What did medical students use before there were clinical review books?

[VisionaryTics]

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Just musing here.

There's a huge market for texts aimed at medical students on their clinical rotations (Blueprints, Step-Up, etc). They strike a nice balance of depth and brevity and are written at the level of someone who has a decent background in pathophys but is not experienced in clinical medicine (i.e. the MS3).

Have there always been books like this? What did medical students use 15, 20, 30 years ago? When you were on your IM rotation, did you just crack open Harrison's?

 

[KnuxNole]

That's what my IM attending said. I mentioned I was reading Step-up-to-Medicine and he starting bursting out laughing. Saying how med students today are soft and how he would spend 4 hours every night reading Harrison's to get to where he was today. When I told him I never even touched that book...he got offended for some reason 😳

 

[D elegans]

That's what my IM attending said. I mentioned I was reading Step-up-to-Medicine and he starting bursting out laughing. Saying how med students today are soft and how he would spend 4 hours every night reading Harrison's to get to where he was today. When I told him I never even touched that book...he got offended for some reason 😳

His loss

 

[notbobtrustme]

Back then, you just needed to get through medical school and you'd have your pick of specialty. The whole "grades/boards/evaluations" song and dance is a relatively recent phenomenom and with it came the explosion of test-prep material.

 

[VisionaryTics]

Back then, you just needed to get through medical school and you'd have your pick of specialty. The whole "grades/boards/evaluations" song and dance is a relatively recent phenomenom and with it came the explosion of test-prep material.

This was also the age when medical school + intern year meant you could practice pretty independently.

My dad graduated medical school, did a surgical internship, and then spent 3 years as the only Navy MD in the Middle East.

So I assume that he must have had SOME effective learning resources as a medical student/newly minted intern.

 

[notbobtrustme]

This was also the age when medical school + intern year meant you could practice pretty independently.

My dad graduated medical school, did a surgical internship, and then spent 3 years as the only Navy MD in the Middle East.

So I assume that he must have had SOME effective learning resources as a medical student/newly minted intern.

I'd also say in prior ages, 3rd and 4th years of medical school were much more intense with respect to procedures. Secondly, the amount of material you needed to know was less, just by virtue of being in the past 30, 40, 50 years. The number of drugs were less, the pathology was presumably easier since we didn't know as much, and the oversight was less, meaning you could experiment more on patients and no one cared.

 

[Perrotfish]

This was also the age when medical school + intern year meant you could practice pretty independently.

My dad graduated medical school, did a surgical internship, and then spent 3 years as the only Navy MD in the Middle East.

So I assume that he must have had SOME effective learning resources as a medical student/newly minted intern.

That's actually still the Navy's system. Two thirds of Navy Interns go out to the fleet right after Intern year.

 

[badasshairday]

That's actually still the Navy's system. Two thirds of Navy Interns go out to the fleet right after Intern year.

WHat do the remaining one third do?

 

[Perrotfish]

WHat do the remaining one third do?

Finish residency. And most of the two thirds that go out come back in two or three years to finish residency. The Navy has full residencies in almost everything, it's just that most of the R2s graduated from medical school three or four years before the Interns.

 

[badasshairday]

Finish residency. And most of the two thirds that go out come back in two or three years to finish residency. The Navy has full residencies in almost everything, it's just that most of the R2s graduated from medical school three or four years before the Interns.

I see. How is that decided though? How do they decide who is in the 1/3 who finishes residency right after internship vs those who go out on the fleet?

Also if you are in that select 1/3 who goes on to finish residency, do you go out the the fleet afterwards?

I'm just trying to figure this out, have a family friend who did the navy thing. Sounds too good to be true. No tuition, living stipend, and now sounds like this friend gets to go straight through IM residency at a Navy hospital. There has to be a catch.

 

[buccsmf1]

That's what my IM attending said. I mentioned I was reading Step-up-to-Medicine and he starting bursting out laughing. Saying how med students today are soft and how he would spend 4 hours every night reading Harrison's to get to where he was today. When I told him I never even touched that book...he got offended for some reason 😳

Let me guess, he did the 4 hours of studying while walking to clinic, up a hill, both ways, in the snow..... Give me a break, hes no different than any medical student that ever went through clinical years. He was tired at the end of the day just like everyone else. Im guessing they all had harrisons etc, but did their best to skim/highlight the pertinent cases. There's no way anyone is going to convence me that all of them read harrisons cover to cover.

 

[link2swim06]

I'd also say in prior ages, 3rd and 4th years of medical school were much more intense with respect to procedures. Secondly, the amount of material you needed to know was less, just by virtue of being in the past 30, 40, 50 years. The number of drugs were less, the pathology was presumably easier since we didn't know as much, and the oversight was less, meaning you could experiment more on patients and no one cared.

Very true.

Many older attendings practically performed minor surgeries in med school. One of my OB/GYN attendings told me she delivered 28 babies in med school. I delivered a grand total of 4 during the entire OB/GYN rotation.

Several of the responsibilities of med students have shifted to interns in the past couple of decades.

 

[mimelim]

Very true.

Many older attendings practically performed minor surgeries in med school. One of my OB/GYN attendings told me she delivered 28 babies in med school. I delivered a grand total of 4 during the entire OB/GYN rotation.

Several of the responsibilities of med students have shifted to interns in the past couple of decades.

Are you going into OB/Gyn? If not, you probably did less OB rotations than they did. We had some people that easily had 30+ before leaving medical school. I had 2, but I did have 10 cesareans since I'd grab them whenever I could (more interested in the surgery side than the baby catching side 😉) It is very highly variable. I mean I heard of some of our students doing 4 deliveries in a single night call. Far from the norm, but happened.

I did a 1st and 2nd toe amp as an MS4 entirely by myself. Did an appy with the chief resident holding the camera. Did dozens of central lines... Opportunities definitely still exist, but they aren't the responsibility of the student. You have to chase after them.

 

[Perrotfish]

I see. How is that decided though? How do they decide who is in the 1/3 who finishes residency right after internship vs those who go out on the fleet?

Also if you are in that select 1/3 who goes on to finish residency, do you go out the the fleet afterwards?

I'm just trying to figure this out, have a family friend who did the navy thing. Sounds too good to be true. No tuition, living stipend, and now sounds like this friend gets to go straight through IM residency at a Navy hospital. There has to be a catch.

Ways to go straight through:

1) Be a superstar. Most competitive residencies get to hang on to a small percentage of their Interns. Ortho, for example, keeps just one per residency, and the rest come back after a GMO tour. AOA, great performance in internship, research, and prior service all help.

2) Choose a field no one likes. The Navy uses straight through training as a way to incentivize residencies that, for whatever reason, aren't attracting enough applicants. If you choose one of those few fields there's a good chance you'll go straight through. I believe certain really, really long residencies like neurosurgery also protect their trainees from GMO tours.

3) Be primary care. When you do a GMO (general medical officer) tour and go out to the fleet to take care of active duty personel you're doing primary care and occupational health. You would never, for example, do surgery or deliver a baby on a ship unless there was some bizarre circumstance where no evacuation was available. The logic for not giving everyone straight through training is that it shares the pain and spares skill atrophy. If you put a fully trained surgeons in primary care roles for two years and they won't be very good surgeons when they're done. If you force just board certified FPs and IM docs to do all the GMO work they'll each need to do several 2 year deployments to fill all the gaps, and then they'll all quit because very few people want to do that. However if you're FP, or to a lesser extent IM or Peds, there's no reason for them to pull you from training since you can do your GMO tour when you're fully trained without needing to worry about significant skill atrophy.

4) Let the stars align. They need R2s, and if no one wants to come back from the fleet then the Interns need to fill the holes. The numbers involved are small enough that this isn't unheard of. If every Ortho Intern two years ago did a three year GMO tour and every Intern three years ago did a two year GMO tour then this year's class gets to go straight through.

Does the 1/3rd ultimately go out to the fleet? If by 'out to the fleet' you mean a GMO tour with the Marines the answer is maybe, it depends on the needs of the Navy and how many wars we happen to be fighting. If by out to the fleet you mean away from a major hospital the answer is almost definitely: a junior attending position in the navy is usually not a tertiary medical center but rather a less desirable base (Camp Lejune, 29 Palms) orsomewhere remote (Japan, Guam, Guantanamo Bay). They also have IM/Peds/FP specific jobs in warzones and on ships in addition to GMO roles, such as covering the wards at one of our major hospitals in Afghanistan. Your friend will probably either be attached to the marines or be the IM attending somewhere far from one of the big Naval hospitals for at least a few years.

 

[VisionaryTics]

I did a 1st and 2nd toe amp as an MS4 entirely by myself. Did an appy with the chief resident holding the camera. Did dozens of central lines... Opportunities definitely still exist, but they aren't the responsibility of the student. You have to chase after them.

Favorite moment of my surgery rotation:

It's 8pm. It's been a long day in the vascular OR with an attending whom I've worked with a ton. Our last case is a IVC filter and toe amp that he let me do.

As the case is finishing up, the anesthesiologist leans over the drape.

"In the room next door, they did a T12-L4 spinal fusion in 2 hours, 17 minutes. You have spent the last two hours cutting this guy's toe off. What the hell are you doing?"

 

[link2swim06]

Are you going into OB/Gyn? If not, you probably did less OB rotations than they did. We had some people that easily had 30+ before leaving medical school. I had 2, but I did have 10 cesareans since I'd grab them whenever I could (more interested in the surgery side than the baby catching side 😉) It is very highly variable. I mean I heard of some of our students doing 4 deliveries in a single night call. Far from the norm, but happened.

I did a 1st and 2nd toe amp as an MS4 entirely by myself. Did an appy with the chief resident holding the camera. Did dozens of central lines... Opportunities definitely still exist, but they aren't the responsibility of the student. You have to chase after them.

True that does make sense.

What rotation did you get to do a dozen central lines?

 

[Stellar Clouds]

True that does make sense.

What rotation did you get to do a dozen central lines?

You can snag a bunch of central lines on anesthesia rotations, especially cardiac cases. Try and go into rooms with CA-2s or CA-3s, since they will be more likely than a CA-1 to allow you to do a central line. You can try in the ICU, but usually there are too many interns who will take them over allowing a med student to do it.

Bottom line, you have to be very active about getting to do a central line. No one is going to come up to you and say, "do you want to place this central line?"

 

[mimelim]

True that does make sense.

What rotation did you get to do a dozen central lines?

Most of mine were subclavians on Trauma, followed by femorals on vascular. I was at a trauma heavy hospital. I was also on rotation with pre-lim interns that didn't need numbers and for lack of a better way of putting it, didn't give a ****.

But ya, anesthesia is a good rotation to get lines, art lines, CVC etc.