University of Oklahoma -- everyone welcome -- Part 4

[Jwax]

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*snort* Excuse me while I laugh my behind off about that.

Good point. Ehhh... I'm not really into the ethics class either. According to my first aid book, the only ethics we need to "know" are the 4 principles and what are reportable diseases. Other than that, I feel it is a lot of hem-hawing (I think that is the proper phrase) about abstract situations. The first class was more interesting with these random situations that were at least somewhat relevant, especially once people started answering how they'd really deal with it (no, I would never practice a procedure on a dead body w/o family's permission.... well, maybe if I was only doing something that didn't leave any signs of trauma like intubations or something.... screw it, I'd do it regardless). Oh well. I support any class that is p/f and you pass just by showing up. 👍

 

[masterofmonkeys]

Naw, I actually think ethics and epistemology are vitally important, same as I do for understanding how science works. But, these things are well beyond the medical student as our educational system is currently structured.

Which is why it all sounds like a bunch of garbage. Everyone's talking out of their asses, using imprecise language, and garbling and mangling basic concepts, meaning one thing the first time they use a word and a totally different thing the next time they use it.

Osler operated in an era in which philosophy and intellectual rigor were basic requirements of a college degree. One could say that they were the whole point of a college degree.

Medical schools were structured with the assumption that we would have already developed a basic understanding of hte principles of science and philosophy.

Read the basic writings of any of the great scientists, doctors, historians, of the past, and you'll see that all of these things were highly valued.

That was true 100 years ago, but not today.

Most of the garbage being spread around the world today is a direct result of the fact that we do not demand precision, rigor, and sophistication from ourselves.

 

[Jwax]

I'm gaining motivation. 🙂

 

[Non-TradTulsa]

I haven't checked-in in a while. I've been getting caught-up on post reading, however, and I'm still scratching my head over the neuro comment about liking The DLG. Me, I've never met the man up close. Everytime I got within about 20 feet of him the forcefield of his ego made the hair on my arms stand-up and I had to back away from the blue light glowing around his head. But, then again, I have a low tolerance for a lot of people, because I have a low threshold for annoyance.

I miss having snow days. I can gripe on here, because I pretty much know who does and doesn't post and we usually flush out the lurkers. Last Tuesday I was wondering what the heck to do because we knew campus was closed and they'd sent Surgery students home but we couldn't get an answer from anybody about what Medicine was doing. So, yours truly bundled-up, warmed the car up early, and trundled down to the hospital - it was glazed ice until 4:45 but then a pellet sleet came down hard which actually gave you some traction. The hospital is nearly 15 miles from my house, I'll add.

Now the other students on my rotation think I'm a tool, because I was the only medical student at the hospital that day and I "broke rank." Hey, I would have been happy to stay home if somebody would have just said for sure that we could. I worked too long in hospitals - on very snowy/icy days, staff was expected to make a reasonable effort to get in, especially if it was extremely bad. Even if you were in administration like me, sometimes they were so short-handed they'd call for office people to pass meal trays and do other unskilled patient care.

There are two valid trains of thought: 1) We're non-essential personnel, so there's no reason for us to kill ourselves to come in (which I tend to agree with, but I expect to see it in writing somewhere), and 2) we're going to be interns soon, so we might as well get used to having personal responsibility for patient care (which, as it turns-out, is how Medicine thinks). I just hated getting dissed. This isn't high school. We all have to look at our own conscience, what kind of car we have to use in snow, how close we are to the hospital, and what conditions are in our particular residential area.

On the other hand, man - did I get brownie points with my senior and the attendings for having shown-up. 😛

So, is First Aid good for the Medicine exam? I'm getting very nervous. I would have assumed they based it on their Cecil text since it's an in-house exam - but I've tried reading the renal section of Cecil twice and will probably severely injure the book if I try to wade through it again. I feel like I need to go back to Costanzo (which is still in boxes, dammit) to even understand what the heck they're talking about.

Sorry - I guess I'm still crabby. It's just ridiculous that students aren't excused from ANY daytime activities when we're post long-call. It's going to be a duty hours violation when they apply resident standards to students - which I understand is coming. I didn't get out of lecture until 4pm - and I'd been working since 6:30am the day before. I'll say this - I was a true hazard to the motoring public while I was driving home. And I was long-call last Sat/Sun, so I haven't had a day off in 2 weeks. I slept over 12 hours after I got home yesterday.

Second year was so cool, when I knew how to study and take tests and didn't have to get dressed and see people when I didn't feel like it. I sure miss it.

 

[Bravofriendly]

I haven't checked-in in a while.

Welcome back, NTT! I consider this thread the official venting thread for our institution. People who never get frustrated, tired, bitter or occasionally whiney need not apply. I'm pretty sure there are plenty of other threads on this board where their kind is recognized and understood.

Didn't anyone tell those pricks that they haven't joined a union. There is no "line" to cross. I would have done the same thing - without explicit instructions not to come in, I would have assumed that meant (as it apparently did) I was expected to come in just like any other day.

You give us a list of the a--holes picking on you and we'll round up an SDN posse to give them a schooling. NOBODY messes with NTT and gets away with it.

Check you PMs. I sent you a link to something that may be helpful with your renal review conundrum.

 

[Jwax]

Second year was so cool, when I knew how to study and take tests and didn't have to get dressed and see people when I didn't feel like it. I sure miss it.

Don't say that...😱 I'm really getting to that point that I feel if I had to go another year studying all day every day non-stop no fun no life... I would have to start singing some Adam Sandler from the Wedding Singer ("Somebody kill me please... put a bullet in my brain..."). I am so so so sick of the "pre-clinical" years. I hate it. 😡

There, now I've gotten to vent. I think my husband gets tired of hearing me say how much I hate studying. Might as well complain to those who get it. I don't get how people can say they like studying. Liars.

 

[Non-TradTulsa]

Don't say that...😱 I'm really getting to that point that I feel if I had to go another year studying all day every day non-stop no fun no life... I would have to start singing some Adam Sandler from the Wedding Singer ("Somebody kill me please... put a bullet in my brain..."). I am so so so sick of the "pre-clinical" years. I hate it. 😡

LOL... well, I hate to be a drag... but the real problem is that once you hit 3rd year - except for the easy rotations - you will realize that you have a brand-new full-time job - it's just one that costs $19K per year. But, then you get home at night - and you are tired from putting in a full day of work just like any other human being on this planet - but you have studying to do and papers to write... just like 1st/2nd year, only now you have to do it all on your "own time" at night.

It's different for everybody. What I find especially problematic - and I've said this many times before - is that, while you're a student on rotations, you're hanging around all day with people who are supervising you and evaluating you - and they won't have more than a month max to figure-out what kind of person you really are. So, to some degree, you have to have your guard up and your best behavior on at all times. I have learned not to bitch even when I have just one bad day (which is very human) - because more often than not - they'll be sympathetic but they're also making a mental note - and "occasional bad attitude" shows-up on your review (which will happen even if you have to listen to them bitch about the attendings every day - the system is not fair). I had a very cool Senior resident this month - I don't want to make it sound like torture - but the people around you, at least when the attending is not there, are right about your own age. You might assume after a few days that these people are your friends - and, truth is, they are not your friends - even if you're on friendly terms.

I'm used to hanging around with colleagues and only getting a performance evaluation once a year. I just find it very stressful being evaluated every single day. When I studied at home alone, I could go unshaven and scratch my belly and nobody ever knew the difference.

As we all have already figured-out, becoming a physician is NOT easy.

Bravofriendly: You're so cool... thanks for giving my day a lift. This is my first weekend off in 2 weeks, and I only have time to study - I needed a grin.

 

[Jwax]

This may be a dumb question, but it seems like the whole applying for residency process is shrouded in mystery so I know very little about any of it... how many LORs do you need? How many need to be from physicians in the field you're going into or does that # depend on the field/program? Can your LOR come from a physician not at an academic hospital? Why am I bothering to contemplate any of this? I just am. Also because despite non-trad's pessimism towards third year 😉, I've got no option other than to believe that I am going to love it. If I don't, well, then I guess I'm going to be just another bitter physician who hates getting up and going to work every day. 🙄

 

[Doctor Bagel]

This may be a dumb question, but it seems like the whole applying for residency process is shrouded in mystery so I know very little about any of it... how many LORs do you need? How many need to be from physicians in the field you're going into or does that # depend on the field/program? Can your LOR come from a physician not at an academic hospital? Why am I bothering to contemplate any of this? I just am. Also because despite non-trad's pessimism towards third year 😉, I've got no option other than to believe that I am going to love it. If I don't, well, then I guess I'm going to be just another bitter physician who hates getting up and going to work every day. 🙄

I'm thinking something like 3, but yeah, I haven't thought about it much. I do know that you really want letters from academic physicians in your area -- maybe a non-academic physician could supplement, but it might not be worth much. I'm kind of wishing our school was giving us a little more advice about this stuff right now.

As for liking 3rd year, you might -- some people think it's much better than 1st and 2nd year. I personally disagree, but I could very well be in the minority. The thing that stresses me out is what NTT mentioned above -- you feel like you're constantly being evaluated, and it's tough. It was especially stressful for me on medicine when I had a senior who acted like he hated me (apparently he did that to everyone and really didn't hate them, but I didn't know that until later). So I kept on wigging out about this guy giving me a horrible evaluation and putting down stuff that would make it into my dean's letter, and it made the rotation borderline miserable. You're isolated from that stuff 1st and 2nd year, which is good. And yes, we still have exams. I would guess however that grades are overall higher 3rd and 4th year because so much of the grade is clinical evaluations, and I haven't come across anyone here who gives you low marks for that unless you really slack. I don't know how true that is in OKC.

And yes, IM weeks with Sat. call suck! And I hate, hate hated IM call. I don't know why, but I just plain hated it.

 

[Antigunner]

This may be a dumb question, but it seems like the whole applying for residency process is shrouded in mystery so I know very little about any of it... how many LORs do you need? How many need to be from physicians in the field you're going into or does that # depend on the field/program? Can your LOR come from a physician not at an academic hospital? Why am I bothering to contemplate any of this? I just am. Also because despite non-trad's pessimism towards third year 😉, I've got no option other than to believe that I am going to love it. If I don't, well, then I guess I'm going to be just another bitter physician who hates getting up and going to work every day. 🙄

Most programs are going to want a minimum of 3, I've heard of a few that want 4. The advice I got from a lot of people before doing it was to get 3 within your field and 1 from another field, that way you should be covered. It's definitely important to have some letters from academic physicians, but if you have a non-academic physician that knows you well and could write a strong letter, I think that's fine. I had an anesthesiologist from St. Anthony's write one for me after I did a month there.

In general, you're going to want letters from people you worked with quite a bit, and from rotations that you did at least pretty well on. If you can get it, a letter from a big hitter is always nice to have in your pocket (i.e. Postier, DLG, Fitch, etc.)

 

[Jwax]

Most programs are going to want a minimum of 3, I've heard of a few that want 4. The advice I got from a lot of people before doing it was to get 3 within your field and 1 from another field, that way you should be covered. It's definitely important to have some letters from academic physicians, but if you have a non-academic physician that knows you well and could write a strong letter, I think that's fine. I had an anesthesiologist from St. Anthony's write one for me after I did a month there.

In general, you're going to want letters from people you worked with quite a bit, and from rotations that you did at least pretty well on. If you can get it, a letter from a big hitter is always nice to have in your pocket (i.e. Postier, DLG, Fitch, etc.)

Would it be acceptable to get another one from in your field from an away rotation? Such as, I hope to do an away rotation in Vegas and hope that I could get a good LOR from it. It would certainly help for my Vegas app, but is it going to be a negative for other apps to have that foreign letter from another program? My non-academic doc is a wonderful physician from Mercy that I shadowed as a pre-med and off and on in med school who knows me pretty well (and likes me) and would write a strong letter, I imagine. I worry that if I'm doing two months of away rotations in 4th year, I won't have enough time to get a third EM rotation here (do they even have them or do I have to go to Tulsa during 4th year?). The EM selective is only 2 weeks in third year and that just doesn't seem like enough to ask for a letter.

 

[Mr. Freeze]

I haven't quite mastered typing on my iPod yet, so this won't be my normal long-winded reply 🙂 but suffice to say, of course away letters count. Where do you think you get letters? 🙂 ESPECIALLY in EM where the degrees of separation between writer and reader are quite small. Basically, you can't rotate everywhere, so program are often trusting the judgement of someone they know on whether you are worth hiring. Which of course is why a letter from someone recognizable is better.

 

[Amxcvbcv]

1. They don't have to be from academic physicians. They should, however, be from someone that can give you a very good, honest evaluation.

2. Yes, you can and should get them from an away rotation physician. I did, and I think it was one of my stronger letters.

3. No matter what you're applying to do, try to get a letter from ob/gyn, medicine, or surgery. They are the core of the core rotations, and PDs want to know how you did with them. Also, some preliminary positions I applied for specifically stated they wanted a letter from medicine.

 

[Jwax]

Cool. Thanks guys. As far as my concern with the away letters, I was worried that a program might wonder, "hey, why didn't they rotate here? Does that mean she'd really rather be in Vegas?" When I am uninformed of something, I can make up some far fetched ideas. Thanks for clearing that up. I had heard the medicine LOR thing once before on here so figured I would find someone in medicine to ask during that rotation.

Oh - and I've been meaning to thank you for your constant praise of baby Robbins, Non-Trad. I like it. I don't know if it will help my grade or help me learn / retain the information, but at least it is organized in a manner I can read. I feel that our IHI class follows Robbins more closely than it does Goljans. It would be better if the print wasn't so freaking tiny though.

 

[Non-TradTulsa]

Oh - and I've been meaning to thank you for your constant praise of baby Robbins, Non-Trad. I like it. I don't know if it will help my grade or help me learn / retain the information, but at least it is organized in a manner I can read. I feel that our IHI class follows Robbins more closely than it does Goljans. It would be better if the print wasn't so freaking tiny though.

Ah, my young friend, you will soon enough know the joys of having reading glasses. I suddenly needed 'em in my second year of medical school (don't worry - presbyopia usually arrives right on time sometime shortly after age 45). I wasn't about to mess with bifocal contacts or one for near/one for far or any of that mess. Readers work fine - I just carry something like 3 pairs in the pockets of my white coat, since I am forever knocking my pair out of my pocket and not noticing it - thereby needing a spare pair. I took a couple of block exams in my second year having forgotten my reading glasses - the tears coming down my face were from eyestrain. It added an extra note of pure excitement to a block test, I might add. But, glad baby Robbins is of some use. I noticed that it followed the course pretty closely, too - especially second semester.

 

[Jwax]

[YOUTUBE]http://www.youtube.com/watch?v=1uR2tDznqC8&feature=channel_page[/YOUTUBE]
Someone in the MSI class posted this. Hilarious.

 

[Non-TradTulsa]

That YouTube is a fitting end to the era of insane consumerism that has gripped us - twice in my lifetime. Once in the 1980s (think "Wall Street" and Gordon Gekko) and our more recent collective loss of sanity, which put consumerism from the 1980s to shame.

Ummm... are we still getting "back to basics" if I'm shopping for my future second home on the lake on realtor.com when I have an absolutely horrible day on rotation? It does make me feel better about all this misery.

Since we, as a generation, can probably forget about traditional retirement like our parents had, I want someplace nice to get away when I'm not a-doctorin'. I have come to realize that, even though I managed to get out of the stock market long enough to cut my losses to about half of what they would have been otherwise - what difference does it make if interest rates are zero and stocks don't appreciate for the next 20 years?

The only bright spot is that it's highly unlikely that we will ever have to look far for a job. One minor reason I got out of the corporate world was that you can't imagine how terrifying it is to have a mortgage payment and a car payment and to suddenly lose your job. You realize that any illusions of having control over your own destiny are a complete joke. Watching the unemployed on TV just makes my stomach churn. I better apply for next year's loans earlier than I usually do - while there are still banks in business.

 

[Amxcvbcv]

Rural medicine is pretty fun.

I'm probably way behind some of my classmates, but I got to write my first orders (laxatives and d/c someone's O2) in a chart last week and got to dictate to H&Ps. I feel like these past three years are actually coming together.

I get free meals at the hospital, and they're paying for my hotel room...

The fun stops there, though.

I really miss my wife and can't wait until next weekend.

😍


I came here with two and a half seasons of House to watch (I think I'm one of the few medical students who hadn't see the show until last month), but I don't think they're going to last until the 27th.

How's the spring going for everyone?

 

[Jwax]

25 lectures in 4 days - done. 😎

I had wondered whether they help pay for living costs when you do your required rural rotation (it is required, right?). It seems cruel if they force to spend a month away from our spouses and force us to suffer the costs as well. Several away rotations I'm looking at provide housing. That earns them a higher spot on my desired away list. Between all the aways, an intended rotation in Tulsa, and a rural rotation, it looks like I'll be spending at least four solid months away from my husband in 3rd/4th year 🙁 not to mention interviews. No me gusta.

 

[Bravofriendly]

Amx - spring is exponentially better than fall so far. Though I could do without the ridiculous convolution that is Dormer. How can someone take a challenging set of concepts (for the physics-challenged of us) and make them infinitely more complicated than the textbook? And why would anyone want to do that? If I, who am physics-learning-impaired, can read the text and make better sense of it that from the lecture or syllabus, there is a genuine problem with that professor. But even he isn't enough to counterbalance the goodness that is the organization, clarity, and overall top-rated goodness of Dr. Blair. 👍


Jwax, that is truly impressive

 

[Jwax]

New show to watch for my study breaks... ER. I've only seen a few episodes here and there in maybe season five, so I'm starting at the very beginning of the series. I don't imagine I'll make it all the way through the series ever because it just seems so stupid for the last several years, but it'll be nice to watch some of the first seasons. Noah Wylie + George Clooney = 😍

This has seemed like an incredibly long test block. I think we've had > 40 lectures for IHI this block 😱 and that doesn't include this week's lectures. Sick.

 

[Doctor Bagel]

25 lectures in 4 days - done. 😎

I had wondered whether they help pay for living costs when you do your required rural rotation (it is required, right?). It seems cruel if they force to spend a month away from our spouses and force us to suffer the costs as well. Several away rotations I'm looking at provide housing. That earns them a higher spot on my desired away list. Between all the aways, an intended rotation in Tulsa, and a rural rotation, it looks like I'll be spending at least four solid months away from my husband in 3rd/4th year 🙁 not to mention interviews. No me gusta.

I'm about 100% sure they provide you with housing. It might be a room in the hospital, but it's still free. As for free food, we Tulsa folks get that at 2/3 hospitals we rotate at. Also, a few of the rural rotations are in places that you can commute to from OKC or Tulsa, so you can actually stay at home. I'm guessing those are more competitive, though. So not looking forward to mine.

Speaking of plans and whatnot, should I be thinking about registering for Step 2 soon? I'm mainly thinking about CS and would like to get that one done relatively soon. And I need to start thinking about away rotations, too. Ugh -- so much stuff to do.

 

[Amxcvbcv]

I'm about 100% sure they provide you with housing. It might be a room in the hospital, but it's still free. As for free food, we Tulsa folks get that at 2/3 hospitals we rotate at. Also, a few of the rural rotations are in places that you can commute to from OKC or Tulsa, so you can actually stay at home. I'm guessing those are more competitive, though. So not looking forward to mine.

Speaking of plans and whatnot, should I be thinking about registering for Step 2 soon? I'm mainly thinking about CS and would like to get that one done relatively soon. And I need to start thinking about away rotations, too. Ugh -- so much stuff to do.

I can't speak for the other sites, but Altus is fantastic. Dr. Sheets (the preceptor here) is a FM doctor that does his own OB (we did a C-section last Monday). He's very laid back and will let you do whatever you feel comfortable doing. They're paying to put me up in a nice, new hotel about 3 miles from the hospital. I can eat 3 meals a day for free, if I want.

Schedule and do Step 2 ASAP. I took CK on June 26th and CS on Sept. 12. Make your 4th year as stress free as possible. Certain caveats do apply for those with spectacular Step 1 scores and aspirations for competitive specialties, but in general, I'd encourage you to get it out of the way.

 

[soonereng]

I can't speak for the other sites, but Altus is fantastic. Dr. Sheets (the preceptor here) is a FM doctor that does his own OB (we did a C-section last Monday). He's very laid back and will let you do whatever you feel comfortable doing. They're paying to put me up in a nice, new hotel about 3 miles from the hospital. I can eat 3 meals a day for free, if I want.

I take it that you're staying at the new Holiday Inn Express by the Bar-S plant? You're down in my old stomping grounds. I grew up in a little town 30 miles west of Altus, almost in Texas.

Assuming that I still have a house and my family is still in Duncan 4th yr, I'm planning on doing it there.

 

[Amxcvbcv]

I take it that you're staying at the new Holiday Inn Express by the Bar-S plant? You're down in my old stomping grounds. I grew up in a little town 30 miles west of Altus, almost in Texas.

Assuming that I still have a house and my family is still in Duncan 4th yr, I'm planning on doing it there.

Nah... I'd probably complain about the smell. 😉 I'm in the Microtel on the north side of town. They even have "happy hour" from 5 to 6:30; you can get 2 free "drinks", including beer, every night. If you're a drinking sort of person. 😛

 

[Jwax]

This is fantastic...
[YOUTUBE]http://www.youtube.com/watch?v=SLxCxw5GnPM&feature=channel[/YOUTUBE]

 

[Doctor Bagel]

Hmm, so I'll start looking at CS. Mainly I don't want to pay for it. I'm really happy with my Step 1 score and am pretty sure my Step 2 score will be lower, so I think I'd only lose by taking it early. Admittedly I'm not going to applying to a super competitive specialty, but I might be looking at some of the more competitive programs in that specialty. On that note, I probably need to start thinking about aways right about now.

 

[soonereng]

So I won one of the Kaplan Qbanks from test prep week. Do you think they will let me delay the start one month or should I just use it until finals (which is when it currently runs out)? I'm planning on using UWorld as my main source.

 

[Jwax]

I'm glad I'm not taking a neuro test tomorrow. But good luck!

This was from last year.... and I thought I'd echo this comment. I'm glad to not be taking a neuro test next week.

I didn't place much faith in the renal syllabus either. I'm hoping it is just a different way of presenting info we are already getting. Powerpoints, lectures, robbins and it's qbook, webpath, brs phys (which I shouldn't have to consult this late in the game 😳), FA, RR path, wiki, google, physio coloring book...If I don't do incredible, I don't know how to. But it's fun to try and turn a corner on a test everyone expects to do poorly (all relative 🙄 ) on...

Also from last year... I think I'm doing a good portion of the stuff you did last year (minus FA and physio coloring book wtf?).

You guys are going to laugh later about how you got all worked up about EBM. You'll have a hard time remembering you even took EBM by this time next year.

You were right. I scarcely remember EBM's existence.

I went looking through the thread to see where people matched last year and got caught up in seeing what you guys said about IHI's exam last year. Fun times.

Preceptor rotations starts tomorrow with a pulmonologist (my least favorite subject in school). At least we're meeting her at the hospital to do rounds instead of at her clinic. 👍 Might be interesting after all. Just not sure how good of an H&P I can do on a patient sick enough to be admitted. SP interview was today and I was told that other than vague transition statements, I was great. 🙂 That was nice.

Oh, and for the record, required activities taking at least 14 hours of my time during the week before exams is malicious.

 

[Bravofriendly]

SP interview was today and I was told that other than vague transition statements, I was great. 🙂 That was nice.

Oh, and for the record, required activities taking at least 14 hours of my time during the week before exams is malicious.

"Vague transition statements" is a laughable piece of protein in a critique sandwich. Unless you said something like, "Okay now that we done talking about that I'd like to talk about something else." I think they are required to have something to say, even it they have to make it up. And does that mean that the cheetah peeps went over okay or did you forego them?

Required preTB crap sucks. And yeah, I'm not looking forward to the neuro exams on Friday. I was extremely confident walking into the phys exam and there was a distinct incongruence in my confidence-to-exam-score relationship. I'm significantly less confident about neuro which is a little scary.

 

[Jwax]

"Vague transition statements" is a laughable piece of protein in a critique sandwich. Unless you said something like, "Okay now that we done talking about that I'd like to talk about something else." I think they are required to have something to say, even it they have to make it up. And does that mean that the cheetah peeps went over okay or did you forego them?

Required preTB crap sucks. And yeah, I'm not looking forward to the neuro exams on Friday. I was extremely confident walking into the phys exam and there was a distinct incongruence in my confidence-to-exam-score relationship. I'm significantly less confident about neuro which is a little scary.

I didn't realize your exams were this week. For some reason I assumed they'd be at the same time as ours. Good luck the rest of the week!

The cheetah shoes didn't look nearly as cute with the outfit in reality as they did in my head so I wore black flats.

 

[Mr. Freeze]

Also from last year... I think I'm doing a good portion of the stuff you did last year (minus FA and physio coloring book wtf?).

Just not sure how good of an H&P I can do on a patient sick enough to be admitted.

Well, then prepare thyself for marginal IHI grades but a step score that doesn't close any doors...
Coloring book is Wynn Kapit [sic?]. I didn't really use it much. Ok, I didn't COLOR it much. But mostly because I had colored everything when I was a mere lad. The kidney is just magical, and I didn't have a real good grasp on where everything happens. You know, stuff that I heard once in broken Engrish but didn't really learn the first time.

And H/P's on said patients are ****-tons easier than the bull**** PCM has you do, IMHO. So much of it just doesn't help to flesh out the HPI, which in my pea brain is the whole purpose for asking. What's a transitional statement? I kid...but seriously, I am working on speaking in complete sentences during a H/P.

 

[Jwax]

Well, then prepare thyself for marginal IHI grades but a step score that doesn't close any doors...
Coloring book is Wynn Kapit [sic?]. I didn't really use it much. Ok, I didn't COLOR it much. But mostly because I had colored everything when I was a mere lad. The kidney is just magical, and I didn't have a real good grasp on where everything happens. You know, stuff that I heard once in broken Engrish but didn't really learn the first time.

And H/P's on said patients are ****-tons easier than the bull**** PCM has you do, IMHO. So much of it just doesn't help to flesh out the HPI, which in my pea brain is the whole purpose for asking. What's a transitional statement? I kid...but seriously, I am working on speaking in complete sentences during a H/P.

Since I've been getting less than marginal IHI grades, I'd settle for marginal. 🙂 BRS renal is so much easier to understand this year than it was last year. I sorta get the kidney ('cept for acid/base stuff, but I even understand that better this year than last year). It is the brain I am worried about. I don't think I can manage to learn lesion type questions in the amount of time we have left and I have a stack of ~180 flashcards that I made solely for the neuro section of this exam. 😱

My partner and I spent three hours at the hospital on one H&P. Our patient was much more inclinded to discuss their social history / life than discussing the HPI, so we've got a heckuva lot more info about not medically important stuff. I think my SP interview took all of 15 minutes and I imagine I can get a physical done w/in 25 minutes, so I just need to learn how to cut patients off when they tend to wander. I'm sure that will be easier in an ED setting b/c I'll have a good excuse for needing to rush off.

 

[Mr. Freeze]

I encourage those MSII's who are rusty on their lesion localization to access the MS3 page>neuro clerkship>neurologic localization ppt. Don't know about the other one, the "communication", but I was really glad I got the tip to check that out at around 0600 the morning of the exam. Seriously, if you did well with Blair, can remember it, and nothing has changed, you could have passed the neuro portion of this test as a first year. I don't remember there being much path. The DLG is in charge with this; whaddya think he is gonna put in!?!?

 

[Jwax]

So I finally finished registration for the boards (yay...) for June 11. I know I've seen things like how to make a schedule for board studying on here somewhere, but if anyone has any suggestions, I'd love to hear them. I really more so need direction in studying once exams are over as I intend to pretty much just start preparing for comprehensive IHI & pharm as my studying during the year. The plan to read FA before spring break completely fell through due to a stronger, more pressing need to study for exams. I might add reading some of FA in to my reading Goljan's RR and baby Robbins during my in-school prep. But after exams are over... where do I begin? Thank you for your advice 🙂.

 

[PreMedMommy]

Well, that neuro exam was awful. The words I'd like to use to describe it are unacceptable for this forum.

 

[soonereng]

Well, that neuro exam was awful. The words I'd like to use to describe it are unacceptable for this forum.

Go ahead and use them. Freeze does and they just get edited out as stars (I think). It makes for a nice departure from proper language.

I didn't like neuro. I still don't like neuro. I have a test on neuro on Monday. 👎 Only worse, the test is also over the kidney. 👎

If it makes you feel any better, my worst score in med school (so far) came from the TB that you just got done with, so maybe it will be all on the rise from here on out for you.

 

[soonereng]

I encourage those MSII's who are rusty on their lesion localization to access the MS3 page>neuro clerkship>neurologic localization ppt. Don't know about the other one, the "communication", but I was really glad I got the tip to check that out at around 0600 the morning of the exam. Seriously, if you did well with Blair, can remember it, and nothing has changed, you could have passed the neuro portion of this test as a first year. I don't remember there being much path. The DLG is in charge with this; whaddya think he is gonna put in!?!?

Thanks for the heads up on this. Dr. H. gave me confirmation that 25 out of the 37 neuro questions (with 4 of those being pictures I guess) on the upcoming exam are from the DLG and Jones. 😱

 

[Mr. Freeze]

I have a schedule that I made, which anyone is welcome to. However, your weaknesses might differ from mine. Although I would like to think I have none, they include biochem, micro, and endo in general. So my schedule was prolly heavier on these than most. So I did, and would recommend to others that you should spend the time to make your own even though you can consult others'.

Rest assured, whatever you spend the most time on will be the least represented. Nature of the beast.

It's good you guys know the clinical vs path breakdown. I dunno that we got that. I certainly don't remember any clinical images. Maybe someone does.

I also encourage the use of whatever @$@&@ing @$&$( @&$@"^(6's are necessary to illustrate adequately the situation. It just so happens to be one of those ****ing days for me as well, where I can't tell my wife how it went until the two y/o parrot goes to bed.

 

[masterofmonkeys]

Since I've been getting less than marginal IHI grades, I'd settle for marginal. 🙂 BRS renal is so much easier to understand this year than it was last year. I sorta get the kidney ('cept for acid/base stuff, but I even understand that better this year than last year). It is the brain I am worried about. I don't think I can manage to learn lesion type questions in the amount of time we have left and I have a stack of ~180 flashcards that I made solely for the neuro section of this exam. 😱

My partner and I spent three hours at the hospital on one H&P. Our patient was much more inclinded to discuss their social history / life than discussing the HPI, so we've got a heckuva lot more info about not medically important stuff. I think my SP interview took all of 15 minutes and I imagine I can get a physical done w/in 25 minutes, so I just need to learn how to cut patients off when they tend to wander. I'm sure that will be easier in an ED setting b/c I'll have a good excuse for needing to rush off.

Yeah the real art of an H&P is getting them to shut up abnout their 10/10 pain despite no sign of sympathetic activation, muscle ridigity, and frozen face. And not to go into the story of how their daughter got knocked up again, their son's in jail for a crime he didn't commit, he just happened to be carrying a gun and a big sack of money when he left the gas station because that's just how he rolls, etc.

And getting them to give you any kind of meaningful data on HPI and PMH. A thing for PMH is to remember that 'no medical conditions' means that they in all likelihood have HTN and diabetes, but you ahve to ask them about it specifically.

 

[Jwax]

Yeah the real art of an H&P is getting them to shut up abnout their 10/10 pain despite no sign of sympathetic activation, muscle ridigity, and frozen face. And not to go into the story of how their daughter got knocked up again, their son's in jail for a crime he didn't commit, he just happened to be carrying a gun and a big sack of money when he left the gas station because that's just how he rolls, etc.

And getting them to give you any kind of meaningful data on HPI and PMH. A thing for PMH is to remember that 'no medical conditions' means that they in all likelihood have HTN and diabetes, but you ahve to ask them about it specifically.

Our patient denied having hypertension or diabetes, but did admit to high blood pressure and high blood sugar. 🙂 I'm pretty sure the pt understood the technical terms just fine, but just didn't like the label.

 

[shortitalian]

Our patient denied having hypertension or diabetes, but did admit to high blood pressure and high blood sugar. 🙂 I'm pretty sure the pt understood the technical terms just fine, but just didn't like the label.

At the free clinic, I asked a patient if she took any other medicines besides the ones listed, and she said no. I asked her about the albuterol noted on a previous intake form, and she said "Yeah, I take that all the time."

Not a pill = not a medication.

 

[Non-TradTulsa]

As far as doing H&Ps go... well, most of us who went to medical school are pretty nice people who care, perhaps more than we should, about other people's feelings. If ya wanna get good at H&Ps and don't want to spend 2 hours getting the info you need, I'd encourage you - and I'm serious about this rather than trying to be funny - start trying to teach yourself how to interrupt without causing offense. It's a critical, life-saving (for you) skill and most newcomers are awful at it. You have to be able to gently break-in with a small smile on your face and redirect the conversation. You can learn to do it without upsetting the patient at all (since they do realize that you have an agenda) but it takes practice.

The other huge problem patient is the one who has a positive for every blessed sign/sx on the review of systems. This is a real problem case, since you really do need the pertinent positives but don't care about the patient's having had diarrhea for 1 day 3 months ago (I just wanted to scream, who the f*** hasn't had one day of loose stools in the past three months, for Chrissake!!!). When I get this patient, I don't mess around. I speed up the rate at which I ask ROS questions and judge from facial expression whether or not I need to stop. While I try to interrupt the HPI gently when I need to redirect, I will cut a patient off by force if necessary on the ROS - otherwise you'll take an hour and have useless information.

So, MS-II test block is next week? Congrats, MS-I survivors. Don't get too hung up on IHI neuro - if you've got Jones' localization handout down, you're halfway there. Most people, as I recall, got killed on renal. I'll remind you again - you wouldn't think they could put up any kidney images, but they will - including electron micrographs. Bring your glasses or whatever you need to see clearly and pray you aren't too far at the back.

 

[Jwax]

If ya wanna get good at H&Ps and don't want to spend 2 hours getting the info you need, I'd encourage you - and I'm serious about this rather than trying to be funny - start trying to teach yourself how to interrupt without causing offense.

So, MS-II test block is next week? Congrats, MS-I survivors. Don't get too hung up on IHI neuro - if you've got Jones' localization handout down, you're halfway there. Most people, as I recall, got killed on renal. I'll remind you again - you wouldn't think they could put up any kidney images, but they will - including electron micrographs. Bring your glasses or whatever you need to see clearly and pray you aren't too far at the back.

Any suggestion on how to do that politely? Other than maybe, Pardon me Mr. X... but when you came in did you experience any x, y, and/or z symptoms? Maybe I'll start taking closer watch of how this part is done in the ED. Will be shadowing one of presby's docs after TB, so maybe that'll help. I'd never really thought about that skill before spending 2.5 hours on an interview.

Since 25 of our 37 neuro questions are coming from Dr. Jones & the DLG, I think I'm going to rewatch their lectures. They didn't really give that many lectures, certainly not enough to deserve 25 of the 37 questions. Whatever. I like the kidneys way better and there is maybe 1/2 the material for it. I can't see anything in the EM's regardless of how I look at them - they look like circles, squiggly's, and blobs to me.

 

[SoonerGeek]

Anyone remember the kind of migraine questions the DLG asked last year?

 

[Jwax]

Anyone remember the kind of migraine questions the DLG asked last year?

He advised in his first lecture that we ought to focus on his learning objectives as he would take his questions from there. Take that for whatever it is worth... I don't know if DLG sticks to what he says or if he plays O'don games and takes things out of left field. The L.O.'s for the migraine lecture were:

Describe four common neuropathic pain syndromes and the management of a pt w/ neuropathic pain
Differentiate primary headaches (e.g., migraine) and secondary headaches
Describe the nonheadache manifestations of migraine
Explain when & how to perform a diagnostic evaluation in a pt w/ headache
Describe the appropriate abortive & prophylactic therapies for migraine

 

[Non-TradTulsa]

Any suggestion on how to do that politely? Other than maybe, Pardon me Mr. X... but when you came in did you experience any x, y, and/or z symptoms?

Just jump right in - reach over and pat the patient on the hand or arm if they're really oblivious - and say, "I understand! Let's move on... I'll come back if we have time (you won't, of course). Now, (...)" The only trick to it is you have to do whatever it takes to avoid looking or sounding irritated, annoyed, or rushed. You can get away with a lot if you interrupt with a hint of a smile on your face - as if you're sad that, gosh-darn-it, you just have to interrupt but you'd love to talk for 2 hours if you had time. Once the patient understands that you are going to impose time limits, generally they'll be a little more brief.

Is IHI Monday or Friday in second semester? On the one hand, I liked having Wednesday night to recover a little bit and then Thursday to go back over everything before IHI (that was first semester, wasn't it) - but it was a huge amount of background stress all week. When IHI was Monday, you were fresh from a whole weekend of study but I was so mentally fried and tired after the exam that it was very hard to work up the energy needed to finish the week.

Good luck with it, though. I was trying to remember that test... seems to me, though, that the questions on the exam sounded more like Jones than the DLG... but don't count on that at all - the DLG has had another year to settle-in, so he may have written his own questions. He sure as heck has done so for the MS-III neurology rotation.

 

[Doctor Bagel]

Yeah, the whole interviewing patients in real life is when you learn that PCM is not super useful. You do need to cut people off because you have legitimate time constraints when doing an interview. IMO, they should teach you how to do an interview in 10 minutes instead of that whole take as long as you want crap. You don't get unlimited in in the CS exam or in real life. Also, for especially chatty patients, focused (and closed!!) questions are your friends.

The other flaw with PCM patients is that they only have one problem. In real life, your average patient has tons of problems, and you have to sort through that in a short period of time.

So I think I'm going to pay the ridiculous $1055 to register for CS today. 😡

And I'm really, really dreading starting peds. It sounds like the whole department is a little weird here in Tulsa, and I don't really like kids that much. I was reading the unofficial guide, and it said something like we have to be there from 6 to 5 or so when we're on wards on top of our 4 calls in 3 weeks (3 of mine are in one week). And reading about newborn nursery gives me the heebie jeebies. I think I'd rather do OB again.

 

[Amxcvbcv]

My complaint with PCM is that while they do a good job of laying a foundation of getting through a complete history and physical, I didn't feel at all prepared for what you spend a vast majority of your time doing - focused H&Ps. I still feel guilty leaving out things during exams on a clinical kind of rotation like rural (which in my case is essentially family medicine on steroids).

 

[Jwax]

Cool. I work on the polite interruptions next time. I think the physical exam training from PCM was very valuable, but I also know that I will rarely (if ever?) do such things as Rinne or Weber testing in an ED. I also feel I will rarely (if ever?) diagnose brain tumors based on any histology in an ED. Why? Because I'll get a CT and say wow their is a large mass in your brain. It could be any number of things, benign or malignant. I will now send you off to speak to the neurosurgeon / oncologist / neurologist. Anyone but me. Subdurals / SAH / strokes / etc are much more high yield for what I intend to do with my life.

I was quite frightened about IHI on Monday at first, but I think it is a good thing. It made it so I could spend the entire weekend prepping for IHI instead of feeling the need to split it between IHI and MMI, with MMI getting more attention than it deserved. I am not capable (willing) to study for IHI throughout the week when there are other exams to be taken, so I think overall this is giving me more IHI study time. At least I feel like I'm getting more time. Maybe b/c I was actually caught up for once so I'm really getting to review for a whole weekend for once 😳.

I didn't think about having to pay for CS during 3rd year. For some reason, I had lumped that in with 4th year financial issues. 🙁