What would you tell your MS1 self?

[NWwildcat2013]

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Did they not have clinical skills tests at your school?

It was focused on how to please patients and physical exam. Good example would be points off for not saying "Im sorry to hear that" if in the family history we discovered someone died semi recently. We didn't really learn how to present, form a differential, or write a note. Sure we did those things once or twice, but it wasn't rigorous or graded and was required very infrequently. Result: nobody learned it.

The residents and attendings don't understand it. They think our school teaches it backwards. Learn the note, generating a differential, and then worry about the interpersonal stuff. I absolutely agree.

 

[Mad Jack]

It was focused on how to please patients and physical exam. Good example would be points off for not saying "Im sorry to hear that" if in the family history we discovered someone died semi recently. We didn't really learn how to present, form a differential, or write a note. Sure we did those things once or twice, but it wasn't rigorous or graded and was required very infrequently. Result: nobody learned it.

The residents and attendings don't understand it. They think our school teaches it backwards. Learn the note, generating a differential, and then worry about the interpersonal stuff. I absolutely agree.

That sucks, we had graded skills exams where we had around 20 minutes to do a H&P, had 24 minutes to write a note, saw a second patient, had seven minutes to prepare a report, then had six minutes to present roughly following the SOAP format. I can't imagine just being thrown into third year like that.

 

[NWwildcat2013]

That sucks, we had graded skills exams where we had around 20 minutes to do a H&P, had 24 minutes to write a note, saw a second patient, had seven minutes to prepare a report, then had six minutes to present roughly following the SOAP format. I can't imagine just being thrown into third year like that.

Im sure my MS1 and 2 self would have cringed at the idea of doing it like your school does, but in retrospect I'd give anything to have had that experience.

On my rotations we aren't really allowed to do anything in the EMR. Residents say we can "write" notes in Word and ask them for feedback, but how practical is that? You can't automatically input lab data and all those other pre formatted things so "writing a note" in Word for practice takes about an hour. Its been frustrating.

 

[Mad Jack]

Im sure my MS1 and 2 self would have cringed at the idea of doing it like your school does, but in retrospect I'd give anything to have had that experience.

On my rotations we aren't really allowed to do anything in the EMR. Residents say we can "write" notes in Word and ask them for feedback, but how practical is that? You can't automatically input lab data and all those other pre formatted things so "writing a note" in Word for practice takes about an hour. Its been frustrating.

What the hell? What kind of school are you at? When I was a [redacted] at [redacted], not only did medical students write notes, but many of us relied on them because medical students took incredibly detailed histories and would get something that 19 out of the last 20 notes missed. If that's what it's like when I'm on third year (I don't think it is but dear god, if it is) I'm going to be pissed.

 

[NWwildcat2013]

What the hell? What kind of school are you at? When I was a [redacted] at [redacted], not only did medical students write notes, but many of us relied on them because medical students took incredibly detailed histories and would get something that 19 out of the last 20 notes missed. If that's what it's like when I'm on third year (I don't think it is but dear god, if it is) I'm going to be pissed.

Im on a fairly specialized service right now so that is part of it. It seems like our Internal Medicine rotation is like what you've experienced, but thats about it.

Heres to hoping you get some more exposure. I imagine Ill really be hurting come intern year.

 

[Mad Jack]

Im on a fairly specialized service right now so that is part of it. It seems like our Internal Medicine rotation is like what you've experienced, but thats about it.

Heres to hoping you get some more exposure. I imagine Ill really be hurting come intern year.

Specialists- that makes sense. Even a generalist would have little to contribute to a specialist note.

 

[Psai]

For medical students, the only billable aspects are past medical history, family and social history, and the review of systems. The rest of it does not count and as the most important part of the note is the assessment and plan, that is how much consideration the medical student note is given.

Learning how to present and form a differential should be done in the clinical years. You have enough on your plate in the first two years to learn how the body works and then how it doesn't (anatomy, physiology, microbiology, pathology, pathophysiology, etc.) When you start getting exposed to patients, you realize that everyone has diabetes and chf and that people will laugh at you if you suggest acute intermittent porphyria or castleman's disease. It's very easy to think that you're just a first year and you will learn all the important things second year or that you're just a second year and that you will start learning the truly important clinical information in third year. Everything builds on top of each other and that's how you develop a solid foundation for your medical knowledge. One of my biggest regrets was not taking the clinical exam portion more seriously because even though people say that the sensitivity or specificity of many things are low and that all you need is some therapeutic radiation from the ct scanner, I think it's a very important part of the doctor patient relationship. I've seen the old school docs do their physical exams and it's very different from the listen to heart/lungs, tap on the belly nonsense that we are limited to because of time constraints.

 

[sloop]

Im sure my MS1 and 2 self would have cringed at the idea of doing it like your school does, but in retrospect I'd give anything to have had that experience.

On my rotations we aren't really allowed to do anything in the EMR. Residents say we can "write" notes in Word and ask them for feedback, but how practical is that? You can't automatically input lab data and all those other pre formatted things so "writing a note" in Word for practice takes about an hour. Its been frustrating.

My school's main teaching hospital still uses paper charts. So everyone, including the residents, is operating without autopopulating lab result functions and whatnot. Honestly, it doesn't take that long. For most patients, the important things to document are basically just the CBC and BMP diagrams, maybe a couple other relevant lab tests, and maybe a radiology report. I think the autopopulate table functions have trained people to think it's necessary to document the patient's hematocrit for the last 10 days on the progress note. It's not.

I've also rotated at places with well-developed EMRs and autopopulate functions that basically automatically fill out more than half of the note from a stock note you've developed. These are quicker but I actually don't prefer them. I find EMR notes are, without fail, more thoughtlessly done, very generic, quite cluttered with unnecessary lab tables, and often contain documented ROS or physical exam findings that you know the person didn't ask or perform. It's just too easy when your exam is formatted as a series of buttons for yes/no or +/- to look at something you didn't really explicitly evaluate and go "eh, I guess . . . "

 

[Psai]

My school's main teaching hospital still uses paper charts. So everyone, including the residents, is operating without autopopulating lab result functions and whatnot. Honestly, it doesn't take that long. For most patients, the important things to document are basically just the CBC and BMP diagrams, maybe a couple other relevant lab tests, and maybe a radiology report. I think the autopopulate table functions have trained people to think it's necessary to document the patient's hematocrit for the last 10 days on the progress note. It's not.

I've also rotated at places with well-developed EMRs and autopopulate functions that basically automatically fill out more than half of the note from a stock note you've developed. These are quicker but I actually don't prefer them. I find EMR notes are, without fail, more thoughtlessly done, very generic, quite cluttered with unnecessary lab tables, and often contain documented ROS or physical exam findings that you know the person didn't ask or perform. It's just too easy when your exam is formatted as a series of buttons for yes/no or +/- to look at something you didn't really explicitly evaluate and go "eh, I guess . . . "

This is exactly the problem I have with EMR. I hate when people document just to document and you can't trust a thing they say. "No murmur" but a med student can hear it from across the room and the patient is like oh yeah I've had that murmur for years

 

[WilliamofOckham]

Not really med school-related, but: get an app like Coffee Meets Bagel if you're still single and in a new place. Waiting around for an educated girl/guy to fall into your lap is a huge waste of time.

 

[Mad Jack]

My school's main teaching hospital still uses paper charts. So everyone, including the residents, is operating without autopopulating lab result functions and whatnot. Honestly, it doesn't take that long. For most patients, the important things to document are basically just the CBC and BMP diagrams, maybe a couple other relevant lab tests, and maybe a radiology report. I think the autopopulate table functions have trained people to think it's necessary to document the patient's hematocrit for the last 10 days on the progress note. It's not.

I've also rotated at places with well-developed EMRs and autopopulate functions that basically automatically fill out more than half of the note from a stock note you've developed. These are quicker but I actually don't prefer them. I find EMR notes are, without fail, more thoughtlessly done, very generic, quite cluttered with unnecessary lab tables, and often contain documented ROS or physical exam findings that you know the person didn't ask or perform. It's just too easy when your exam is formatted as a series of buttons for yes/no or +/- to look at something you didn't really explicitly evaluate and go "eh, I guess . . . "

I have looked over notes from five different doctors that had the exact same history and physical as if it were collected by that physician. Like, not just addendums to notes, but whole notes that had clearly just been cobbled together from prior notes by other people. Finding anything useful was difficult, as you'd have to read the previous notes just to figure out what they had and hadn't done themselves since there was no way of telling otherwise.

 

[FindMeOnTheLinks]

I have looked over notes from five different doctors that had the exact same history and physical as if it were collected by that physician. Like, not just addendums to notes, but whole notes that had clearly just been cobbled together from prior notes by other people. Finding anything useful was difficult, as you'd have to read the previous notes just to figure out what they had and hadn't done themselves since there was no way of telling otherwise.

Have you done any retrospective research? I swear, 80% of the notes I've gone through are like this.


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[mimelim]

I have looked over notes from five different doctors that had the exact same history and physical as if it were collected by that physician. Like, not just addendums to notes, but whole notes that had clearly just been cobbled together from prior notes by other people. Finding anything useful was difficult, as you'd have to read the previous notes just to figure out what they had and hadn't done themselves since there was no way of telling otherwise.

We have this excellent feature in our EMR. There is a button that you hit on a note and it removes everything that was copied in from somewhere else. You will be amazed how many times it removes the entire note.

 

[Integral]

We have this excellent feature in our EMR. There is a button that you hit on a note and it removes everything that was copied in from somewhere else. You will be amazed how many times it removes the entire note.

Wasn't the main purpose of having EMR to save time? Mission accomplished! 😀

 

[Psai]

We have this excellent feature in our EMR. There is a button that you hit on a note and it removes everything that was copied in from somewhere else. You will be amazed how many times it removes the entire note.

Well I don't see the point in writing a soap note everyday when all you're really doing is waiting for the patient to get better and the overall plan is the same

 

[Dr. Anonymouss]

*BUMP! I'd say that the anki really was worth it. It makes step studying so much easier and really pays off. Lectures aren't important, just use boards and beyond or sketchy if you go to a pass/fail school. Other than that try not to stress or lose sleep over trying to learn everything. You can't learn or master everything, so don't try. Just do your best and forget the rest.

 

[Redpancreas]

Good thread to bump I guess.

"Repetition is key"
1.) The key is indeed spatial repetition and testing yourself, but I don't think ANKI is the only way to do that, especially if it takes you a lot of time.

"Perfect is the enemy of good"
2.) I'd tell myself to roll with the punches in M1. I knew logically being at the top of the class would be difficult since the competition was steeper. For some reason, I was still hung up on slightly below average test scores and lost an incredible amount of sanity on that. There are A LOT of pieces to your residency applications and it's best not to go off the rails because you're below average in M1.
3.) Those good habits my parents taught me like getting up and going to bed on time, eating meals at regular times, exercising, etc. that I unlearned in college actually go a long way. Believe it or not, caffeine, crash work-out sessions, and all-nighters only go so far. Medical training is stressful and the best way to combat that is to follow the basic human habits I thought didn't apply to me.

"Be Proactive"
4.) You are truly accountable for your education. If you don't know something or are weak in a certain area, be true to yourself. Don't tell yourself that everyone cuts corners and thus you don't need to pay attention during the clinical correlation lectures in M1 or just half-ass the clinical skills in M1/2 because everyone passes. I would have spent more time proactively identifying my small deficits because those deficits (clinical skills, etc.) turn into larger ones.
5.) Address any issues with mental health early on. You may or may not have them. It doesn't hurt to see a counselor to discuss your insecurities and seek help. Chances are when things get rough, those issues will get magnified and learning coping strategies earlier on helps.

"Think about the end product"
6.) Professionalism is extremely important, despite it appearing as an administrative front. Yes, we are all adults but showing up on time, responding to emails and completing tasks in a timely manner, and knowing how to communicate professionally are all expected exponentially more beyond medical school and if you suck at that now, you'll suffer later on.

 

[psyspy]

You have one chance. You don’t get any extra years or have lots of time to repair your residency app.

Med school friendships/relationships can and will be fickle compared to previous ones you had. In the words of another attending: “No one in medicine is truly your friend.”

You might regret it. Your peers might regret it. You might also find something you enjoy in it. Impossible to know as an M1. Do your best. Hope for the best. Don’t have super high expectations. Know the pitfalls (though this is also impossible to truly know at that point).

 

[The Knife & Gun Club]

The person that comes out on the other side of training looks and feels very different from the person that goes in. Do what you can to try to keep a few scraps of that old you around - it’s what makes you feel human and gives you a self worth beyond medicine.

 

[Aurarice]

Doing Anki is not an excuse to skip the gym. You can just do cards between sets.

 

[psyspy]

The person that comes out on the other side of training looks and feels very different from the person that goes in. Do what you can to try to keep a few scraps of that old you around - it’s what makes you feel human and gives you a self worth beyond medicine.

At the same time it’s ok to leave some stuff in the past. You’re basically still a kid as an M1, and you’re much more an adult as an M4.

 

[JeterIsStud]

Definitely make more time for yourself - work out, go to those weddings/concerts/outings. Don't sacrifice a night or two of studying. At the same time - make sure you take boards seriously (I guess step 2 these days more than step 1)

 

[Rogue42]

Never forget your reason for doing this in the first place; it is hard, and grueling, but never forget where you came from, where you're going, and why you did it to begin with.

 

[Blueprint Med School]

P=MD and the pre-clinical grades are like 6th or 7th in terms of importance for most specialty rankings.

Spend more time enjoying the process and less time trying to squeeze every point from an exam.


David D, MD - USMLE and MCAT Tutor
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