What makes a student good clinically?

[Jack is Back]

---

Members don't see this ad.

Students that are successful at transitioning from pre-clinical to clinical years, what makes the difference?

Is it the students that were able to honor all their courses and learn the extra trivia on the exam?

Is it some type of outside consistent work or using some type of clinical correlations sources (like books with cases)?

Is it mastering all the board relevant info?

Skills/knowledge/both?

I'm just curious what things one should review or focus on during these first two years. It seems like I can push harder to get a higher class ranking, but at my school I honestly don't think there is much of a difference in knowledge between the honors and near honors students, it is really just a few questions. So I'm trying to find the daily activities to improve myself in the clinic for years 3, 4 and beyond.

 

[Rollo]

So far in my experience, what makes you a good student on the wards or in the clinic is your interest level in learning the day to day tasks of a resident/attending and your ability to learn quickly.

You need more "street smart" than "book smart" to honor clinical rotations.

 

[VoiceofReason]

So far in my experience, what makes you a good student on the wards or in the clinic is your interest level in learning the day to day tasks of a resident/attending and your ability to learn quickly.

You need more "street smart" than "book smart" to honor clinical rotations.

....unless your shelf exams are a huge component of your grade

 

[Bacchus]

....unless your shelf exams are a huge component of your grade

Which is awful. Blah, just saying.

 

[Rollo]

....unless your shelf exams are a huge component of your grade

Fair enough. At my school though, we take exams made up by the faculty and so far they have all been insultingly easy.

 

[Phur]

Unfortunately, I didn't figure it out until well into third year, but succeeding in clinicals is just about being able to play the game. Have to be able to feed those evaluating you exactly what they want. Yes, there is the baseline necessity to perform a basic physical or take a decent history. However, the difference between HP and H are the little things...(Appearing interested and helpful vs being annoying and hovering, Knowing the little things that certain attendings are obsessed with, etc)

Ask 4th years about the attendings and residents. Does attending X like the whole story everyday when presenting or just the updates from the previous day?

If you have annoying tendencies, try to keep it low key.

Use common sense. Don't ask the surgeon a question when they're in the middle of doing a tricky part of a surgery.

Don't ask any question that can just be looked up. Makes you look lazy.

Don't screw over classmates. It can/will come back to bite you. Similarly, make sure you are always on the same page with the other students on the rotation.

Maybe it was just where I did rotations (but I doubt it), evaluations are stupidly subjective. A component is stuff like knowledge/presenting/history taking/whatever. In the end it seemed it was just a matter of how much everyone liked you.

 

[Mr Cookie Pants]

Using your brain helps. I mean really. Chances are the residents have already though of it so its not going to be a zebra. Common sense at baseline + years of training + literature study = good clinical accumen. Some people fail at part one and want to just do algorithms. That's fine but in order to put them in the right category, you have to have the accumen. Otherwise you're just like the nurses.

Also, be willing to work. Med school is so watered down these days with coddling, no scut, lectures so there's never any call*, etc. You have it 1/10 as bad as the attendings and about 1/2 as bad as the chiefs. They went to school in the pre-80 (or loosely adhered to) and pre-electronic era. We don't have as much responsibility anymore (thanks medicare), so be willing to put the hours in even if they're not terribly exciting. This isn't 1st and 2nd year so asking for reading time at 1pm every day isn't going to fly (on surgery, OB...it will on most others).

Just be smart, realize the residents are tireder, smarter and harder working than you are right now. Get the chip off your shoulder, read a book and don't be a zebraologist. You should be fine. And not everyone deserves Outstanding/Honors/Congressional Medal of Honor/Handjobs from MGH.

 

[Jack is Back]

I guess I should also clarify my stance, while I'd like to get honors here or there in the end I'd rather just be good at what I do after medical school. I was more asking along the lines of "what makes you a good clinician?"

So sticking to the basics instead of hunting for a zebra (I've heard this a few times, does this mean like a strange disease, i.e. 1/100,000?). Reading lots of new literature helps? What are the highest yield activities? If you know golgan path really well will that make you better?

How do you gain clinical acumen without seeing a bunch of patients, i.e. how do you prepare yourself to have better clinical acumen?

Common sense at baseline + years of training + literature study = good clinical accumen.

Could you please expand on "years of training?"

What I'm trying to get at, is what are the highest yield activities in the pre-clinical years that makes you a good clinician? What are the activities that are less important that people usually spend too much time on that contribute little?

 

[VoiceofReason]

Using your brain helps. I mean really. Chances are the residents have already though of it so its not going to be a zebra. Common sense at baseline + years of training + literature study = good clinical accumen. Some people fail at part one and want to just do algorithms. That's fine but in order to put them in the right category, you have to have the accumen. Otherwise you're just like the nurses.

Also, be willing to work. Med school is so watered down these days with coddling, no scut, lectures so there's never any call*, etc. You have it 1/10 as bad as the attendings and about 1/2 as bad as the chiefs. They went to school in the pre-80 (or loosely adhered to) and pre-electronic era. We don't have as much responsibility anymore (thanks medicare), so be willing to put the hours in even if they're not terribly exciting. This isn't 1st and 2nd year so asking for reading time at 1pm every day isn't going to fly (on surgery, OB...it will on most others).

Just be smart, realize the residents are tireder, smarter and harder working than you are right now. Get the chip off your shoulder, read a book and don't be a zebraologist. You should be fine. And not everyone deserves Outstanding/Honors/Congressional Medal of Honor/Handjobs from MGH.

i would love to see your personal statement

 

[Jack is Back]

i would love to see your personal statement

I lol'ed.

 

[Bacchus]

Fair enough. At my school though, we take exams made up by the faculty and so far they have all been insultingly easy.

You musn't have taken the surgery exam yet.

 

[2012mdc]

You don't have to be "strong clinically" to do well clinically. You have to be hard-working, know your patients, show interest, have a decent personality (doesn't mean extrovert, just non-douche/obvious gunner), and do well enough on shelf exams.

 

[Rollo]

You musn't have taken the surgery exam yet.

Have not. Peds, Ob, & Psych exams are laughably easy. Don't study for it until the night before!

 

[2012mdc]

Fair enough. At my school though, we take exams made up by the faculty and so far they have all been insultingly easy.

You're lucky. Surgery (too ambigious) and IM (too much material) were pretty difficult shelf exams. I assume most people who cracked the 90th percentile on those exams put at least a decent amount of studying in. I didn't find any other shelf particularly difficult but FM can be hard if you have it early on

 

[loveoforganic]

You mean it doesn't correlate strongly with the ability to distinguish between 100 shades of pink and blue? Hooray!

 

[Brewmeister]

"Doing well" clinically is a crapshoot. Evaluations and grading are often total BS.

 

[mjl1717]

Id say:

1.) Compassion..And as Barbara Fadem stated and I always say"You don't go
into this field for money but if you happen to make some along the way its
ok.

2.) Being a pathophysiology master/monster.. When others are somewhat
asleep you already have a differential diagnosis of maybe 12 diseases
at the tip of your fingertips.

3.) Good with basic procedures.

4.) Kindly attitude with different personality coworkers and colleagues.
Diplomatically parrying with and knowing that there is always one
knucklehead claiming how easy this field is..

5.) Good communication, concisely and at the right time. (which many want
to claim they can do)

6.) Hmm-Perhaps humour? But again at the right time.

7.)

 

[Jack is Back]

Id say:

1.) Compassion..And as Barbara Fadem stated and I always say"You don't go
into this field for money but if you happen to make some along the way its
ok.

2.) Being a pathophysiology master/monster.. When others are somewhat
asleep you already have a differential diagnosis of maybe 12 diseases
at the tip of your fingertips.

3.) Good with basic procedures.

4.) Kindly attitude with different personality coworkers and colleagues.
Diplomatically parrying with and knowing that there is always one
knucklehead claiming how easy this field is..

5.) Good communication, concisely and at the right time. (which many want
to claim they can do)

6.) Hmm-Perhaps humour? But again at the right time.

7.)

Thanks, this is along the lines what I'm trying to get at.

I know others have given good political advice in the wads, but that really won't help as an clinician in the future (or maybe it will?🙂)

Anyway, to your #2 point. How do you develop great pathophysiology skills? Would it be safe to say that pathology / physiology are the two most important subjects in years 1 and 2? If so, getting better at these involves just reading more or more repetition of 1 quality source (like the classic board review books, golgan/brs physio) or is it actually huge texts like Robbins path?)

How would one develop a plan to become a "pathophysiological beast" or master?

 

[2012mdc]

Thanks, this is along the lines what I'm trying to get at.

I know others have given good political advice in the wads, but that really won't help as an clinician in the future (or maybe it will?🙂)

Anyway, to your #2 point. How do you develop great pathophysiology skills? Would it be safe to say that pathology / physiology are the two most important subjects in years 1 and 2? If so, getting better at these involves just reading more or more repetition of 1 quality source (like the classic board review books, golgan/brs physio) or is it actually huge texts like Robbins path?)

How would one develop a plan to become a "pathophysiological beast" or master?

Robbins is too dense and has a bunch of crap you don't need 3rd year. Master cardiac and renal phys 1st and then go after the major diseases. Lilly is a great book for cardiac pathophys and McPhee is a decent book for the rest of pathophys.

 

[olemissbabydoc]

At my school, it's definitely eagerness and willingness to learn, not throwing your teammates/groupmates under the bus, and studying (some) for shelves. But clinical/ward experience is weighted much heavier.

 

[da8s0859q]

Which is awful. Blah, just saying.

It's kind of nice to have more control over your rotation grade though. Not that shelf exams are "predictable" like Step 1 sort of was, but it beats subjective evaluations.

 

[Jack is Back]

Do you guys think you become a good doctor from years 1 and 2 or more from 3 and 4? Or is it more in residency?

What makes a good doctor good?

Time is a limited resource, and it's nice to have a life outside medicine, this is why I am trying to figure out what and when are the most crucial portions of training. Yes someone could say read a ton of textbooks, which I don't mind doing if I have to, but what are the highest payoff tasks?

I've found some good podcasts that go over clinical situations, I wonder if listening to these in random travel or exercise time would be a good boost?

 

[Siverhideo1985]

Do you guys think you become a good doctor from years 1 and 2 or more from 3 and 4? Or is it more in residency?

What makes a good doctor good?

Whether you'll make a good doctor or not, in my opinion, is decided somewhere between pre-school and high school. Serious statement.

 

[Mace1370]

1) Always be in a good mood. Smile and be positive.

2) Work hard. Study a lot after you leave the hospital.

3) Even if you are running on no sleep, do the above 2.

#1 gets you good evals. #2 gets you good shelf scores.

Basically, you have to be a machine.

 

[Rollo]

Do you guys think you become a good doctor from years 1 and 2 or more from 3 and 4? Or is it more in residency?

What makes a good doctor good?

Time is a limited resource, and it's nice to have a life outside medicine, this is why I am trying to figure out what and when are the most crucial portions of training. Yes someone could say read a ton of textbooks, which I don't mind doing if I have to, but what are the highest payoff tasks?

I've found some good podcasts that go over clinical situations, I wonder if listening to these in random travel or exercise time would be a good boost?

A good doctor is very hard to define because on the one extreme you will have people whose definition of a good doctor is somebody who relates well to their patients and has an extremely like-able personality. On the other extreme you will have people who say a good doctor is somebody who is spot on with their initial diagnosis and subsequent management decisions.

Best advice I can give you is you are more than just a doctor therefore your life is more than just medicine. Face it, thousands and thousands of doctors have gone before you who've worked hard and sacrificed life for the sake of medicine and where are they now? In a grave rotting away. And of course, thousands more will come after you who will do the same thing...toiling away under the sun...and what will happen to them? In a grave rotting away.

I don't mean to sound cynical but that is reality. This is one of the few things that has helped me figure out that even though I'm blessed to be in medicine, I shouldn't have to ignore the other gifts that the Almighty has put in my life for me to enjoy like food, friends, and relationships.

Sometimes we give away so much of ourselves to this field that we forget to love and take care of ourselves and those non-patient people around us.

 

[CatFactorial]

A good doctor is very hard to define because on the one extreme you will have people whose definition of a good doctor is somebody who relates well to their patients and has an extremely like-able personality. On the other extreme you will have people who say a good doctor is somebody who is spot on with their initial diagnosis and subsequent management decisions.

Best advice I can give you is you are more than just a doctor therefore your life is more than just medicine. Face it, thousands and thousands of doctors have gone before you who've worked hard and sacrificed life for the sake of medicine and where are they now? In a grave rotting away. And of course, thousands more will come after you who will do the same thing...toiling away under the sun...and what will happen to them? In a grave rotting away.

I don't mean to sound cynical but that is reality. This is one of the few things that has helped me figure out that even though I'm blessed to be in medicine, I shouldn't have to ignore the other gifts that the Almighty has put in my life for me to enjoy like food, friends, and relationships.

Sometimes we give away so much of ourselves to this field that we forget to love and take care of ourselves and those non-patient people around us.

I agree with much of that, but I also think that there are times, such as during medical training, when it's okay or even desirable to be fully focused on one's career.

 

[tiedyeddog]

Whether you'll make a good doctor or not, in my opinion, is decided somewhere between pre-school and high school. Serious statement.

What do you mean by that?

 

[Jack is Back]

A good doctor is very hard to define because on the one extreme you will have people whose definition of a good doctor is somebody who relates well to their patients and has an extremely like-able personality. On the other extreme you will have people who say a good doctor is somebody who is spot on with their initial diagnosis and subsequent management decisions.

Best advice I can give you is you are more than just a doctor therefore your life is more than just medicine. Face it, thousands and thousands of doctors have gone before you who've worked hard and sacrificed life for the sake of medicine and where are they now? In a grave rotting away. And of course, thousands more will come after you who will do the same thing...toiling away under the sun...and what will happen to them? In a grave rotting away.

I don't mean to sound cynical but that is reality. This is one of the few things that has helped me figure out that even though I'm blessed to be in medicine, I shouldn't have to ignore the other gifts that the Almighty has put in my life for me to enjoy like food, friends, and relationships.

Sometimes we give away so much of ourselves to this field that we forget to love and take care of ourselves and those non-patient people around us.

I agree with the idea that we can give too much to this career. I also agree that things like family, friends, exercise, hobbies, are part of what makes life enjoyable. At the same time, just as a carpenter can become good at his craft and work towards perfection (when he does work), I think my efforts are towards trying to use the "career time" wisely as opposed to making all my time career time.

I'm excited and grateful to be in this career, while @ the same time I'm not trying to over do it.

 

[NickNaylor]

What do you mean by that?

I believe he's pointing at more character traits as important rather than anything you might learn in medical school.

 

[mrwesticles]

Knowing every little thing about their patients.

Seriously, if you just know your patients and their morbidities really well, you are mostly there.

 

[PinkIvy08]

It depends on what you're defining a "good doctor as," but I must say that I've noticed that the people who've held customer service-oriented jobs are the ones most at ease with patients and have some of the better communication skills in the school. One thing about med school that shocked me is the number of my peers who can talk for hours about random biomedical science stuff but then freeze or have panic attacks when they have to talk to patients...still makes me chuckle.

 

[Rollo]

I agree with the idea that we can give too much to this career. I also agree that things like family, friends, exercise, hobbies, are part of what makes life enjoyable. At the same time, just as a carpenter can become good at his craft and work towards perfection (when he does work), I think my efforts are towards trying to use the "career time" wisely as opposed to making all my time career time.

I'm excited and grateful to be in this career, while @ the same time I'm not trying to over do it.

Good advice that I got from an attending who is one of the smartest, most knowledgeable people I've met was that pick a topic to learn about every other day or so and read up on it. Spend no more than an hour reading about it.

To answer your original question, I think studying smartly during first 2 years is crucial. This means figuring out which details are irrelevant and which are relevant. Things like mechanisms of drugs and pathophysiology of a disease, I would say personally, are very relevant and should be the focus of your energy. Understand the WHY and the HOW. The WHAT and WHICH will come later naturally when you can mentally connect the dots between symptoms and treatment options.

During 3rd and 4th year, you expand on your knowledge base from first 2 years and add new stuff on top like which studies are crucial and which treatment strategy is desirable.

Residency, I imagine, is putting all this stuff in practice yourself with supervision.

But anyway, you definitely don't need to pour over mountains of textbooks on a daily basis. They are good to have to look the WHY and the HOW stuff up initially. But you should not be reading Harrison's every night for 2 hours.

 

[SGuttenberg]

Being a pretty girl must make you a good student clinically because they always get good grades on their clinical rotations.

 

[Siverhideo1985]

What do you mean by that?

The truly outstanding physicians that I've met have a way of looking and interacting with their patients, their colleagues, and especially those that work below them that isn't learned or taught anywhere.

I really have no idea how these character traits come about or if they are somehow inherent...does the bully in kindergarden necessarily end up being a condescending surgeon with a superiority complex? Or does the kid that gets bullied end up the caring family doc whom everyone loves? No clue...too many confounding factors.

All I know is that the truly outstanding physicians (and residents & medical students) are not considered 'outstanding' because of most of the things listed in this thread (certainly they are part of it). Some things you just can't train or learn.

Not sure if that makes any sense.

 

[mjl1717]

I agree with much of that, but I also think that there are times, such as during medical training, when it's okay or even desirable to be fully focused on one's career.

Agree..Many times you want to be totally engaged or very involved in one's medical career..
It's just not the field to expect a lot of "breaks", "downtime", the "12 hour coffee break" however you want to say it..🙄

 

[mjl1717]

The truly outstanding physicians that I've met have a way of looking and interacting with their patients, their colleagues, and especially those that work below them that isn't learned or taught anywhere.

I really have no idea how these character traits come about or if they are somehow inherent...does the bully in kindergarden necessarily end up being a condescending surgeon with a superiority complex? Or does the kid that gets bullied end up the caring family doc whom everyone loves? No clue...too many confounding factors.

All I know is that the truly outstanding physicians (and residents & medical students) are not considered 'outstanding' because of most of the things listed in this thread (certainly they are part of it). Some things you just can't train or learn.

Not sure if that makes any sense.

To me this particular and favorable communication and interacting skill is about 50% of the saga. 🙂

 

[Mr Cookie Pants]

Thanks, this is along the lines what I'm trying to get at.

I know others have given good political advice in the wads, but that really won't help as an clinician in the future (or maybe it will?🙂)

Anyway, to your #2 point. How do you develop great pathophysiology skills? Would it be safe to say that pathology / physiology are the two most important subjects in years 1 and 2? If so, getting better at these involves just reading more or more repetition of 1 quality source (like the classic board review books, golgan/brs physio) or is it actually huge texts like Robbins path?)

How would one develop a plan to become a "pathophysiological beast" or master?

I took your thread as how to be successful 3rd year. Being a patho beast will backfire, I promise you. It's ok to be inquistive, but every time I found a paper or a syndrome or any of that ****, I got laughed at, because while it fit, I was wrong. The common things are more common. Yes it's good to study and be well read, but doing this will at best make you look like a douche and upstaging the resident. At worst, you're a douche, upstaging the resident and wrong.

Be quiet, interested, well read and have half a brain, and you'll do fine.

See my personal statement if you want. It basically says why I want to do what I want to do and how I've worked towards that goal.