With my MS-II year taking its last gasps of breath, yet still twitching with one last psuedocourse (a graded Step I review course), I've been waiting anxiously for the release of my third year clerkship schedule.
At UTMB, we are given a list of 'tracks' to chose from and then we enter our rank list of preferences into our computer so that it can randomize and optimze (how those two words aren't an oxymoron I don't know) our true assignments.
Much to my surprise, I got my first choice! Here's what I'll be doing starting June 23, 2003:
Internal Medicine 6/23 - 9/12
OB/GYN 9/15 - 10/24
Psychation 10/27 - 12/05
Christmas break 12/08 - 1/02
Surgery 1/05 - 2/27
Elective! 3/01 - 3/26
Family Medicine 3/29 - 4/23
Peds 4/26 - 6/18
We're the first class to have a third year elective. I want to do EM. Since it requires the completion of medicine and surgery, this schedule rocks for me.
Plus, I figured it will never know as much medical trivia as I will on June 12 (my Step I is on June 11) so I should be primed for the great pimp-match that is the medicine clerkship.
I'm excited! I've really enjoyed the sense of discovery in my first two years, but have noticed a wee bit of impatience during my last course or two. I'm ready to get on the wards and start learning how to BE a doctor and not just use the same words as a doctor.
Anyone have any advice for this soon-to-be scut monkey?
Good shoes, be confident, assertive & know your limits. Believe me, it is far more impressive to ask questions, admit to something being beyond your comfort & seek guidance in performing the task than it is for you to simply “wing it” and hope all works for the best. We all must learn by pushing our own personal envelopes, the professionalism and maturity comes in knowing when it is appropriate (& not potentially detrimental to your patient) to push your envelope.
And always always always treat your patients as people - you do not have like them all (you won’t) - but you must treat them with the dignity & respect that you would expect were it to be you sitting in their circumstances.
Every single patient, peer, attending, resident & allied health professional you encounter has something of value to teach you – however, you must choose to listen & learn what it is that they are offering. The gift of knowledge is one of the most precious.
Spend the preponderance of your time with your eyes & ears open…and your mouth in idle (one of my favorite quips of wisdom that I used to pass onto my RT students many moons ago)
For Internal Medicine: Get a good basic reading text such as Cecil's Essentials for your basic reading. Read about everything that your patient has while you are taking care of them. Try to divide the categories of IM up so that you cover a major topic each week such as Gastroenterology Week 1, Cardiology Week 2, Pulmonary Week 3 etc. When you have read each major topic, start a good question book. Be sure to review Rheumatology and Connective Tissue Diseases, a couple of times. I used Medicine Recall for review.
For Family Practice: Get Swanson's. It is going to be a good review book for IM also. It has plenty of questions. Be sure to know about preventive medicine on this rotation. Know basic preventive heathcare for Geriatrics, Pediatrics, and adults. The sports medicine aspect of FM is pretty cool!
Psychiatry: Be ready to learn the language. Psych docs don't do too much medicine but they expect you to know how to take a psychiatric history. Get a small pocket psychiatry book and count the days until you are off this rotation.
OB-Gyn: I used the BRS book for OB-Gyn but BluePrints is great. If you are not going into OB, then don't buy any of the bigger OB texts. You need to know how to present an OB patient so learn this presentation early in the rotation. The Gyn surgery is pretty neat.
Pediatrics: You need to have a good peds book for walking around. I used Nelson's Essentials of Pediatrics. It is great for the pre-Board exam. Many folks used BluePrints but I liked Nelson's better. I also carried a Harriet Lane handbook which works well for Emergency Medicine too.
Surgery: Get a good comprehensive text such the Lawrence's General Surgery. You also need a good pocket book such as Surgical Recall or Mont Reid. If you think that you might go into surgery, you should use Mont Reid. Read about your patient's problems and know how to work up things like acute abdominal pain, upper GI bleeding, Lower GI bleeding, peripheral vascular disease and pancreatitis.
For Medicine: Wear comfortable shoes (Dansko clogs), khaki pants, shirt and tie with white coat on rounds. Take your Ophthalmoscope and look into everyone's eyes. You will never learn to use the thing if it stays at home. Dim the lights in the room, turn down the light in the scope, and look. First you will see nothing, then you will find a vessel, then you will learn to follow the vessel and finally you will learn how to examine fundi.
Know more about your patient than anyone and talk to your intern often. If you don't know the answer to a question, say so. Don't do any procedure that you have not done before. Ask for supervision. Please learn how to present a patient by systems.
For Family Practice, Psychiatry, Pediatrics: Be nice to everyone and talk to patients. Listen to what they have to say. For Peds, wear a sweatshirt over you scrubs sometimes to keep the kiddies comfortable. Get a little animal for your stethoscope (Works for psych too!)
For Surgery and OB-Gyn: Pre-round on your patients and know them well. Gather lab data and keep up with vitals etc. In the OR, your Dansko clogs will work well under scrubs. Clogs for standing; running shoes for walking. Learn to drive the camera well! Nothing will get you yelled at more than poor camera work. Sleep when you can, eat when you can and pay attention to Mother Nature! If you are sick, don't come in to work! Push patients to radiology and help the team at all times even if it isn't your patient. Go to clinic with a smile. Be nice to the nurses. The Scrub nurse is always right! If you break sterile field, admit your mistake and take care of it. You are learning and it is no harm unless you try to hide it. Learn how to do a surgical presentation for rounds and formally.
Finally, read, read, read! You can sign up for the video-version review for USMLE Step II. Do each subject while you are going through the rotation. The Kaplan Videos are great review for the Pre-Board exams. Take Step II at the end of your third year. Don't take Step II any later than September.
The best feeling in the world is to have you Step II score in hand and all of your electives set for fourth year. Ask for letters from any of your teaching attendings while you are on the rotation. When you figure out what you want to do, meet the chairman of that department at your school and get to know him or her. Get to know the residency director and get a faculty mentor early. Start working on your personal statement for residency towards the end of third year. Work with your faculty mentor on this. Get to know the residents of your chosen specialty well and ask them about good places to interveiw and apply to. Join the student interest group of your specialty interest and be active. Do an ICU rotation and a Radiology rotation early in your fourth year unless you are going into Psych or Pathology.
Don't listen to things like competitive and non-competitive residencies. You don't have to be AOA to get into neurosurgery if that is what you want. If you have been coasting along, passing everything, passed USMLE but not in the 90th percentile, start making contacts as soon as you know what you want to do.
Enjoy third year, be a team player and help your fellow classmates. They will be your physician colleagues when you graduate and you may have to refer patients to them. The more you help them, the better for your future patients. Never whine!!! In the time that it takes for you to complain, you can do the chore and have it done. Whining only delays the inevitable. Ask questions!
Howdy Dave and Natalie!
Wow, talk about great advice! Of course, I guess I shouldn't be surprised since I've been getting great advice from y'all for a couple of years now. Thanks!
I'm going to copy this thread into a Word document and keep it on my desktop and in my PocketPC. Thanks so much for the text recommendations.
Speaking of texts, though, what are y'all's thoughts on Harrisons? I've been using the online version through our school up until now (sporadically when needed for reference) but I really dislike reading books online. Is there a better general medicine reference that is as comprehensive yet easy to use? I got the Essential Cecil's for GI but returned it as soon as I figured how low yield it was for that class.
I love Harrison’s and used it for my big presentations. I keep my Harrison’s nearby at all times. It is a wonderful reference book. It just wasn’t my book for everyday reading or study for the shelf exam. In terms of shelf exams: From hardest to easiest: Hardest - Family Practice, Medicine, Pediatrics, Surgery, OB-Gyn, Easiest - Psychiatry. Most of the folks in my class thought Surgery was the hardest but that might have something to do with interest. That Family Practice exam was beastly for me. It had a definite focus on preventive medicine for all age groups. It focused on things that you would not be admitted to the hospital. As I said above, Swanson’s was great reading and practice for both Family Practice and the Internal Medicine Exams.
Have fun third year! My learning curve was so steep that year. The next time you will be learning so much will be intern year when you really learn how to manage patients from start to finish. I can tell you that nothing is more satisfying to me that seeing a kid in the ER, working up his appendicitis, performing the laparoscopic appendectomy and dictating his discharge summary. It was totally a blast from my end. I feel like a surgeon more and more.
Thanks for the great advice! I am starting off with Psych , which rumor says will not be all that helpful for the other clerkships. Any advice on how to maximize the yield from Psych for experience that will help on other clerkships?
|QUOTE (mrwagner @ Apr 26 2003, 05:59 PM)|
| Any advice on how to maximize the yield from Psych for experience that will help on other clerkships?|
From what I hear, the best psycation can offer is....sleep?
At least that's what I'm hoping for after 12 weeks of medicine and 8 of OB/GYN.