this preceptor wants, in 6 monts of my 3rd year i've never run into anyone that picky about verbiage. some attendings like lots of details and some don't, you just have to figure it out each time you rotate... some like a full description of everything, some want "lungs clear, heart regular rhythm no murmurs, abdominal exam benign" if things are normal, and some just want "rest of exam normal." of course, you always detail the abnormal findings.... hope this helps a little. 🙂

 

[deleted109597]

I agree with the above. Nothing takes the fire out of an antagonistic attending like saying "I don't care." Trust me, it works great during surgery.

I have heard some new info from two separate 3rd years. Are they are dropping their number of classic clinical cases for questions involving:

1.)research articles and how to apply new research to a patient.

2.)Info that we wouldn't know, but can deduce based on our scientific knowlege learned from first year

How true is this?

I have a feeling that theese questions may have been the experimental questions we will all encounter, because from what I know USMLE wont make major changes without making it public, but I was wondering if anyone else has experienced anything like this

No. They can't write new questions that fast, and new research changes way too much to write questions based on it. You are going to get gold standard questions only.

 

[PreMedAdAG]

wow everyone, thanks so much, that was great support!!!

no more tears

 

[AmoryBlaine]

So let me get this straight. The OP is in the first semester of her second year of school and was ripped by a "preceptor" for not getting her PE right on presentation?

What's ironic is I'll bet $20 he tells people that he "loves to teach." This guy should be caned.

 

[njbmd]

So.... i'm not on the wards, but i just got torn a new one during my last preceptorship visit in the hospital. I have a really tough preceptor who teaches me sooooo much and I'm super thankful, but when I present to him, I totally suck. It's like, I can make it through the HPI and ROS but when I get to PE, it's like I can hardly talk. Most of it is b/c I don't have clinical skills and I don't really know how to describe things at the level he wants me to describe... I'd like to know if there are any books bedsides Bates that can help me put together a good presentation with words that are correct. I find myself laboring to try to find the right words to describe "normal"

For example, instead of saying "the lungs were resonant and clear to auscultation" he prefers that I say "the lungs were resonant in all fields and upon auscultation, no adventitious sounds were heard"

He corrects every little thing that comes out of my mouth and I really want to fix it, so are there any good resources to practice the "lingo"?

I'm struggling with this... it's not like First Aid or Robbins is going to offer a second year like me any insight! Ideas so I don't keep getting killed everytime I go in to see him?

But regardless, funny moment of the year.. he ripped me soooo bad that as a sensitive woman, in my head I was thinking, "holy crap, I might actually cry... dude.. pull yourself together, what are you doing?" Sure enough I got a little wellage going on in both eyes which I'm sure he totally saw... can you blame me.. my first humiliating medical school experience.... glad I wrote it down, I should start a little collection 🙂

There is a nice little book called "DeGowin's Diagnostic Examination" that you might find useful. It is chocked full of the "lingo" and descriptions that will get you up to speed in a hurry. It's a great book for learning how to hone your history-taking, physical exam skills (even tells you how to stand) and evaluations of signs and symptoms. It's a small book and one that you will find yourself reading and re-reading through your career. You may want to get a copy of this book as you start third year.

I am a chief resident in General Surgery and sometimes our M & M sessions turn into grilling sessions for the residents. (Actually "grilling" is a nice term for what happens.) When I was a junior resident, I would often get nervous (and almost on the verge of tears) when these ranting and yelling sessions started but I learned to stand there, glean any knowledge that I can from the attending rants and calmly continue with my presentation when they are over. It's part of developing a "thick skin" which will serve you well in residency and practice. My key was to practice becoming calmer as things get more heated. Even now, as a chief, my surgical experience pales in comparision to the experience of some of the attendings in the room. I WANT the benefit of their experience (even if it comes in the form of a rant). In the past two years, I have honed my ability to keep myself calm and maximize my learning.

I suspect that you will develp these skills with practice and increased level of comfort with history taking and physical exam skills. The important thing to try to do, is not become frightened or frozen by the preceptor rants. Take a deep breath, listen and concentrate on what is being said and let the emotions go. Remember that nothing is directed at you as a person but at your words. They can yell at you but they can't eat you so you will be quite safe. Anything that doesn't kill you in medicine, gives you experience and makes you stronger. I suspect that when you hit the wards, you are going to shine above your colleageus who have not had to perform under stress. When you get to M & M as a resident, you will shine there too. 👍

Good luck!

 

[Richie Truxillo]

There is a nice little book called "DeGowin's Diagnostic Examination" that you might find useful.

Appreciate the recommendation! I will pick that up and give it a read! 👍