So when I ask the question what to study in preparation for intern year..everyone says don’t, just enjoy 4th year and go on vacations. But I spent the first two years of med school vacationing pretty much and being unfocused/lazy. Definitely feel as if I’m lacking a lot of fundamental knowledge that my peers from top institutions have down and wanted to take time during my fourth year to build my knowledge base up.
Performed pretty below average on Step1/2 220s/230s, 25-50th percentile at a low tier MD school. On the interview trail now and have enough interviews to match into gas, what can I do to prepare myself for residency and turn the curve around to where I can be performing at the 90th percentile for basic exams in residency/be a top resident/set myself up for a good fellowship?w aswondering what I should do to prep/study, go over old material?
Hey man. Here's to hoping you match well. Now to your questions.
1. Sorry to break it to you but nothing prepares you for intern year and residency. There's just waaay too many variables to consider: new EMR, hospital politics, different rotation sites, type of program, categorical vs prelim year in med vs surg. So, don't worry, all the new interns coming in will have to learn all of this on the fly unless they came from that hospital system. That being said, assuming you're going to a medicine prelim year there are a few things you can brush up on that are also relevant to the practice of Anethesiology.
a) COPD: how to diagnose and evaluate exacerbation/severity as well as management options for it (inhalers, steroids, bipap, ABG, intubation)
b) CHF: diagnose/evaluate exacerbation vs chronic problem, compliance with meds, weight gain/loss, orthopnea, BNP as well as management
c) any arrythmias but most commonly Afib, SVT. Stable vs unstable. New vs chronic. Is it underlying MI? Differentials. Management.
d) Other things like OSA, MI/NSTEMI, CKD/ESRD.
But the best way to learn is having done and paid attention in MS3 year.
2. For residency, it's the same deal. You will not know anything about Anesthesia at the start. The learning curve will be incredibly steep and you're going to feel like you're drowning the first couple of months. Not to mention scared ****less when left in the OR alone the first time by your attending. There's nothing you can do to prepare for it except to learn as much fundamental medicine in intern year as you can. All of that stuff carries over to Anesthesia but with specific considerations that I won't go into too much detail here.
But the MOST IMPORTANT thing to remember in order to be a good resident is you need to work hard and show dedication to the field/your craft. Your first impression coming into the ORs is HUGE. People will judge you quick so those first couple of weeks you gotta show them you're on top of your game. Know your patients inside out to the extent you can spit out their med list from memory. Stay late and help with big cases or traumas. And that first impression? That carries over to the rest of your residency and can save your ass. Everyone has a bad day but a good resident having a bad day will be shrugged off as "oh he's just having a bad day" vs a known lazy/bad resident having a bad day will get his ass chewed out for incompetence. You're going into a field where your actions matter and vigilance/preparedness can make the difference between a smooth surgery and adverse events happening to the patient on the table. Its your attendings name on the chart so he wants to know that he can TRUST you in that OR with his patient. Also, don't slack off and shirk off work or try to leave early everyday. Every day you're in the OR and doing cases you're learning something new. Try to take the biggest/hardest cases every day those are the best for learning. Take advantage of studying and working under someone elses license. Be proactive and if you're free walk in on a awake fiberoptic case. The more enthusiastic you are, the more likely your attendings will be willing to teach you stuff.
3. In terms of exam prep. What you learn regarding PRACTICAL Anesthesia is totally different than what you learn for THEORETICAL EXAM Anesthesia. I'm not joking, the emphasis is different. Obviously, you need to read up on your patients the next day along with any concomitant comorbidities and weird diseases that impact your Anesthetic management. However, in order to do well on the basics and advanced written boards, ITEs you need to actually study material and do questions. Head over the Anesthesia forums to find more resources on this but off the top of my head: old ITEs and the ACE questions are the best, Truelearn is very helpful for boards, Faust review book for advanced and whichever Basic Exam review book you choose. I wouldn't necessarily waste time reading Baby Miller or Barrish but have them as a reference when you do need more in depth discussions on a topic. Doing questions make you a better test taker not necessarily a better Anesthesiologist.
4. It's good you're thinking about Fellowship already but in all honesty, the only fellowships worth going into are Peds, Cardiac and Pain. But only go into a fellowship if you feel like you truly love that field and want to do it every day. It's an additional year of training with minimal upside in terms of additional pay. There are still good PP jobs out there that don't require fellowship though some places do require a fellowship to get in. Again, head over the Anesthesia forum to find out more if you're interested. Don't worry, you got time to decide and it'll also depend on the program you go to. Sometimes its easier to fill internally anyway. But just like anything else the key things in landing a good fellowship: high ITE scores, good LORs from faculty.
Ok man. Good luck. Feel free to ask any other questions.
