The brand new third years started their first rotations this morning, which means that dispite my disbelief, I am actually a fourth year medical student. Here are my tips for a successful rotation & clinical year.
Be nice to the interns! At this time of year, they are all brand new–they may not know where anything is yet, including things like the restroom. If you’re a medical student with training on the EMR, you may need to help them out with it, if they came from other schools with different EMRs. If you know more than them, help them out. On some rotations, it’ll be the interns that write your evaluations, so don’t be a jerk to them.
Be nice to your classmates. No one likes working with a jerk who only looks out for himself.
Find ways to be helpful. Even small things will be appreciated by the team. If the patient is crying and is surrounded by physicians, no one will notice if you leave for a minute to grab a box of tissues from the nurses’ station, but they’ll remember how you helped the patient, and that’s what will go in your comments on the MSPE dean’s letter for residency.
Start studying on day 1! 4, 6, and even 8 week rotations go by quickly. Always have reading material on you. It’s hard to juggle working all day and studying only at night, so get used to using those little pockets of downtime.
Put the UWorld app on your phone. Do questions during downtime. If you’re concerned that the residents will think that you’re on Facebook/screwing around, ask questions about something in the current question (even if you already know the answer)–they’ll know that you aren’t just screwing off, and can teach you things. It makes you look interested, and then they won’t care if you pull out your phone during downtime.
Helpful apps: UpToDate, PEMSoft, MedScape, CDC Vaccine Schedule, New Innovations NI UME, various medical calculators.
Keep a snack in your white coat pocket. You may not always be able to just run back to the office/lounge/etc. to grab something out of your backpack. The three rules of surgery: Sleep when you can, eat when you can, and don’t mess with the pancreas. Very true rules, actually. Keeping that snack on you helps.
Be prepared to show up early and stay late. Don’t complain.
The residents know that “Is there anything I can help you with/do for you,” really means, “Hey, can I go home now?” After awhile, they get tired of hearing it and may keep you around longer to do nothing if you keep asking it. My advice is to go in with an idea of what you could do to be helpful or tell them what you just did to be helpful. Example: “I just finished the discharge summary for Patient X, what else can I do to help?” or “Can I go drop off scripts to X unit?” That way, you’re asking the same thing but in a much more helpful way. The answer was usually, “You did a great job, go home! See you tomorrow!” And then everyone is happy.
You have to be aggressive for your education. If you want to see/do a procedure/test, ASK. Volunteer as tribute. If the residents ask, “Have you seen….” or “Have you done…” say no, but I want to! The more you volunteer for, the more you’ll learn. For example, 10 minutes before the end of a long call day on internal, my intern turned down the opportunity to perform a paracentesis because he wanted to go home (I did, too). But then my upper level resident asked me if I wanted to do it. Ummmm, heck yes! So I got to perform one by myself, with an upper level resident as a guide/supervisor. And it was awesome. It made my 14-hour day a 16-hour day by the time we gathered everything/consented/performed/wrote notes/checked out, but it was so worth it. On OBGYN I was asked to go to the ED to use an ultrasound on a lady that had been in an accident. I’d never used the ultrasound machine by myself before, but I did it anyway. I couldn’t get the thing to calculate the heart rate for me, but I did see the fetus and showed the mom. When I told the residents I’d seen the fetus but couldn’t find the heart rate calculator, they were like, “But you TRIED! Hooray!” Everyone is happier if you make an effort.
No one cares if you get a pimp question wrong, so don’t beat yourself up over it. They just want to know where your knowledge is so they can teach you stuff.
If something happens that is just plain wrong: don’t be afraid to bring it up to the clerkship director/coordinator, or school administration.
UWorld is a must. Go ahead and get a Step 2 CK subscription now, even if it means you’ll need to renew it before your dedicated Step 2 study time.
Every rotation will have its own Case Files book. I really liked these. They work through cases start to finish, with questions at the end of each case. Each of these books fits in my white coat pocket, so they were great to keep on me during downtime.
Some rotations will have their own resources that are great. Internal has Step Up to Medicine, Surgery has Pestana’s Surgery Notes, for Pediatrics I used BRS Pediatrics, and for Psych I used First Aid for the Psych Rotation.
I did much better on exams this year than in the clinical years (it all makes much more sense, and in general aren’t just random factoids to remember anymore). Here’s what my strategy was, but be warned, I really think what I did was overkill.
Before the rotation started: DIT Crash Cart for that rotation to get a jump on some important topics. Starting Day 1 of the rotation: Case Files + any other resource for that rotation (see above for Internal and Surgery). Throughout: UWorld questions. Two weeks before the shelf, I’d go through the Emma Review (The University of Texas link) and take notes. Throughout: Master the Boards Step 2 CK, Step 2 Secrets, and First Aid for Step 2 CK. MTB is terrible in my opinion, and there’s no way I’d use it as my sole resource to study for Step 2, but there were a couple notes per chapter that were useful that I would transfer to my copy of First Aid. No one talks about using First Aid for Step 2, but I blame that on Step 1 PTSD. I really liked FAS2. Secrets fits into nearly every pocket and is a quick read of high-yield topics, and I really liked it too.
The day before the shelf: Emma review again, notes from UWorld questions, one or two passes through FA.
Your job as a third year medical student is to learn. You’re learning how to write notes, how to present, how to be part of the team, how to be a good intern–in addition to learning things that will be on the shelf. There will be people on your teams that are great examples of what to do as a physician, and there will inevitably be one or more that are great examples of what you don’t want to do as a physician. Make the most of it, because it goes by extremely quickly. It is so much fun–so much better than classroom work. Good luck, and have a great rotation!