Gold Humanism Honor Society

Transcription

1 Gold Humanism Honor Society by Members of the GHHS Class of 2012 Presented at the Ohio State University College of Medicine Student Clinician s Ceremony April 13, 2011

2 Section 1 Inspiration: How to Mentally and Emotionally Survive Med Section 2 Ward Behavior Section 3 Book Suggestions and Study Tips Section 4 Progress Notes: Advice and Templates... 49

3 Gold Humanism Honor Society 2 Guide to Clinical Clerkships 2011

4 Joshua Jones 10 Ways to Avoid the Third Year 15 Freshman year weight gain is back, and this time, with a vengeance. As a third year medical student, you are going to have approximately ten thousand reasons to not take care of your body. Let me enlighten you with some of my personal favorites I ll work out when I m an attending. I have been at the hospital since 5:30am and it is now 9. At night. I held retractors in the OR today for 2 hours and already broke a sweat. I delivered a ten pound baby and got a couple bicep curls in while handing him over to the neonatologist. I m tired. There are things you can do to ensure healthiness is a lifestyle and not a burden. 1. Take your gluteus to the maximus by taking the stairs. Give yourself a little stress test every morning by trying to make it to the 11 th floor of Rhodes Hall without stopping. Believe me, even an avid marathon runner is going to feel the burn. 2. Keep snacks in your white coat. This does not include a bag of peanut butter M&M s (which are delicious, by the way). I like almonds and baby carrots. They help curb an appetite when rounds take you well past lunchtime and don t force you to play Hungry Hungry Hippo at lunch by binge eating. 3. Set apart time for the gym. Enough said. If you don t put it on your agenda, it won t happen. 4. Walk while on call. You are at the hospital for what seems like an eternity. However, I have never been on a call where there wasn t some sort of down time. Go outside for a walk when there is a lull in the workload and say hello to natural sunlight. 5. Get plenty of sleep. Unfortunately eight hours every night is not practical when you have to take overnight call or you are on your surgery rotation. Even so, attempts at good sleep etiquette will help your energy, mood, and ability to focus while on rounds. 6. Prepare meals on the weekend. I have the hardest time with this one. During the week, you always think you have so much time on the weekends to cook, but mostly I end up laying on the couch and catching up on DVR. Cooking on the weekends frees up time during the week and is certainly healthier than Wendy s (please see #7 below). 7. Wendy s is not healthy. I don t care how much money they spend on commercials promoting sea salt on their fries. Underneath that sea salt is still oil and starch. It seems like the easiest option when you re in a hurry, but try and stick with packing your own lunch or grabbing something healthier at the cafeteria. 8. Secretly do push-ups/crunches in the call room. It may be awkward when someone walks in when you re doing a push-up, but just pretend you dropped a pen and it went underneath a desk or bed. Everyone s doing it. Trust me. Gold Humanism Honor Society 3 Guide to Clinical Clerkships 2011

5 9. Work out after call. A 30-hour call sounds exhausting, but surprisingly I am awake when I leave the hospital. It takes a little bit of time for your mind to decompress from patient care and take advantage of this energy with a quick workout. Once you go to bed after a call, it is all over. No one ever wants to do anything when they are post-call. 10. Go to doctor visits. The medical school is a big proponent of allocating personal time each rotation for health-related appointments. Don t feel bad when you have to leave your rotation for an afternoon to get your teeth cleaned or attend to your hypochondriasis. A healthy med student is a happy med student! Jeremy Davis Med 1 check. Med 2 check. Step 1 double check. Med 3 hmmm? Congratulations! You have now mastered the first two years of medical school, and not to worry, you will master the next two years too. Here are a few tips on how to mentally and emotionally survive Med 3: Set multiple alarms. It is imperative that you are ALWAYS on time. A sure way to look bad on the wards is to show up late. Your itouch works great for a second alarm, especially if you lose electricity which unfortunately happens all too often here in Columbus. Eat breakfast. Nothing like starting the day off right. While breakfast may be easy to skip, you have to remember that unlike Med 1-2, your start time is much earlier than 8:30am. You may be rounding until 12 or 1pm and it s extremely hard to pay attention when your stomach is growling and eating itself. Even when you do eat a substantial breakfast you may still get hungry while rounding so try to keep a granola bar or some other snack in your white coat. Eat healthy. Med 3 is exciting but it is also busy and tiring. Sometimes you get home late and cooking may be the last thing on your mind. Fast food/unhealthy food is tempting. Avoid this pitfall and try to plan for your meals in advance. Shop on the weekends. Cook on the weekends. If you are lucky and have a significant other/family in Columbus try to make arrangements to share the responsibility. (Make sure you wash your dishes afterwards though, they pile up!) Don t neglect your health. The hospital is full of sick people and sometimes we get sick as well. If you are sick, go to the doctor. It s hard to take care of your patients and contribute significantly to your team if you aren t taking care of yourself. Additionally, your sickness is one thing your team will appreciate you not sharing. Routine appointments can also be scheduled on post call days (you should be dismissed by 12pm) and during the several breaks we get throughout the year. Student Health does have Saturday hours. Maintain outlets outside of medical school. Again, Med 3 can be busy but there is still time to do things that you enjoy. If religion is important to you, make time to attend your respective services. Play intramural sports. Continue to participate in particular groups and activities. Your life does not end with the beginning of Med 3. These outlets will help to provide balance and ultimately keep you from becoming physically, emotionally, and mentally drained. Gold Humanism Honor Society 4 Guide to Clinical Clerkships 2011

6 On that same note, make time for the people you care about. Although some adjustments, compromises, and sacrifices may need to be made, don t neglect these relationships. They can be a great source of comfort, encouragement, and motivation. Utilize 4 th year students. They were once in your shoes and can offer great advice about rotations, attendings, how to complete a DI, or how to navigate Eresults (although we will be just as lost when Epic rolls over). Ask them if they have any templates, resources, or advice that may make your job easier. Ask for advice/feedback on your presentations. They aren t evaluating you and can be a tremendous resource. Pimping. You aren t expected to know all the answers all the time. Don t get down on yourself. Attendings often ask questions that they know medical students can have trouble answering. If you don t know the answer, make it a point to look up the answer later. Study. As a general rule, you should try to study at least one hour a day during the week, and as much as you can on the weekends. Utilize your down time at the hospital to study. This cuts down the amount of time you have to study at home when you are drained with one eye half open. Attendings and residents can often recognize if you aren t reading. Share books with your classmates when you can. This saves money and trees. Lastly, enjoy the experience. Med 3 is an exciting year full of new experiences. Remember that ultimately you are still a student and embrace every opportunity to learn and grow. Saad Ranginwala Tidbits for Surviving and Succeeding Congrats on making it to your first step towards becoming a doctor! Third year is different from anything you ve experienced before; there s absolutely no denying that. You hear about the stories of how punishing it can all be, and it can be pretty intimidating. I m not here to say that it won t be taxing. It will be, without a doubt. Some months will be great, and some months you might wish you were back on your service from 2 months ago. Such is the nature of the beast. I d just like to share some tidbits that may help to lighten the load, or at the very least, give you something to identify with when you experience them. Take a deep breath. When you first start, you probably will feel overwhelmed. I still sometimes feel that way, even more than two-thirds of the way through. There are going to be good and bad days. Know that. Not all services are created equal for you. If you find that you re loving what you re doing a certain month, make it a point to let the people you are working with know that. If you re not so hot on a specific month, at least try to enjoy it. If you can t at least enjoy it, still attempt to show interest. This will go a long way towards being successful moving forward. Feedback. Take feedback seriously and implement it. Most of the people you work with aren t trying to be malicious. They re just telling it to you how they see it and most likely, how everyone else sees it. Perception is reality in the real world, and so if there s Gold Humanism Honor Society 5 Guide to Clinical Clerkships 2011

7 something that people say they think you could improve on, do take it into consideration. It s just one step in reevaluating yourself and improving for the future. Studying. The toughest part of it all for me. After a long day at the hospital, the last thing you want to do is come home and read books for hours and hours. Do it anyway. Set aside 30 minutes to an hour everyday and try to learn something. If it doesn t get done a certain day, don t despair. You do need some days to just relax too. The goal is to continue to make the effort. Team harmony. Probably one of the greatest factors in how smoothly a rotation will go. While how well your team might get along is not completely in your hands, you can definitely have a huge impact on how it plays out. Be a team player. Help out the senior members if possible. Work with the other med students, not against them. You can demonstrate your merit without showing up others. Being considerate goes a long way and you ll have a much better experience when your team is actually working as a team. This is just a small start. Luckily, you have the rest of this guide too. Third year will be what you make it. You ll probably work harder than you ever have before, but at the same time, you ll be working with people, watching their health improve, and having a hand in it all. Push on, have a good attitude, and you will be successful. Jane Stremming Med 3 is very different from the first two years of med school. The hours are long, your patients and colleagues can be frustrating, and there will be days where you just feel like a complete moron. Expect to work hard, and you will be tired. However, you will also learn more than you thought possible, meet some great people (including all of those ISP students!), and have a lot of fun. Here s some of the best advice that I received last year: Take care of yourself! Sleep, exercise, see your friends, and pursue hobbies. Do whatever it takes to stay sane! Along the same line when a resident tells you to go home, don t argue just leave! The gunner inside every med student will urge you to stay, but you can use this valuable extra time for studying or relaxing. Focus on the big picture. No matter how much you hate a rotation, you only have to endure it for a few weeks. Take the rotation one day at a time, and you ll survive. Don t stress out about pimping. The attendings don t expect you to know everything, and most of them are just trying to teach. Try your best, but if you really don t know an answer, a good response is always I don t know, but I will look it up. Finally, relax! Remember that this is new for everyone, and you are probably doing a lot better than you think. So, have fun. Get to know your team. Chat with your patients. Enjoy yourself now while you aren t expected to know everything you re only expected to learn. Gold Humanism Honor Society 6 Guide to Clinical Clerkships 2011

8 Matt Flynn Congratulations on making it through those first few years I know there are times when you may have questioned if sitting in lecture and taking computerized exams is really what you signed up for! Well, thankfully, it s safe to say things really do get better (aside from the fact you probably still have to take Step 1 ). Now I can t promise that lectures and exams are gone, since you ll actually have plenty of each this next year still; however, working on the wards, seeing patients, and participating in various procedures makes everything a bit more bearable! While I m sure you are all ready to move on, many of you probably wonder if you are actually ready. I d like to say that is OK many of us, myself included, felt like we somehow didn t know anything even after two whole years of learning stuff! Things will work out just fine though you probably know more than you give yourself credit for, you probably actually don t know anything about what is expected on the wards, and either way, you will learn everything you need to while you go along! In the meantime however, here are a few of my thoughts and some book suggestions Keep Living Life Contrary to popular opinion, life does not end when you start 3 rd year. You will not have the free time that was there the first two years, but this does not mean you will necessarily be miserable. I really encourage you to keep doing the things you love right now whether it s rock climbing, going to concerts, talking to friends/family, playing intramural sports, cooking, or (not that anyone does this) going out to bars. There may not be time for all of these things, and you may not be able to do them as often as you wish you could, but don t buy into the belief that you need to stop enjoying life and just study/work all the time. If you do, your performance will probably actually suffer, and more importantly, you just won t be happy who really wants that?! Support Each Other This year can certainly be trying at times, but you are not alone. Everyone is going through the same things together. Talk to your fellow classmates who may have already had a certain clerkship, and take advantage of 4 th year students as well. Help out your fellow med student who is struggling to figure out what is expected on daily rounds. Assist each other in finishing up work, collecting labs/vitals, calling consults etc. Everyone will be happier this way, the entire team will function much better as well, and your residents will think more highly of everyone! On a related note, really think twice about showing up your fellow med students do not make others look bad, withhold information so you look smarter, speak over other students to answer every question, or show up at 5am to round when you all previously agreed to start at 7am. The residents will notice, in a very negative way, and your fellow students will not be so happy with you either! Learn from your Patients For all the studying you will inevitably do this year, you really learn the most from the individual patients you care for. Take the time to really get to know the patients their medical problems, social issues, thoughts on life etc. Try to interpret the labs and imaging on your own. Read about the primary medical issues and make differentials. Work on coming up with treatment plans or think of tests that might be useful to order. If you do all of this, even if you are wrong, you will learn A LOT and look like a pretty good medical student to your resident as well. You will probably find that the more involved you are in managing patients, the better you will understand the disease, and the less you will need to study the particular topic outside of the hospital. Be Nice This seems so obvious, but when you are tired and stressed, it can tend to go by the wayside. With patients, really try to go out of your way to make their life better no matter how you are feeling on a particular day. Just remember, they are in the hospital, Gold Humanism Honor Society 7 Guide to Clinical Clerkships 2011

9 they probably feel pretty badly, may be frightened/anxious, can be lonely, and are often confused by what is going on. Take the time to come back after rounds and say hi. Follow up on questions they have and help them/their families navigate the services available at the hospital. This little bit of extra work may or may not be noticed by your team or be reflected in your grades, but it can go a long way towards improving the lives of your patients. Try to extend your nice demeanor to everyone else you encounter as well, especially support staff like technicians, nurses, social workers, etc. They can make your life a lot easier if they like you or a lot more difficult if they don t and bad behavior tends to have a way of making its way back to your primary team too. Stephen Barman Congratulations on making it through your first two years of medical school! You are about to undergo one of the biggest transitions you have had in your academic career. You will go from books and lectures to actual real patients with all the conditions that you have only read about until now (although the books and lectures don t completely go away). This is an exciting time and one that will remind you why you went into medicine in the first place. As you move through the year you will figure out a system that works best for you, but here is some advice to get you started: Survival. You need to remember to keep some balance in your life despite all the new things being asked of you. How much time you will spend in the hospital varies greatly by rotation, but you can expect anywhere from 8 hours to 12+ hours a day. It is easy to get wrapped up in the hospital, studying, shelf exams, and grades (not that anyone really completely understands where they come from anyway). Despite the increased time commitment, it is important to remember to do the things that are non-medical. Kimberly Hoang Things I ve struggled to learn this year: 1. No throwing anybody under the bus. It s my pet peeve. Under no circumstances are you ever remotely allowed to throw one of your fellow students under the bus. Don t be a know-it-all, make your fellow students look bad in front of the attending, engage in excessive brown-nosing of your superiors, or write all the progress notes at 3am and tell your chief resident you did all the work. I know you can t believe this would ever happen, but gunners, I m looking at you. Medical students need to stick together. There is enough room at the top for everyone to shine, so be a team player. 2. Play to your audience. There is no one right way to write a progress note, to give a presentation, to study for Shelf exams, etc. Every attending, resident, and team you are on will have different expectations and preferences. The faster you can adapt to a new way of doing things, the better you ll do. That goes for each rotation too. Each rotation has grading based on different criteria, so make sure you read that syllabus on the first day carefully. On some rotations like Surgery and Neuro, your evaluations don t carry nearly as much weight as your Shelf score, so study hard. On rotations like IM and Peds which are evaluation-heavy, make sure you know your patients well and stay on top of developments all day. Gold Humanism Honor Society 8 Guide to Clinical Clerkships 2011

10 3. You will be wrong. A lot. That s good because it means you are learning. Getting pimped is a good thing. It means you are LEARNING(!) and that they haven t forgotten the med student is still there. 4. Take time for your patients. The questions your attending cares about (What artery is in the round ligament? What are 12 causes of hypercalcemia?) are NOT the questions your patients care about. They WILL NOT care so much that you know achalasia looks like a bird s beak on barium swallow. They WILL care about whether the barium for the barium swallow tastes bad, which is totally legitimate. Your patients will ask you ALL SORTS of questions, things you will never encounter in textbooks nor be prepared for without any real life experience. Do not make things up. Instead, follow your patients to procedures like scopes and abscess drainages, ask them how traumatic the Go-Lytely really was, and spend some extra time in their room checking in. It may not be required, but hopefully you will be able to put a few of your patients questions and fears to ease in the future. 5. Shelf exams matter. 6. Be positive, even if it kills you. And what doesn t kill you makes you stronger. 7. You might get yelled at, even if you are just trying to help. See number 6. Hospital culture is a new culture to get used to. 8. Read. Read up on the case before you go into the OR. Read up on the diseases your new patient has. It is a privilege to be a part of patient care, so trying to be prepared shows you respect that privilege. It is hard to choose between reading and sleeping, though. 9. Blessed are the humble. Be humble and respectful to your attendings, residents, interns, fellow med studs, nurses, scrub techs, PCAs, the volunteers at the entrances with those buttons that say How can I help you? and most of all your patients. They are living through some pretty tough stuff and you probably don t really know what it feels like to have to go to dialysis 3 times a week or try to find a ride to the doctor s when you can t make it to the bus stop. 10. You will do great. David Lustenberger Although 3 rd year is a great escape from the purely academic focus of the first two years, the hours can get long, and not everything is rainbows and butterflies. However, in the grand scheme of things, being a medical student on the wards really is a great opportunity, for a number of reasons. In terms of staying positive, one instance that occurred at the beginning of my year has really stuck with me. I was on OB/Gyn, which is by most accounts is anything but a piece of cake. A few of us med 3 s were sitting in our cramped conference room; bleary eyed after our typical 5am whirlwind rounds, we watched the sun rise without any corresponding radiance of our own. As we prepared our notes and checked on labs, one of our attendings strode through the door with baffling cheerfulness. Good morning med students! (Your name will often be irrelevant). How are you all this morning? We managed to mumble a few good how re you responses while preparing to go see patients with him. He was unfazed by our lack of zeal. Better than the patients are, eh? Gold Humanism Honor Society 9 Guide to Clinical Clerkships 2011

11 Although his wording wasn t exactly the most delicate way of phrasing his attitude, I suddenly realized that my situation was really pretty great, especially with respect to some of the patients we were working with daily. Most patients are simply happy to be alive. The more I reflected on it, the more I realized that, as med students, we should be enjoying our time seeing patients, rounding, and assisting in procedures with such relatively low pressure. Residents, and especially attendings, have some pretty weighty responsibilities. Our responsibility is to help the team in any way we can, and also to learn the most we can. So, if you don t understand something, ask a question. Don t hesitate to make suggestions, because if you never bring something up, you may get all the way to residency before figuring it out. At that point you may figure it out AFTER you ve made the mistake, a mistake that might really matter. Gautam Mankaney Although the transition from Med 2 to Med 3 may appear daunting, you must remind yourself that you have been making similar transitions all your life from middle school to high school, high school to college, college to med school, and now Med 2 to Med 3. Your schedule is going to change. You are no longer taking classes in the morning or reading your ISP packets, or podcasting your lectures at double speed. Now, you will be working throughout the day, and studying for your shelf exams at night. Your first day or maybe even few weeks will be difficult, but that is expected. However, in time, you will learn to adapt to this new environment and will make the transition just fine. By reading this guide, you are already taking the initial steps in preparing yourself. For the first day of the rotation, make it to orientation on time (that s half the battle) and if you want, buy the books you want to use for studying in advance. Having to study for a shelf AND your days on the wards may sound impossible, but understand that by having your own patients, interacting with your residents and attendings, and being attentive on rounds, you WILL already be studying for the shelf. If you want (for emotional comfort), you can spend an hour each day reading one of your books. Be sure to take time for yourself everyday. It is possible; you just have to be proactive about setting aside time to do things you enjoy. For those of you type A students (i.e. [MED2013]), here is a rough schedule of your days on your rotations: Psychiatry 7am-4pm OBGYN 5am 6pm IM 6am 5pm Peds 6am 4pm Neurology 7am-4pm Surgery 6am 6pm Ambulatory 8am 5pm Those times are averages, but let s take one of the tougher ones and break it down. In OBGYN, your day will end around 6pm. That leaves you with three hours to study, exercise, and have some fun. You can be in bed by 9pm, and ready to kick butt the next day. PLUS, you have some of your weekends off too! And again, OBGYN can be one of the tougher rotations and you still had time to spare. Please remind yourself that everyone is in the same boat, and every year, classes survive. Use the same tools you used to survive your first two years of med school. Gold Humanism Honor Society 10 Guide to Clinical Clerkships 2011

12 Nisha Joseph Welcome to your clinical rotations! The first thing to realize is that your next two years in medical school will be a completely different experience than your first two. You may feel unprepared, but that is normal and completely expected. The good news is the learning curve is steep during Med 3, and even after a few days, you will notice improvement in your clinical skills. There are a couple of things to keep in mind that will hopefully make this transition easier. 1. Be prepared. One of the most dreaded terms associated with Med 3 and Med 4 is pimping. It can be intimidating, and lead to extremely awkward silences, but bottom line is it is part of the medical teaching culture and it will happen. It can be difficult to guess what you will be asked, but there is always some baseline reading and preparation you can do. Always know some basic facts about the medical condition of your patient. If you are on a surgical rotation, be sure to read the H&P before the surgery. If you are asked a question and you are unable to answer it, make sure you read about that topic in case you are asked again. Some attendings do this on purpose to test whether or not you have the initiative to go and read and learn on your own. If you are on a specialty rotation, such as Hematology, you already know generally what you will be asked. Take a little time before the rotation starts to read the Hematology section in StepUp or whatever book you are using. However, don t stress out if you get some questions wrong. If you knew every answer, you wouldn t be a Med 3. Ultimately, you are being evaluated on your improvement rather than just the amount of knowledge you have at baseline. If you show interest in improving, you will make a good impression. Even if you don t know all of the answers, try to at least offer some related information that proves to your attending that you are reading. They understand you are here to learn and they are here to teach, but at the same time, they expect you to put in the work as well. 2. Be respectful. Not just of the attendings and residents on your team, but of all staff in the hospital. Mainly, do it because that is just the right thing to do, but also because it will make your life easier. Some staff, such as scrub nurses, can be notoriously hostile to medical students. However, if you are polite and humble, and ingratiate yourself to them, it will be a more pleasant experience for everyone involved. The worst things you can do are think you are better than staff members and behave superiorly. Accept the role of the medical student. We are not useless, but we can be a little clueless. Embrace it, and just appreciate and accept any and all help you can get. 3. Be interested. Not every rotation is going to float your boat, but you need to show interest and curiosity. The residents and attendings are not going to be invested in teaching you if you look bored. These rotations for some of you will be the last time you are ever in an OR or have the chance to deliver a baby, so try to appreciate that for what it s worth and get the most out of the experience as you can. Try to ask questions and involve yourself in rounds and discussions. It s a hard and sometimes intimidating thing to do, but be a part of the team and involve yourself as much as you can. You will look better, and more importantly, you ll have a better time. 4. Be yourself. Attendings and residents have a lot of experience with students, so they can see right through excessively sycophantic behavior. Sucking up and throwing other students under the bus will not do you any favors. You don t need to be anything but yourself (or maybe just a slightly more enthusiastic version). Just work hard and worry about your own performance. Gold Humanism Honor Society 11 Guide to Clinical Clerkships 2011

13 5. Be compassionate. Some patients can be difficult and even less amenable to working with you once they realize you are a student. However, I learned this year how important it is to maintain your compassion. It is much too early in our careers to become jaded. Try to remember that it is impossible for you to fully understand where the patient is coming from, and strive to be as empathetic as you can. Sometimes as students we feel that there isn t much we can actually do for the patient, but we can listen. We may be the only ones on the team who have the extra time to spend with the patient, and sometimes a little extra attention can make all the difference. I hope these tips are helpful as you start to prepare yourself for Med 3. It is definitely a challenge and an adjustment, but learning to be flexible will just help you be a better clinician down the road. If I can get through it, you most certainly can. Help each other out, and make sure to have some fun along the way. Good Luck! Jeff Peck Third year is upon you. You did a lot of work over the last two years to get there, but most of you are undoubtedly pretty intimidated by the prospect of completely changing your day-to-day life. It is an exciting, stimulating, tiring, and occasionally frustrating time. Here are my general thoughts on how to approach Med 3. Ward Behavior. Be helpful. Be respectful. Be flexible. Help your fellow Med 3 s. Cover each other s backs. Basically, be a good team player. Survival. At times you ll be very aware of your place at the bottom of the totem pole. You ll also run into people who constantly complain, both your peers and your superiors, which can really embitter you if you let it. Stay upbeat and try to enjoy everything as best you can. Things may not seem very fantastic at the end of a 30-hour call, but having a good attitude can really help your experience. Additionally, try to keep your life going outside of the hospital. Go out to dinner with a friend on a free weeknight. Go hang out with people on the weekends. Go to the gym or do intramural sports with classmates. Basically, whatever your life was before third year, make sure you don t lose it. If you let it, third year can make your life no fun. It may seem like a lot to pull yourself off the couch after you get home from the hospital, but it s worth every ounce of effort. Gold Humanism Honor Society 12 Guide to Clinical Clerkships 2011

14 Roma Moza Surviving 3 rd Year Flexibility and positivity. This is the mantra you should remind yourself about everyday. Changing from service to service, having no idea what s going on, not knowing who your next team will be these are all daily occurrences during third year that you simply get used to. How? By remembering to be flexible, and being positive about having to be flexible! The joy of third year is that you learn through your interaction with patients. Your first/second year knowledge combined has given you enough of a knowledge base to allow the hospital to entrust you with patient care! You may be oblivious to medications and treatment plans (that you will later look up and learn), but you can always rest assured that you are an advocate for the patient. Whether it is something as simple as revisiting the patient in the afternoon to make sure everything is going well or something as critical as reminding the team of a pertinent drug allergy. You will battle with the feeling of not knowing anything (which will improve as the year progresses), but it is important to remind yourself of how much you DO know and how much has changed since you started medical school! Do not forget to do the things that make you happy. We all have lives outside of medical school. Whether this is spending time with your family, reading a good book, or partying downtown everybody has activities that have kept them centered through the grueling process of medical school. Don t let this change with the increased demands of third year. Prioritize your life, and know that you will do well in third year because you have already done well in first and second year. It might be a different learning environment than the first half of medical school, but you can rest assured that learning during the day, doing some reading (1 hour max) at home on a daily basis, and actively thinking about your patients and their management will gear you towards success in third year. Have fun! You will meet a lot of new and amazing people that have lots to offer. Enjoy their company and the unique opportunities offered to medical students. Go see procedures that you haven t seen before, ask if you can insert lines/pull tubes that you have never done before, meet the support staff in the unit and learn about the additional patient services. Everybody has great personal experiences to share, and learning about these will not only help the day go by quickly but also help you decide what kind of doctor you want to be in the future! If you have any questions, please feel free to contact me roma.moza@osumc.edu Sara Maguire How to Mentally and Emotionally Survive Med 3 Hello soon-to-be Med 3s! Welcome to the clinical years! I want to start off by saying that these years are really fun. Take advantage of all the neat things you ll get to see and do. And don t worry if you re ready for this. And you ll feel even more ready after you integrate all the info from the first 2 years with Step 1. Here are a few pointers, from me to you. Gold Humanism Honor Society 13 Guide to Clinical Clerkships 2011

15 The absolute first and foremost thing that I have to say is take care of yourself. Just because you re a third year medical student doesn t mean you can t eat, sleep, or do anything you enjoy. Make sure to stay hydrated on the wards. Keep a granola bar in your white coat. When you have the opportunity to eat (especially on busy services like surgery), do so! Even if it s 9am and you re not hungry cause you might not have time for lunch until 4pm. At times during third year you may feel like an elderly person eating dinner at 5pm and going to sleep at 8pm. That is ok! Take care of yourself get the sleep you need and it ll make studying that much easier when you have time to study. And definitely do things you like and things that relieve stress. For me, that s spending time with my fiancé, cooking, or going to the gym with a buddy of mine we work out on adjacent ellipticals and get to socialize while we re working out. Whatever it is that you like doing, find a way to fit it in even if it s every once in awhile. This will help you maintain your sanity! Andy Yoder Congratulations on making it to 3 rd year! Hope you are ready for the most exciting year of Medical School. Third year can be both the most challenging year and the most rewarding year of medical school. The rewarding part of third year is that you finally get to spend time with patients and you actually get to be part of the medical team. However, you will have days or will be on rotations where you find it hard to find your place on the medical team. The following tips helped me enjoy and get the most out of third year. Be Confident Having confidence in your ability to work with patients and the medical team will make a huge difference. You may feel, as do most third year medical students, that you are not prepared to be part of a medical team. Trust yourself, all the hard work during the first two years of medical school more than prepared you for this next step in your medical training. Be confident when doing a history and physical, presenting during rounds, and in your treatment plan for the patient. You may not always be right but you will be right 9 out of 10 times and being right with confidence goes a long way with residents and attendings. Your Peers Rule number 1, be a team player. Work together with your peers in seeing new patients or spending time in the OR. Take turns doing various procedures and when you find/hear new information about their patient, please tell them so that they can pass it on to the team. Residents and attendings love students that work together and it makes for a much better third year experience for everyone when doing so. Free Time Make sure to take time out of each day for yourself and get plenty of sleep. You will feel better, have better relationships with your patients, and the medical team and be more productive while being stress free. For myself, I worked out every day plus spent two hours each night studying and still got at least 7 hours of sleep no matter what rotation I was on. Make sure to be engaged and learn as much as possible from every rotation. The residents and attendings will not teach you unless you act interested. Finally, enjoy this year and make sure to take advantage of all the learning opportunities. Gold Humanism Honor Society 14 Guide to Clinical Clerkships 2011

16 Seth G. Holt Welcome to Third Year. You ve probably already heard this, but this year is going to be completely unlike your first two years. It will be amazing to finally really get a glimpse of what it is like to be a doctor. At times that will be even more inspiring than what brought you on this path in the first place and other times it will be overwhelming. You will get to interact with some really amazing people, patients and their families. Some of their stories will intrigue you and you will find yourself wanting to know how they are doing later. Others may try your patience and you will realize that, no matter how strong or logical the evidence is that you are presenting, they will do nothing to improve their health and lives. This will be the point where you will have to remind yourself of the multitudes of people who want help and that, with perseverance, those who deny it now may change. So talk to people and get to know them. Not as your new best friend, but as a human being who can provide you with many teachable experiences and as someone you can also have an impact on. This is true of staff as well. Every med student, resident, fellow, attending, nurse, and volunteer has his or her own stories, lives outside of the job, and opinions. It is important to remember that these backgrounds and experiences give each of these individuals different lenses from which they view other people and situations. Some may be courteous and respectful; learn by their example. Others may be judgmental or condescending; from these pull only the best teachings from them and leave their attitudes behind. You are not being formed into someone s clone, you are developing yourself into the best professional you can be. You are in control of your education for this year, from what you choose to read to what you choose to derive from the teachings of others. You will hear many examples of what worked best for other students. This advice is great to receive, but only by knowing how you learn best will you be able to succeed. This is true of the USMLE exams as well. On every rotation you are learning a brand new job in a short span of time. Make the best of it. You will never have the opportunity to be a pediatrician, neurologist, surgeon, etc, all in the same year ever again. Don t like surgery? Still don t ignore it, try to excel since, no matter what you become, you will deal with surgical patients at some point in your career and you need to know what they have gone through. That can be said for all of the rotations. This year will be a series of ups and downs. At times it will be great and you feel like you are really getting it. Other times will be low points, an I can t do this... or Why am I doing this moment. You are not alone. Not only has every physician gone through the same journey, remind yourself that you are surrounded by your peers who are experiencing the same thing. Be a support for others and rely on them when it is your turn. Be a team player and always say, What can I do to help? Ask for help, forge ahead and lead by example. You ll find inner strength that you never knew you had. Good luck, your goals are closer than you realize. If you have questions, shoot me an . If I don t have the answer, then we can learn together. Gold Humanism Honor Society 15 Guide to Clinical Clerkships 2011

17 Kelly Eagan Tips to Avoid Med 3 Burnout 1. Spend time with friends and family. Spending time with people who care about you and who encourage you can go a long way to help you re-focus and re-energize. For me, occasionally taking time to visit with my family in Cincinnati gave me an opportunity to have fun, to laugh, to relax, and just be myself. 2. Stay active. As we all know, it is important to incorporate physical activity into your lifestyle. However, with the rigorous schedule of most rotations, this can be considerably more challenging than it was during Med 1 and Med 2. I found that I was more motivated to stay active when I was somehow accountable to other people. I would make plans to meet up with friends at the gym, or to go for a walk while catching up with classmates who were on different rotations. Making time to stay active will help relieve stress, increase your energy level and help you avoid gaining the dreaded Med 3 fifteen. 3. Make healthy food choices. Maintaining a healthy diet during third year can also make a huge difference in your performance. Eating breakfast in the mornings will help you stay on top of your game when rounds go extra long and when your attending is testing your knowledge late into the afternoon. I would highly recommend packing your lunch, because sometimes you won t get a chance to officially take a lunch break or go buy food, but you may have time to eat quickly while you are working. I recommend setting aside Tupperware containers filled with leftovers to be packed for lunches, since it can be difficult to find time to put together a lunch from scratch when you are getting ready early in the mornings. 4. Get some sleep. You will be working long hours and taking on a role that can be physically, mentally, and emotionally exhausting. The best thing you can do to prepare yourself for the next day is to get a decent amount of sleep. 5. Relax and see the big picture. This is certainly easier said than done. With so much to learn every day and with the wide variety of lectures, workshops, projects, presentations, and other clerkship requirements and assignments, it is easy to become bogged down and overwhelmed with relatively insignificant details. While it is normal to feel nervous as you start a new rotation, focusing too much on small details can prevent you from fully appreciating the experiences and opportunities that you have during your clinical rotations. Third year is a time for tremendous personal growth, both in your knowledge base and your professional skills, and a time to build a better understanding of how different healthcare systems function. So try to relax and enjoy your experiences. This will make it easier to keep things in perspective and to focus on the most important and most relevant points. Keep your eyes and ears open, and take everything in, and you will be learning all of the time. Gold Humanism Honor Society 16 Guide to Clinical Clerkships 2011

18 Gold Humanism Honor Society 17 Guide to Clinical Clerkships 2011

19 Russell Legg Congratulations to each of you for the work you ve done so far in medical school. As we are given knowledge from this great school we are put in a unique position to help others, which can be a very gratifying experience. As students, our first significant opportunity to do this is during Med 3. I m pleased to have the opportunity to share a few tips about Med 3 that have helped me out. During Med 3 we begin a new rotation every 2 months and sometimes every 2 weeks. You will receive an orientation on day one, which is helpful but not enough. The additional information you will need can be obtained by asking the resident for additional expectations early. Without this you ll find that it took a week for you learn what you re supposed to do on that rotation. My advice would be to do two things. 1.) Ask the resident what is expected of you early (like the first or second day). 2.) After the first rotation block, try to find out which student just finished at the service you re going to. Take a minute to pick their brain about what your responsibilities will be. Once you know what you re supposed to do, another way to shine is to look up articles in UpToDate or PubMed and share them with your team. What should you look up, you ask? During the day topics will come up that the team has questions about. When you hear these, make a note and then take a minute later that night to find a paper that answers it. The next day you can casually mention the paper. You shouldn t have to invest more than 20 minutes on this and only need to do it a few times during the rotation. This will help you shine! I realize that much of the advice found here will seem abstract when reading it at the beginning of Med 3. Pull this back out after your first rotation and I think you ll find it more helpful. I would be happy to chat with you if you re wondering what to expect to have any other questions. Please shoot me an and we can talk. Congratulations again! Sara Maguire This is a tough one because every service and every team is different. It s ok to ask your resident and/or attending what they expect from you. It s important to find a balance between being assertive and interested and being in the way. Your team members are busy, so they may not have time to think, How can I involve the medical student. It s ok for you to say, Can I watch that procedure? or Can I scrub in on this surgery? If they say no don t take it personally, but they will respect you for showing interest. ALWAYS pay attention to what s being said and done. That way you can ask informed questions and answer questions when asked. If you want to be really prepared, you can find out what your attending s subspecialty is and read up on it. They love to ask questions and teach about their own subspecialty and they will love it if you know something about their greatest interest. Act independently whenever possible. Follow up with your patients in the afternoon after rounds. Look into labs that are pending and report the pertinent findings to your resident. If you have down time, read about your patients conditions. I ve found that the absolute best way to learn is to do this not just the chief complaint, but also any interesting disorder that your patient may also have and any associated or categorically related conditions. You will learn so much this way, and because it s connected to a name and face for you, and not a book, it ll stick much better. Gold Humanism Honor Society 18 Guide to Clinical Clerkships 2011

20 Vaughn Harris Success in the OR and Success with your Peers I know that sometimes students don t always have a positive experience in surgery. They feel slighted or looked down on, especially in the OR. I had a really positive experience in the OR and wanted to share some ideas my fellow gave me that really helped me work well with the nurses and scrub techs. She said that this is what a 3rd year student should do for a patient in the OR: Know the case you are going to scrub in on. Read about the patient and understand the basics of the procedure. If you can, review a few things in a pimping book like Surgical Recall so you know a bit more and can look better if the doctor engages you in a conversation. Before the case begins, while the nurses are getting the room ready, step in and introduce yourself to them. Every OR should have a whiteboard listing all the people participating. Write your name on the board with MS3 next to it and your glove size. Let the nurse and scrub tech know you will be scrubbing the case and offer to get your own gown and gloves for them. They often say that they can get it. Thank them and ask if there is anything you can do to help get things ready. Before the case begins, go meet the patient in the pre-op area. Usually, you will not have met the patient prior to their surgery, so go in and meet them. If you are there when the physicians come by, it s good for them to see you there. Offer to answer any questions you can for the patient (as long as you know the answers). If timing works out, escort the patient back to the OR with the nurse. You can help navigate the bed, hold doors, take the bed back out to the hallway once the patient is on the table, etc. Help get the patient situated. Offer to get blankets from the warmer or other things the nurses may need. Be happy and helpful and courteous. If you can, be present while anesthesia gets the patient to sleep. It s a chance to sort of see a lot of anesthesia without spending a whole rotation on it. Be in the OR when the physician enters, ready to help prep or scrub or whatever. Show interest in helping prep the patient and you will likely get to do more. When it is time to scrub, jump out a minute before the attending if you can and you ll be gowned when the attending is gowned. That s good. If you can t get out before the attending, let him/her gown first and wait patiently until the scrub tech has a chance to help you gown. Be extra conscientious of sterile fields and don t be afraid to step out and rescrub or gown if you need to. During the case, do what you are told to do. If your attending is open to questions, asking questions can sometimes keep the pimping to a minimum. After the case, when the physician leaves, stay and help get the patient out of the OR. You can go out and bring the bed back in the room, help roll or slide the patient onto the bed. Take them to recovery if anesthesia would like help. Then offer to help clean and sterilize the room. It doesn t take long, but that really impresses the nurses. If you show them you are not above cleaning up, they appreciate it. It s a chance to talk with them and let them get to know you better too. Offering to help clean up, I think, is the best thing you can do to get on the good side of the nurses and scrub techs. Gold Humanism Honor Society 19 Guide to Clinical Clerkships 2011

21 Then before you leave to do this all over again, let them know that you ll be in on the next case, and can you pull out your gown and gloves for them? Etc. Keep communication open, and always be willing to help. That was a lot, I know, but I really think those sort of things/attitudes really did me a lot of good on surgery. Just always be willing and offering to help. Be interested to find out about what the nurses and scrubs do, and you can help more and be more involved. The other piece of advice I have is in working with your fellow students. One of the students in the class ahead of me gave us some very good advice. Don t ever make your fellow classmates look bad. Treat each other respectfully and look out for each other. Help each other, especially when you notice someone struggling. Offer to help in ways you can. In fact, just yesterday, one of my classmates had finished his work and I still had a lot to do. He took my new complicated patient that I still had to work up and looked up all about his previous hospital course and stay in the ICU and made up a skeleton H&P for me to fill in, having already filled in the PMHx, Labs/Imaging, and the ICU H&P and Hematology consult note. It was a huge help to me and he covered so much ground for me. Specific pointers: Don t answer an attending s question that is directed at another student. Don t offer your ideas too often when discussing another student s patient. Instead, help each other look good in front of the residents and attendings. Anyway, your 3 rd year can be great, but a lot of its success is determined by how well you can work with others. Being helpful and happy makes others appreciate having you around. Getting people, especially nurses, on your side will make your 3 rd year so much more pleasant and will establish a pattern of how you will interact with a team as a physician. Peggy Williams This is a tough year because you are expected to work hard, learn a lot, and along the way, maintain a good attitude. Speaking to this last point: Think of this year as being like a job interview, every day. That is a lot to swallow, but you are constantly being evaluated. Be on your best behavior, be polite to everyone, be willing to take on tasks, and be timely about completing those tasks. All of these things will help put you in a good light in the eyes of the residents and attendings, and even if you don t say the most brilliant things on rounds, they ll be able to answer a lot of evaluation items favorably. Remember that you are part of a team, and that team includes nurses, PCAs, doctors, scrub techs, patients, and their families. Everyone has the same goal. The more you contribute to this goal giving the patient the best outcome possible the more valuable you are to your team. This may include glamorous things such as participating in a surgery, but it also might include helping a nurse push the patient s bed to another location, photocopying some documents to put in the patient s records, or running to get supplies when the resident or nurse needs them. Offer to help your residents every day. Be on the lookout for things that you are able to help with, such as calling an outside hospital to obtain a patient s records, calling the pharmacy to check on an appropriate dose or choice of medication, making appointments, going over discharge instructions with the patient, etc. The more you can show your residents that you are trustworthy and eager to help them with their work, the more responsibility they will entrust to you. Gold Humanism Honor Society 20 Guide to Clinical Clerkships 2011

22 Veda Bellamkonda On medical rotations, arrive at least an hour before rounds to pre-round on your patients. Gather their vital signs and lab data before you talk to them. If it s a new patient confirm their H&P by interviewing them yourself. Keep your presentations on rounds in the correct order the team will appreciate it and it will help you organize your thoughts. In your assessment and plan always report a differential diagnosis if the patient does not already have a diagnosis. Make sure you assess the patient yourself say what you think is the most likely diagnosis and why and report your own treatment plan. You have more knowledge than you think don t be afraid to put your ideas out there. Your afternoon will be spent writing progress notes, following up on imaging and labs, and updating discharge instructions. Try to have the most current information on your patient regarding new labs and imaging studies. Your residents will appreciate it if you keep the discharge instructions updated. If you didn t get to do a full physical exam on your patients in the morning, do so in the afternoon. If other medical students have patients with important physical exam findings ask the student to go over these with you. Pick up as many new patients in the afternoon as you can doing a full history and physical exam on a relatively undifferentiated patient is the best way to learn! Once you are done with notes and discharge instructions ask the resident if there are things you can help them with. On surgical rotations read up on your patients before you enter the OR. Each afternoon split up the cases for the following day with the other medical student/s on the team and then read up on the cases you will be attending. Read the patient s H&P and look at any pertinent imaging. Read about the patient s case in Surgery Recall most of the questions you will be asked in the OR are from this book. Know the anatomy pertinent to the case. Arrive to the OR a little early and ask anesthesia if you can intubate the patient. Ask to suture at the end of a case even if the resident doesn t ask you to. Ask if there is anything you can do to help with procedures on the floor for example if a patient is getting an NG tube placed ask to place it. In general, stay engaged and try to learn as much as you can on each rotation. Some days will be difficult, but try to stay as positive as you can. Overall you will have a very memorable year unlike any other! Jane Stremming 1. Be on time! 2. Don t be afraid to be wrong. This is a time for you to learn! Come up with a differential diagnosis and treatment plan for your patients. Most of your attendings won t care if you are wrong; they just want to see your effort. 3. Be a team player. Help out your fellow med students. Everyone will have a chance to shine, so don t sabotage each other. You will look good if your team looks good. 4. Don t be a Debbie Downer. You won t love every rotation, but try to be enthusiastic anyways. You will learn something, and it will make the rotation much more fun. Besides, the residents will let you do more if they think you are interested. 5. Ask questions, but at an appropriate time. Gold Humanism Honor Society 21 Guide to Clinical Clerkships 2011

23 6. Use your resources. The nurses and techs can be a great resource for students. Most of them have much more experience than us, and they usually know everything that is going on with their patients. Don t be afraid to ask them questions. 7. And most importantly carry snacks in your pockets! You never know when you will get the chance to eat, so it s nice to have a granola bar handy. Stephanie Tang Savoring Third Year Congratulations on finishing the first half of medical school! Classroom days will soon be behind you and the wards are waiting! Some may find the thought of third year daunting, but some may be looking forward to it with anticipation those patients that we mention in class will finally have some real faces! As I thought about what wisdom to impart, I looked back on the wisdom passed down to me and decided to share a couple that has really helped make the third year ward experience memorable and enjoyable: It s about the team. For each of your rotations, you will find a team consisting of attendings, fellows, senior residents, junior residents, interns, and other medical students. Sometimes there will also be case managers, social workers, and pharmacists. There will be large teams and small teams, but regardless of the size, remember that all of you are working together for the benefit of the patients that you are taking care of. Thus, making the team look good makes you look good. Working cooperatively with the other medical students and helping out your residents and interns will help you build better rapport with your team. Being on good terms with your team can help make a particularly difficult day (due to patients, pimping, etc.) a little bit better because your team will look out for you. When you put your team first, your attendings and residents DO see it, will appreciate it, and it will reflect on your evaluations. Show interest. We all have to go through rotations that we don t really care about, maybe even dread. Your residents and attendings did the same. Respect their career decision and the passion they have. Even if you will not be going into it, there is still much to learn from each field and who better to learn from than those who really care about the topic! Be humble. Needless to say, two years of classroom knowledge cannot compare with the practical experience those before you have. You will not have the all answers and you will make mistakes. However, rather than be defeated, learn from them and improve. Be teachable and your attending and residents will throw many clinical pearls your way. Get to know your patients - beyond their H&P. If you have free time in the afternoon (and some rotations do more than others), go and talk to the patients you re following. You will find that many of them love talking to students and hearing their stories will help keep you grounded. They will inspire you and help you remember why you are in medicine and make those long days a little bit brighter. Gold Humanism Honor Society 22 Guide to Clinical Clerkships 2011

24 Take care of yourself! If you don t take care of yourself, you can t take care of others. Thus sleep, spend time with friends and family, and do whatever it is that you enjoy so that you have a healthy balanced life and can bring that refreshed energy to your team and your patients. I wish all of you the best as you embark on to the wards! May you find third year rewarding in the midst of new challenges! Stephen Barman My greatest advice would be to remember that you are now part of a team. A strong team that works together is good for everyone: your patients, your attending, your residents, and for you. You will be on teams with residents and maybe even students that you have never met before. I would encourage you to use your time to branch out and develop new relationships. It can be hard, especially initially, to determine where you fit into the team, but work to add something to the team, even if you need to ask how you can help. A good place to start is to be an expert on your patients, prepared to answer and address any issues that may come up. You will most likely spend more time with your patients than anyone else on the team and as such you will be in a unique position to help. Third year is a special time when you will realize why you spend countless hours reading; that your patient matters above all else. Whether this means spending extra time explaining drugs, drawing pictures on the marker board, or talking with family members, you will finally be in a position to make a difference in your patients lives. Nick McKenzie Surviving Third Year Congratulations to all of you for finishing second year! I think that with the Step looming closer it s little consolation but you should be proud of how hard you have worked in and out of the classroom and how much you have learned in such a short time. Focusing our attention on what lies ahead in third year, I m not convinced we can completely subdue the anxiety that this transition seems to carry but hopefully our advice can give you a leg up on what you can expect and some tips to make your first rotation less intimidating. Let s start with some general advice: 1. The single best piece of general advice I think I can give is throw yourselves into this with enthusiasm. While there are definitely lots of great and fulfilling experiences in third year, often there is a lot expected of you from multiple levels and over time this will make you tired and anxious. When you feel like you re reaching your limit is when keeping your attitude in mind is important. There will be things you don t know, things you can t control, even bad rotations, but how you approach things is completely up to you and that choice can influence your experience. 2. Third year is FILLED with ambiguity. Can I wheel this patient up to their room? Where can I find an otoscope or tongue depressor on the floor? What does this person expect of me this month in order to help them? I wish there was advice to avoid this, but at the start of almost every rotation this is bound to happen. I guess I add this to legitimize Gold Humanism Honor Society 23 Guide to Clinical Clerkships 2011

25 what you ll feel at times and reassure you it s a normal part of third year. When you re not sure about something, ask you re not psychic and it s unreasonable to think you ll function like it s your last week on service on your first day. 3. Be flexible. There is always a food chain and we re somewhere near the bottom. This means that sometimes two different people will expect you to do two different things at once. For instance, a fellow is expecting you to scrub a case then your senior resident pages you to do an H&P in the ED don t get stressed out, use your judgment. Sometimes it comes down to who is evaluating you other times you should keep in mind who you work the closest with and do what they ask of so you re involved. Either way, it doesn t happen often but flexibility goes a long way. 4. Focus on work first, getting out early afterward. I am just as big a culprit in this as anyone in wanting my free time, but once I started viewing the workday this way I was less frustrated and able to invest my attention more completely. Along with that, I definitely appreciated a free afternoon more when I wasn t expecting it. 5. Try to build relationships with the people you work with that aren t physicians too. Remember names and don t be afraid to socialize a little if there is a lull waiting for a patient to get to the OR or your attending steps away on rounds to answer a page. From the circulating nurses and scrub techs, to the night nurses and pharmacists caring for your patients, they can all be assets to you doing your job well. Most services will last a month so you will likely work with these people often and the more comfortable they are with you the more you will be seen as a member of the team. 6. Have as much fun as you can. So much of your day-to-day is stressful it s important to remember it s okay to enjoy yourself while you re doing your job. Caring for people is what we have chosen to do for the rest of our lives, and that s what you ll be doing starting next year make sure you re finding some gratification in it! Rotation specific: OBGYN: Make sure you introduce yourself to all the women admitted on L&D at the start of your shift, as something may come up and you get to cover the delivery for another student. Also, don t be afraid to go back and check on people who are waiting to go into active labor, the more they see your face the more comfortable they are with you when the time comes. I would say along with that and this goes for all rotations really try to be proactive and anticipate what people will need. Warm blankets, saline, gowns, surgical gloves, tape, etc. Knowing where to find that stuff is great because when someone is asking across the room for something and you get right up and grab it for them it will go a long way. Along with things like that offer to wipe down operating tables and instrument trays and such the looks you get will be worth it alone, but little things like that make the nurses happy and they will put you in the right spot to do a lot if you are lucky and have shown interest and willingness to contribute. Blueprints and Case Files got me through the shelf on this rotation. SURGERY: You will work long hours but if you show enthusiasm generally it s rewarded in the end. Work on knot tying with someone coming off service (or off OB) and you ll be ready to help close, which is fun. Presentations are generally faster than medical services so don t be afraid when your senior residents start moving towards the room and you re still talking just finish up with the important things. Pre-op visit your patients and introduce yourself (also for OB) and make sure you talk with the scrub nurses prior to see if you can help or pull gloves/gowns. NMS Gold Humanism Honor Society 24 Guide to Clinical Clerkships 2011

26 Surgery and NMS Cases were what I used, along with that good old Essentials in Clinical Anatomy, and always brush up on local anatomy prior to seeing a procedure for the first time. MEDICINE: Reading is huge during this rotation. I recommend knowing what you re picking up in the morning and doing a quick scan on UptoDate to see if there is a good overview you will generally be asked questions following your presentations regarding pathology, treatment, and complications. Step-Up to Medicine is great, as is Case Files. I also used the MKSAP Question Book (provided by the department) quite a bit. PEDIATRICS: Get ready to have some fun! Kids are completely different than adults, from problems all the way down to vitals. Things to know early to shine: strep throat, otitis media, RSV, and asthma. If you know those things, even vaguely, walking through the door it will be helpful because you will see a lot of it and it can be helpful. Along with that I would say take care not to answer parents questions you don t know the answer to with certainty without the disclaimer you are not the end of the line. Lots of them will assume you speak for the attending and if something changes you get stuck holding the but he told me this. Never fun, even if it s just what day they will be able to go home. For this rotation Blueprints was decent, we have access to Nelson s (the Peds bible) on the Prior website. Also used Case Files and the CLIPP Cases were generally pretty helpful. NEUROLOGY: I don t have a whole lot on this rotation to offer but make sure you take advantage of the outpatient clinic days because they were some of the most interesting and informative for me. Along with that the clerkship director, Dr. Hoyle, is always available and if you need help he s a great resource. It is a tough shelf and is combined back to back with psych in the latter half of the day. I used Blueprints and didn t care much for it here, along with that I read through the Case Files and did Pre-Test Neuro questions. PSYCHIATRY: Psych is a really fun month. It is lower stress with a reasonable ability to contribute from the start with DIs and writing the notes. At first you may be apprehensive with the patient population but the more you just go with it the better it is for everyone and you get used to it. I would also encourage you to keep an open mind here and listen to your patients. Sometimes a legitimate complaint is disregarded as a consequence of their disease; always try to at least consider something because you are definitely in the position to advocate for your patient. First Aid for Psychiatry, Pre-Test for Psychiatry, and Case Files were enough for me. Mary Shull Things to have in your white coat pockets: (yes, it s going to be really heavy!) Stethoscope, reflex hammer, and penlight (residents/attendings never have penlights and will often be very glad when the med student does and lets them use it. If the one you bought at the bookstore doesn t work anymore, go to Target and buy the Energizer one for about $6 it s much better!) Driver s license and credit card (don t bring your purse unless there s a locker for you because it isn t safe to leave it lying around the hospital, even if it s in a conference room) Gum (your team will love you if you share it!), Chapstick, ponytail holder Lots of black pens, maybe a highlighter Gold Humanism Honor Society 25 Guide to Clinical Clerkships 2011

27 A little notebook to write down things you should look up later or things your attending teaches you that you might forget later Maxwell s (also has an eye chart on the back) Your itouch I keep a few papers folded up like a list of antibiotics and what bacteria each treats you will acquire things like this during your rotations and can pick what is good for you to carry. Things to have in your bag that you keep in the conference room: Review books to read if you have down time Granola bars for a quick snack I keep Tylenol, ibuprofen, and Excedrin all in my bag. It has saved me lots of times when I have a headache, and I have also shared it with residents, fellows, and other med students who are really grateful. I really recommend packing your lunch! Most people don t do it because it takes time in the morning to pack, but it is much cheaper, usually healthier, and faster to just grab your lunchbox when you don t have much time and can t always run down to the cafeteria. David Lustenberger So, on the wards, make sure you bring things up that you don t understand, or at the very least, write them down to investigate later. Enjoy being at the bottom of the food chain, because for the most part, you ll only elicit the ridicule of a resident or attending if you mess up but it typically won t have the gravity of a resident mistake. I m not telling you to go around wreaking havoc just because you re consequence-free. Simply try your best and be active and forward in your learning. A few more thoughts: Be polite and friendly all the time to everyone. Especially to anyone who rankles you. I remember once in the OR, I was scrubbed in, and handed the attending an instrument from the table. The scrub nurse brusquely told me I had bumped a non-sterile wire with my glove and gown, and I needed to go re-scrub. I was one thousand percent sure I hadn t, and I knew she had a poor angle to see where I was anyway. I was somewhat incensed, but no amount of argument would convince her otherwise (I had some scouting reports from other students), so I calmly walked out and re-scrubbed. Surprisingly, after the case, the attending actually asked me if I had contaminated myself, and I told her I hadn t thought so. She smiled and told me, That s the perfect way of handling it as a med student. Blessed are the meek. Be on time. On the wards, there IS such a thing as bad publicity. Don t be known for slacking. Gold Humanism Honor Society 26 Guide to Clinical Clerkships 2011

28 Write notes for the residents if you can. If you are too slow, often they will take over, but after the first few days of watching what the residents write, you should be able to get faster. On services where you typically type out notes (IM etc.), the resident your notes with plans and discussions, and ask them to critique them, if they have time. Never contradict an attending or resident directly unless you re 100% positive on a matter of life and death. Phrase it as a question, or say something like, I thought I had read I ve seen a few direct confrontations, and they are not positive for anyone. Think of directly confronting an umpire in baseball: it doesn t matter if you are right; you ll probably get thrown out of the game. Also, never contradict a fellow med student in front of others (duh). There is some gray area, though, when attendings start asking rapid-fire questions and the med student who was asked the question before you gets it wrong. I usually just answer questions to the best of my ability, regardless of what has happened leading up to it. However, never smugly blurt out the right answer if someone else got it wrong, unless you are directly asked. Most importantly: Talk to your patients, get to know them and what their life is like outside of the hospital. Walk around with them if you have time. When applicable, make sure they have an Incentive Spirometer and teach them how to use it (learn this yourself first). Offer to open their curtains. Simple stuff that sometimes people don t think about often can lift their spirits. Ask them for advice on how to be a good future physician. Obviously, read about their illness. Gautam Mankaney Must Dos: Show up on time. After your orientation (generally on the first day of your rotation), you will meet your team. They will tell you what time they would like you to come in. Work hard. You are there to learn, not to slack. Your residents/floor staff will let you know what they would like you to do. Dress well wear your white coats over your scrubs or dress clothes, depending on your rotation. Respect ALL staff. You can learn a lot from them, and it will make your life a lot easier in the end Smile. Don t stress Don t forget to eat. Bring snacks. Don t Do ANY of the following: Show up late Argue with your team members Think you are in charge and complete your tasks on your own schedule. Gold Humanism Honor Society 27 Guide to Clinical Clerkships 2011

29 Memorize all of the electrolytes and lab values for your patients because as a med student, you feel that you need to know the answer to any question the attending asks you. You should be able to report on how a patient is doing and the patient s treatment plan, and refer to your notes for any objective data. Outdo other members of your team aka gun. I don t define gunning by working hard, completing your tasks, and helping your team, but by making those around you look bad so that you look better. Everyone can smell out a gunner. In fact, your grade on rotations is often a reflection of your team dynamics and performance if everyone looks good, you will look good. *Hopefully, this is all obvious stuff Brownie Points: Read about your patients. Go to Uptodate.com to learn more about their medical conditions. Not only will your hard work reflect in your presentations, but you will also be studying for your shelf exams. PRESENTATIONS your presentations will be tailored to your residents and attendings. For example, some attendings preferred brief presentations focusing on important events overnight, while others wanted a more detailed plan. Prepare for your attendings. If you are to give a plan, follow the SOAP note template. It is ALWAYS good to offer your own plan. You will often be wrong, but your team will understand that, and ultimately it s the only way you are going to learn. It demonstrates your ability to transition from solely a reporter, to a clinician. Offer to help your team members when you can. Work with the other med students on your team. Ben Christensen Congratulations and welcome to Med 3-dom. Life is about to change, but if you are feeling anything like I was, anything is better than the library. My quick advice on rotations includes: Internal Medicine: This is truly the place to show what you know. Every physical finding, every piece of history, and every lab could be the key bit of information needed to help your patient or survive a pimping question. As I approached a new patient, I tried to work through the patient's differential, reading up on specific diagnoses and researching relevant tests for management. When I did this, the information seemed to "stick" a little bit better, leading to better presentations and better performance on the shelf test. While it isn't always possible to do this for every patient, tackle a few minutes of it every night and always have something to reference with you during the day such as pocket medicine, your itouch, or Step-Up to Medicine. If possible, run through your presentation with a friendly resident before you have to present at rounds. The residents are willing to help you identify the small details that the attending wants to hear. One of my residents shared this basic template with me to use for admission H&P's. Ideally students should have an hour to work up a new patient, but I found that this was rarely the case. To save time, I would quickly type in the information that I had available before seeing the patient from past notes, and then I could print it out the sheet and fill in the blanks during my interview. I could present quickly if I had to, or polish the note before submitting it later. Add details to tailor it to your specific service. Gold Humanism Honor Society 28 Guide to Clinical Clerkships 2011

30 H&P CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS REVIEW OF SYSTEMS No fevers/chills/sweats. No lightheadedness. No headache. No vision/hearing changes. No chest pain/palpitations. No SOB/cough. No abdominal pain, nausea/vomiting/constipation/diarrhea. No dysuria/frequency/urgency. No myalgias/arthralgias. No edema. No rash. No paresthesias. PAST MEDICAL/SURGICAL HISTORY MEDICATIONS ALLERGIES FAMILY HISTORY SOCIAL HISTORY PHYSICAL EXAM T P BP R O2 Gen: Laying in bed, NAD HEENT: NCAT. PERRL, EOMI. MMM. Neck: Supple, no LAD. No carotid bruits. CV: RRR, no m/r/g. Normal S1 and S2. PMI non-displaced. Pulm: CTAB, no w/r/r. No accessory muscle use. Abd: Normal BS, soft NTND. Ext: No edema. Skin: No rash. Neuro: A+Ox3, CN II-XII grossly intact, no focal deficits. LABS/STUDIES For complete labs/studies, please see eresults. Na K Cl CO2 BUN Cr Gluc Ca Mg Phos WBC Hgb Plat Hct Tot Bili Dir Bili Prot Alb ALP ALT AST ASSESSMENT AND PLAN Gold Humanism Honor Society 29 Guide to Clinical Clerkships 2011

31 Ob/Gyn: This was unique because it incorporates distinct 2-week blocks of gyn-onc surgery, benign-gyn surgery, and labor and delivery. All call is based on labor and delivery. BEFORE oncology, read Blueprints on staging cervical, uterine, and ovarian cancers. All call nights were spent in labor and delivery; make sure you ask your residents questions during these extended hours. These discussions will really help you get through the oral exam at the end of the rotation. Peds: Your happiness on this rotation (and the other ones as well) is based on your team. To improve the dynamics between you and your team, always stay involved. That means be available to help with a new admission, make follow-up phone calls, or write notes. Ask your residents for additional ways to help. Most importantly, consciously strive to keep positive even when you are tired. Psych/Neuro: The skills learned in these rotations will show up in every other rotation as well, so don't blow these off even if you aren't interested. First Aid for Psychiatry is a great resource for the psychiatry test. Consider working on a consult service for a different type of hospital experience. Ambulatory: This is a great opportunity to work closely with an attending. I asked for feedback daily, and felt like I improved over the course of a month. If they see you trying to incorporate their suggestions, they will reward you with increasing trust in your exams and better evaluations at the conclusion of your month. Even if your hours are a little shorter, don't slack off. The family med shelf is historically a tough one. Surgery: Although your relationship with your residents is always important, don't forget your fellow students. There is absolutely no room for conflict or competition. My best experiences with my classmates came when we helped each other through tough moments, and others easily see that you are a team player and will reward you. Show up at the same time in the mornings, and if reasonable, leave the hospital each day together. Never try to show off or make yourself look better at the expense of a fellow med 3 in hopes of a better evaluation. Good luck and remember to have fun. Keep a record of what you liked and disliked in each rotation; this will help guide you to the next big decision of what to do for the rest of your life. Enjoy! Paul Marcus A Few Words of Advice Congratulations on becoming a Med 3! Yes, starting your third year of medical school can be overwhelming. Everyone s experiences will vary from service to service. Even if two students take the exact same rotation, their experiences will be vastly different depending on who their attending is and which residents they will work with. The important thing to remember is that you are never alone in your rotations. It is extremely important to stay in touch with your family and friends throughout the year. Your fellow medical students are struggling with the new routine, just like you are, and are a great resource. Gold Humanism Honor Society 30 Guide to Clinical Clerkships 2011

32 Below are a few thoughts of increasing importance. Please do not be afraid to ask any of us Med 4 students specific questions that arise throughout the year. Odds are we dealt with the exact same issues a year ago. 1. Textbooks. Everyone has their own personal preferences. Your notes that you have accumulated the first two years of medical school are generally too detailed and not clinically oriented enough to be useful for your third year. Find a good general review book (Case Files, Blueprints, First Aid, etc.) that works for you and find a good resource for practice questions (USMLEWorld Step 2 questions, Kaplan practice questions, etc.) Most people tend to start using general review books at the beginning of rotations and then transition to practice questions closer to the time of the exams. 2. What to bring with you. Apart from the obvious (name badge, stethoscope, etc.), make sure you have at least two pens on you at all times. Your residents will borrow your pens and likely you will not get them back, so it is good to have spares. Keep a small notebook that can fit in your pocket to jot down issues that come up over the course of the day. Finally, for some services, especially surgical ones, one challenge is finding time in the day to eat. Find a snack bar you like that you can carry with you and quickly eat between surgeries. Another option is to keep some money in your inside scrub pocket so that you can quickly go buy food and not waste time running to your locker to grab your wallet. 3. Use all of the resources that are available to you. Remember that you are part of a team now. While you have many more responsibilities than you did your first two years of medical school, you also have many more people that are available to help you out. A scrub nurse was the first person to teach me how to prep a patient for a surgery. Another medical student taught me how to tie surgical knots. A janitor once warned me that one of my patients was becoming agitated and I was able to alert my team before the patient hurt anyone. If you are respectful and helpful to those you work with, they will repay the favor. 4. Have fun. Remember, this is the reason you came to medical school to practice medicine. There will be good days and bad days, but always remember that you are one step closer to finally becoming a physician. Enjoy the year, because believe it or not, it will fly by. Roma Moza Ward Behavior Do s and Don ts DOs Be positive. This may be hard at times, when the team gets frustrated about patient care, but as the medical student you have the wide-eyed innocence and enthusiasm that can help keep a team going. Gold Humanism Honor Society 31 Guide to Clinical Clerkships 2011

33 KNOW YOUR PATIENTS. The medical student often is the only one who can relay details of past medical history/home medications/laboratory test results when the rest of the team may not know. It s an opportunity to look good, and who doesn t want that! This includes a thorough H&P, quickly reading the most relevant UpToDate article regarding patient pathology, and paying attention to the patient plan and daily changes. Anatomy of a White Coat Keep your badge visible at all times. o Introduce yourself to the medical team, the social workers, and nurses so that you don t end up being called hey you or the medical student for the rest of the month. Always have a pen and highlighter. o Never lend your favorite pen out. You may not get it back. Always carry a stethoscope, penlight, and reflex hammer. o On Neurology you will additionally be carrying a tuning fork and (if you have one) ophthalmoscope. Pocket Medicine. Purchase it. Keep it in your coat. Use it. Maxwell s Quick Medical Reference. o (Given to you at the Student Clinician s Ceremony). White coat clipboard. o Not necessary, but easy way to keep your papers organized. Inside pockets o Credit card/cash (for quick getaways for snacks/meals). o Snack (for moments of hypoglycemia that inevitably will occur). o Notepad. Scribble down patient notes or topics to look up later when you get home. Respond to pages quickly o Make sure you know the sound of your own pager (yes, your team will actually page you for important things). Help out wherever possible. o Your first goal as a medical student is to learn from your patients. But if you have the time, help out! This can include communicating with nurses or helping with discharging a patient from the hospital. You re learning as a student, but you re also learning how to be a doctor! Have fun! Third year will provide you with some of the best stories of medical school, so enjoy the ride! Gold Humanism Honor Society 32 Guide to Clinical Clerkships 2011

34 Don ts STAY OFF YOUR PHONES FOR TEXTING AND S. o This will be hard because you will see interns/residents/physicians do it. Avoid the urge. It is also easy to tell if somebody s looking up medical information on their phone versus texting/ ing, so don t try to fake it. Never talk negatively about other members of the team or support staff. o This is a poor reflection on you. If you need to vent (which is an understandable part of third year!), wait till you get home and talk with your friends in the privacy of your own home. Never make your team look bad Inform your intern of patient updates, never withhold information to look good for the attending, this plan will backfire quickly and easily. Update other medical students about their patients if you hear an update that they missed, help each other look better and you will come off as superstars. If you have any questions, please feel free to contact me roma.moza@osumc.edu Gold Humanism Honor Society 33 Guide to Clinical Clerkships 2011

35 Gold Humanism Honor Society 34 Guide to Clinical Clerkships 2011

36 Russell Legg You will hear a lot of, study one hour per night, and I completely agree. One good way to help yourself do this is to make a study schedule that has which pages you should get done by the end of every day. The best way I found to do this is the Cram Fighter USMLE Step 2 ipod Application. It has all of the standard books that you re likely to use and will keep you on track. I also got a year s subscription to USMLE World and did practice questions throughout the year, something I would also recommend. Sara Maguire I learn best with questions, so that s what I did mostly. I used the questions in the back of Blueprints (though these are generally quite easy), Pre-Test (though these are generally quite hard!), Case Files, and for family med I used the AAFP questions that you get through a membership. I did not have time or patience to read through textbooks for each rotation (except ob/gyn. I knew NOTHING about ob/gyn so I had to start from scratch). And that was ok! You don t need to spend hours every night reading about these things. You will see a lot on the wards and as long as you read up on your patients, understand the reasoning behind your teams clinical decisions (very important!) and do some practice questions, you should be just fine. For books, I bought them for one rotation and forever after was able to trade with classmates. That s fine. You will never need these books again so why waste the money? Peggy Williams Welcome to your third year! It is fun, exciting, and you will learn a lot. Sometimes the amount of information you are exposed to each day may feel like you are trying to take a drink out of a fire hydrant. Here are a couple of study tips for trying to get key points that you learn on rounds and throughout the day to stick in your head. Print out a census of your service s patients every day. On rounds, write down all of the decisions made that day for each patient: for example, to change dosing of a medication, or to get a consult. Go through these items after rounds and make sure you understand why each decision was made. If you don t, ask your resident; most are happy to explain and are glad that you are taking an interest in each patient s care. Also use the back of the census to write down key points that are discussed during rounds or new facts you learn, like a side effect of a drug, or the significance of a physical exam finding. I also write down topics that came up during rounds that I felt rusty on, as a reminder to myself to read a little bit about that topic that night. At the beginning of the rotation, start a running document and jot down these points in the document. It will only take about 10 minutes each night. This becomes a resource that you can refer back to at any time to brush up on pearls that you ve learned along the way. You will be able to remember these points much more easily than items read in a book; you ll be able to imagine that particular patient and think about how each medical concept applied to that patient s care. Gold Humanism Honor Society 35 Guide to Clinical Clerkships 2011

37 Veda Bellamkonda Each series of books is set up differently but I think using any series is fine. The two main series of books used are Blueprints and Case Files. Case Files is organized by clinical cases and Blueprints is organized more like a textbook. My personal preference was the First Aid series. I found the information to be very high yield with helpful mnemonics. Though some of the First Aid books look long they are a relatively quick read. If I could go back again I would use First Aid for each rotation. I used Pre-Test as a source of questions for each rotation. Here are the books I used: Ambulatory: Case Files for Family Medicine, Pre-Test Family Medicine (given to you by the clerkship), online AAFP questions Neurology: Blueprints Neurology, Pre Test Neurology Psychiatry: First Aid for the Psychiatry Clerkship, Pre-Test Psychiatry Surgery: NMS Casebook, First Aid for the Surgery Clerkship, Pre-Test Surgery, Surgery Recall great for pimping Pediatrics: First Aid for the Pediatrics Clerkship, Pre-Test Pediatrics; the clerkship will give you a book with the normal ranges of vital signs based on age carry this around in your white coat Ob/Gyn: First Aid for the OB/GYN Clerkship, itouch Application: The Perfect Wheel (very helpful in clinic!) Internal Medicine: haven t had it yet but most students use Step Up to Medicine Have on hand for every rotation: Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine a small book you can carry around in your white coat very helpful to look up diseases, differentials, and treatment quickly. There is also a similar book for Pediatrics. The full form of Epocrates (with diseases, differentials, labs and drugs) for your itouch. It s a free resource through OSU and INCREDIBLY helpful. I use it on almost a daily basis. MedCalc application for itouch tons of incredibly helpful equations! Study Tips: Reading about your patients illnesses is a very effective way to learn and also a great way to formulate treatment plans for your patients. I would do this by first reading the pertinent section of the book I was using (First Aid/Blueprints) and then supplementing with an Up To Date article. I usually spent the first month of a rotation studying from First Aid, and then used Pre-Test during the first two weeks of the second month, and used the last two weeks before the shelf to review any weak areas. Shelf exams are incredibly difficult and I found it hard to be motivated to study after being in the hospital for so many hours. Don t get discouraged by how difficult the exams feel if you studied regularly you should do just fine on your exam even though it may feel like you are not doing well. Gold Humanism Honor Society 36 Guide to Clinical Clerkships 2011

38 Ben Abramoff Yay! Free ipods! Congrats on making it to Med 3. It s a great year and you ll learn a ton, whether you like it or not. There are ways, though, to enhance your learning experience and make everything a bit less painful and more efficient. I think the most practical advice I can give you is about some ipod applications and websites that can help you on the wards. But first, I can t help but give you some cushy general advice. Own your physical exam, bring a sense of this is what I find and this is what I see. Don t be afraid to describe what you notice and investigate it. Also, enjoy what you re doing now. If you keep waiting for two years down the road to be happy (when I finish med 2, when I finish med school, when I finish residency etc.) you ll never really be happy. Med 3 is full of ups and downs, good days and tough days, but the secret is to forget about the bad days and fully make the most out of the good days. If you re having a rough day, take the night off from studying and just go to sleep. You ll feel better. Before I get into specific apps, here are some tips about general ipod use. You ll find that you have many five or ten minute intervals that you won t be doing anything while on the wards. I find these times excellent opportunities to look up things I ve read about or the team talks about that I don t quite understand. Try to make it so there s nothing you don t understand. Every time you hear something you don t understand, look it up. It s really tough at first to keep up with all the new information but it gets better as you build your knowledge base. I find it helps to keep a notecard of things I plan to look up later when I get the chance. The sooner you look it up though, the better. Often you ll get home and feel exhausted and won t feel like looking it up. Also it s easier when it s fresher in your mind and in the proper context. The most important thing is to approach the year with a sense of curiosity. For my overall studying plan, I find that I get a quite comprehensive study plan looking up things throughout the day and reading further up on difficult concepts at night, working through a review book and completing a set of questions on that subject. It s important to recognize that it s very important to be tactful in your use of your ipod. I find a good time is when we re walking on rounds. I suggest trying to avoid it while someone s talking and never in a patient s room. You ll get the flow as the year progresses. You ll find that the ipod can be an invaluable tool, in many ways replacing your Maxwell or Pocket Medicine. Finally, don t be afraid to pay a dollar to try out a new app and share it with your friends. Without further ado, here s a list of some ipod applications that I ve found (or heard) have been useful. Occasionally having these at my fingertips has made me look much smarter than I actually am. Finally, if there is something you re looking for and it s not on this list, search for it. Chances are, there s something like what you re looking for out there. 1. Lexicomp (Free): I consider this the most important and useful application I have. It s a little confusing to get the hang of at first but I ll walk you through some of its features. First, you can use it to look up drugs. These detailed drug descriptions and guidelines are probably the most complete of any ipod apps with dosing, adverse effects, and fairly complete mechanisms of action. It also has the drugs organized by pharmaceutical category which you ll find is a great way to compare and contrast different drugs. Finally, Gold Humanism Honor Society 37 Guide to Clinical Clerkships 2011

39 the 5-minute clinical consult is a great reference tool for looking up disease basics on the run. It s almost like having Up-to-date on your ipod. 2. Epocrates (Free): I consider this the toned down version of Lexicomp. With the free basic version, it only has drug information and isn t as complete as Lexicomp. The one advantage is that it s a bit quicker to load and navigate to the drug you need. It also has a pill-id feature and drug interaction features (I don t really use these). 3. Eponyms (1.99 but I believe you can get it for free through the med school website): This is another nice free app. It s a list of medical eponyms (duh). 4. Diagnosaurus (.99): I love this app. You can look up different signs and symptoms and it will give you a list of some differential diagnoses that you might not have thought of for your patient. You can also look up diseases and possible differentials for that disease. 5. AHRQ epss (Free): Eh, this app is okay. It can give you some good preventative health measures for patients given certain demographic factors. It also has some good screening information. Probably best used in family medicine rotation. 6. USMLE Step 1 Flash Cards (Free to $$$): This is basically having USMLE First Aid for Step 1 on your ipod in flashcard form. I used this application a lot when studying for the boards and also use it while on the wards. It is priced on a per chapter basis. For studying for the boards I would go through a section of First Aid and then try to do the questions. This helped me confirm I was picking up the information in First Aid. It has cool features like marking wrong answers to come back to later. I continue to use it on the wards to refresh some of the basic science principals as well as for those times when you think, as in, I think I remember this from First Aid. 7. Mediquations (4.99)/MedCalc (.99): I use Mediquations and find it the best medical formula application. If you look under the More info tab it will also give you the actual equations and what normal values are. Some people use the MedCalc application although I don t really know much about it. It is cheaper though. 8. MedAbbrevs (.99): You would NOT believe the amount of medical abbreviations used on the wards. This application has hundreds of abbreviations and everyday you ll see an abbreviation not in this app. You won t need this app quite as much as the year goes on. 9. LabGear (2.99): Great, great app. Gives a list of different laboratory tests, reference ranges, thorough descriptions of the test, and different things that high and low values might mean. Very useful. 10. Instant ECG (.99): I just got this application a couple of days ago and haven t really gotten into it quite yet. It has a nice review of different ECG findings and example tracings. It s kind of hard to see on your ipod. 11. Med Mnemonics (1.99): This is a great list of medical mnemonics that you can filter by medical discipline or organ system. I never really used mnemonics very much as a first and second year but now that I have the basics under my belt it s useful to have them to help remember lists of tricky things like medication side effects or causes of nephritic syndrome. You can also add your own mnemonics. 12. NEJM App This Week (Free): Also an app that I recently got but I really like so far. Contains recent articles from NEJM, some images, and a few procedural videos. 13. University of Maryland Medical Center Medical Reference (Free): I haven t really used this application much but it seems like a nice reference tool worth checking out. Gold Humanism Honor Society 38 Guide to Clinical Clerkships 2011

40 14. Text Page (2.99): I don t personally use this application but some people really like this application. It lets you text page people directly from your ipod. Also allows you to save contacts for quick and easy paging. 15. Doctor Derm (Free): Nice dermatology reference with a comprehensive list of conditions. Most of the conditions have small but nice accompanying images. 16. SkyScrape (Free): This is basically an application that houses medical books that you can purchase onto your ipod. I don t use this app but I ve heard it contains some pocket manuals and other nice resources that can come in handy. 17. Med Games: I like the Speed Bones, Speed Anatomy, and Speed Muscles games. They re a moderately fun way to do some reviewing without feeling like you re studying quite as much. Prognosis: Your Diagnosis is also a game that gives you cases and basically asks you what you would do. For the nerd in all of us. 18. Words with Friends (Free): Not really a medical application per se, but can be used in particularly slow lectures. Basically scrabble with your friends online played one turn at a time. Good way to stay connected to friends on different rotations that you might not see quite as much. 19. Other Apps I ve Heard are Good But Don t Have (Yet): Medscape, imurmur2, USMLE Buzz, Iradiology, Medpage Today. Papers for Mac Users. Also a long list with descriptions can be found at Websites That are Useful: UptoDate.com- Definitely a go-to resource for looking up stuff about different diseases. Here s a tip from Paul Marcus in accessing outside the hospital: If you access any UptoDate article while on campus, there is an option to the article. When you do so, you can check the option to send a free trial offer with the article to the recipient. With this trial, you can access articles off campus. You are limited to a 1 month trial per address, but there is no limit to how many different addresses you can use." Prior Library website: Good stuff in the core 25 and other databases like access surgery. Elementary ECG (just Google it and it s the first entry, good ECG resource) Rale Repository: Good lung sound reference RedAtlas: Retinal and eye images Pronounces different medical words LabTestsOnline.Com: Very comprehensive lab test website Good review of how to evaluate research evidence Also check out NEJM procedural videos on the NEJM website I hope this info was practical and helpful. If you have any questions or concerns feel free to e- mail me at Benjamin.Abramoff@osumc.edu. I d also love to hear of any apps that you find particularly helpful. Good luck next year, you ll have a great time. Gold Humanism Honor Society 39 Guide to Clinical Clerkships 2011

41 Joe Meyerson Strategies for Med 3 About Med 3: I can t stress this enough even though you have heard it before; make sure you take the time to do things other than clinical work. Exercise, watch TV, make dinner, and meet up with friends or any other activity you enjoy. You are going to be busier than you have ever been and some days you'll just be too exhausted to crack a book. Realize that there will also be days when you will be working from 6am to 6pm and have to come home and study. To do well on a shelf and a rotation for that matter you have to be consistent. Chip away at the material over the 2 months. Spend at least an hour a night reading or doing practice questions. What to Study: Obviously, everyone one studies differently and there is no right way to study. But I will say that by the time you're done studying for Step 1 most people are going to agree that doing Kaplan or USMLEWorld questions was the highest yield. This will carry over to Med 3. Amongst the grind of long days and constant learning on the wards, coming home and reading a textbook is not that appealing. Using one of the popular question books or purchasing a question bank (like UW) is necessary. Doing as many questions as possible each night and reading the answers is much easier to process than reading paragraphs of information. How to be Efficient: Always have study material with you or nearby. Having a question book in your white coat may give you a hunched back with shooting neck pains, but it is critical. I can't count the number of times I have studied in minute increments sitting and waiting for rounds to start or for a patient to be brought back to the OR. Learning to study anytime and anywhere during the day adds extra time studying or even better can give you a night off. How to Study: This is just one way to study during a 2-month rotation. It is smart to spend the first 3-4 weeks in a rotation and try and read through a First Aid or Blueprints type book that highlights diseases important to that specific rotation. The reason this is important is because you will have to learn/remind yourself of the basics of each rotation. Once you have the basics down, doing practice questions will teach you how to answer the questions on the shelf. For example, reading information in First Aid or Blueprints will tell you that the workup for a 42 year old obese women with five children and RUQ pain, likely due to gallstones, involves getting certain imaging (CT, US, X-ray). This is good information and important to know, but on the shelf the question will ask what is the initial step in management? So unfortunately knowing all the imaging done for gallstones does not tell you that ultrasound should be ordered first. This is what doing numerous practice questions will help you learn. Summary 1. Freshen up: spend the beginning of the rotation refreshing on material (First Aid, Blueprints, etc.). 2. Be a turtle, not a hare: study a little everyday. 3. Preparation: whenever you have downtime, study. Studying in bits adds up over time. 4. Do questions, do questions! Gold Humanism Honor Society 40 Guide to Clinical Clerkships 2011

42 Here is a list of resources that many people use for different rotations: Ambulatory Resources Case Files Family Medicine Step-Up to Medicine Family Medicine: Pre-Test The Resident s Guide to Ambulatory Care Blueprints Family Medicine Internal Medicine Resources Step-Up to Medicine MKSAP Case Files Internal Medicine Neurology Resources Blueprints Neurology Neurology: Pre-Test Case Files Neurology Psychiatry Resources First Aid for the Psychiatry Clerkship Psychiatry: Pre-Test Case Files Psychiatry Obstetrics & Gynecology Resources Case Files Obstetrics & Gynecology Blueprints Obstetrics & Gynecology Obstetrics & Gynecology: Pre-Test Hacker and Moore s Essentials of Obstetrics and Gynecology Pediatrics Resources Blueprints Pediatrics Pediatrics: Pre-Test Case Files Pediatrics Surgery Resources NMS Surgery NMS Surgery Casebook Surgery Recall Gold Humanism Honor Society 41 Guide to Clinical Clerkships 2011

43 Jane Stremming General: Study for an hour each night. I know this sounds easy after studying for boards, but after a long day in the hospital, studying is the last thing you ll want to do. Just do it; you ll be thankful come test time. If your patient has an interesting disease, read about it! Not only will this prepare you for your shelf exam, but it s also nice to dominate a pimping session every once and a while. Book Suggestions: Helpful hint: Buy books for your first rotation and trade with your friends for the remaining rotations! Pediatrics: Blueprints, Case Files, and Pre-Test Psych: First Aid for Psych and Pre-Test Neuro: Blueprints, Case Files, Pre-Test Surgery: NMS Textbook, NMS Casebook, Pre-Test, Pestana review o Some people also used Surg Recall, but I really didn t care for it. OB/GYN: Blueprints, Case Files, Pre-Test Family Med: Case Files, Pre-Test o You ll get a copy of Pre-Test on the first day, so don t buy this! Internal Medicine: I haven t had this yet, but Step Up to Medicine is supposed to be helpful. Matt Flynn Study Suggestions Family Medicine You have a lot of lectures during this clerkship, so that will help with some of the basics. I personally used Case Files as a primary resource. There is also an ambulatory section in Step Up to Medicine that is pretty good. As far as practice questions, they will loan you a Pre-Test book, but I found the free AAFP online questions to be sufficient and very representative of the shelf. Be aware that family medicine is a pretty all-encompassing specialty, and that is true of the shelf you will see OB-type questions, orthopedic questions, pediatric questions etc early in the year when your knowledge base isn t as strong, doing well on this shelf will probably require a little extra studying. Internal Medicine The primary must-have text for this rotation is Step-Up to Medicine. They will also loan you a MKSAP text and MKSAP question book. The MKSAP text is pretty decent, but Step-Up is probably the only book you will really need to reference. For practice questions, I felt the MKSAP question book is actually quite good and representative of shelf questions. You will probably hear other students using USMLE World Q-Bank for practice questions, which is Gold Humanism Honor Society 42 Guide to Clinical Clerkships 2011

44 certainly an option if you want to spend the money. If you don t, the MKSAP questions are enough in my opinion. Most people would probably consider this one of the more difficult shelf exams depending on what time of the year you encounter it. Pediatrics Another clerkship with a number of lectures, not to mention mandatory CLIPP cases. Aside from those learning opportunities, most everyone uses Blueprints Pediatrics for a primary text. I personally found the Pre-Test questions to be good practice on this clerkship, and representative of the shelf. I hesitate to call any shelf easier, but students tend to do a little better on this shelf, and I feel it has a few more straightforward questions than some other shelf exams. Surgery Most students use NMS as a primary text I had the actual NMS textbook, but a majority use NMS Casefiles. Another fairly useful book is Surgical Recall I wouldn t really recommend studying from it for the shelf, but it definitely comes in handy when trying to quickly learn the most important facts you will probably be pimped on in the next surgery. A random file floating around the internet known as Pastana s Review is actually a really good resource for learning the basic things you absolutely need to recognize in test vignettes. Finally, people use various question sources, including USMLE World once again. I personally used Appleton & Lange, which despite a horrible editing job and various typos, was really a pretty good book. Most people feel this shelf is a bit easier if you have already done internal medicine, as the test focuses more on the medicine of surgery rather than any surgical procedures. Psychiatry I m on this rotation right now, so take any advice here with that in mind. People seem to mostly use First Aid for Psychiatry as a primary text. The recommended textbook, Introductory Textbook of Psychiatry, seems pretty good too for people who like a bit more detail. For questions, Pre-Test seems to be a popular choice. So again, congrats, best of luck on Step 1, and welcome to the clinical years! If you want to know anything else, feel free to ask me! Stephen Barman I purchased a question bank for the entire year. I found this to be helpful to test your knowledge as you work through each rotation. As you work through 3rd year you will figure out which books are most helpful to you. It also works great if you can buy books among a group of friends and then trade as you move through the year. These are the books that I found helpful in each rotation: Surgery: I used NMS Surgery, NMS Casebook and Case Files: Surgery. I also thought the Pestana review was helpful to provide an overview of the most important topics. Surgical Recall is a good book for possible pimping questions, but I didn t find it as helpful for shelf studying. Ambulatory: Case Files: Family Medicine and the ambulatory chapter in Step-Up to Medicine. Pediatrics: I used Pediatrics: Pre-Test, Case Files Pediatrics and Blueprints. Medicine: For this rotation you are given two text books, a question book and a text book. I found both of these to be useful in addition to Step-Up to Medicine. Gold Humanism Honor Society 43 Guide to Clinical Clerkships 2011

45 Psych/Neuro: I have yet to finish this rotation. For psychiatry I am using First Aid Psychiatry, Case Files Psychiatry and Psychiatry: Pre-Test. The recommended text, Introductory Textbook of Psychiatry, is a useful resource, but perhaps too detailed for general studying. For neurology I will be using Blueprints Neurology, Case Files Neurology and Neurology: Pre-Test. OB: I have yet to do this rotation, but I ve heard that Blueprints Obstetrics and Gynecology, Case Files Obstetrics & Gynecology and First Aid for Obstetrics & Gynecology are helpful. Mary Shull You guys will hear this again and again, but it really is a good idea to read for an hour each day when you get home. An hour a day really doesn t sound like a lot when you ve just finished studying for Step 1, but there will definitely be days when that just isn t possible. On those days, try to at least look up things relevant to your patients (learn about the diseases they have, medications they re on, surgeries they are having, etc). These are topics you re likely to get pimped on, and even if you don t, it really helps you understand what is going on so much more. I keep a little notebook in my white coat pocket and jot down things I need to look up later. It s also great for writing down things you learn on the wards but might forget later! Each rotation recommends a textbook, but most people use review books. I really like the Case Files series. Each Case Files book has cases that each start out with a one page description of a patient and some questions and then there are a few pages explaining that disease and other similar ones and how you should manage them. The Blueprints books are set up more like a textbook, with chapters based on different organ systems or topics. They are good references, but sometimes can be too much (or too little!) detail. The Pre-Test books are also popular. They are question books with long explanations of which answers are correct and why. Up To Date ( is a great resource for many questions you might have about diseases and treatments. It is a more respected source than Wikipedia but usually just as quick and easy to read. These are the books I specifically used for each rotation: Pediatrics: Case Files and Pre-Test were the best for Pediatrics. Blueprints was okay, but it was limited in detail in some areas and had too much in other areas. It was really difficult to get through. There are a lot of lectures in Peds which help with learning. They also require you to do CLIPP cases online, which are helpful but take 45 min to an hour each so definitely don t put them off until the end of the rotation. Internal Medicine: Step-Up to Medicine is the best book for internal med, and it is also really helpful for other rotations (family med, neuro, etc). They give you a book of MKSAP questions, so don t bother buying Pre-Test for this one. They also give you a MKSAP book that is like a textbook, but most people use Step-Up instead. A lot of people bought Pocket Medicine (the Massachusetts General Hospital Handbook of Internal Medicine), but I didn t and felt like it was fine to not have it. It seems like something to buy as a 4th year sub-i or intern in Internal Medicine. Psychiatry: First Aid Psychiatry is very good for the shelf and very readable. The quizzes that you do each week are also great, and it is a good idea to go over them again before the shelf. Gold Humanism Honor Society 44 Guide to Clinical Clerkships 2011

46 Neurology: I thought that the Neurology Blueprints was one of the better versions of Blueprints. I thought Neurology Case Files was one of the worst Case Files though. It hasn t been updated in awhile and seemed to contain a lot of irrelevant, minute details. Neurology Pre-Test is good. OB/GYN: Blueprints OB/GYN was also one of the better versions of Blueprints and is a great overview. I also really liked Case Files OB/GYN. Surgery: NMS Casebook has a lot of little cases and information about the management of key diseases. NMS Surgery contains the same information in more of a textbook format with a lot more detail. It s probably best to read both, but you probably will only have time to get through NMS Casebook and use NMS Surgery to look up specific things you have questions on. Surgery Pre-Test is very good. Surgery Recall is a very handy book to look at in between cases. It is written in question and answer format and includes many of the questions you will get pimped on during cases. I have heard it isn t as useful for the shelf, but I haven t taken this shelf yet. Family Medicine: I haven t had family med yet, but I have heard that Case Files, Pre- Test, and the ambulatory section of Step-Up to Medicine are good. I have heard that the family med shelf is one of the hardest because it is so broad and can include questions about anything. David Lustenberger Case Files were my favorite because much of the reading you can get in during the day is fitful at best; so nice little packaged cases were something I liked. USMLE WORLD question bank is pretty good, particularly for IM, in my opinion. All the other books people will talk about are good if you read them. The four SHELFs (I used to think SHELF was an acronym, like, super hard extra long final) I have taken: Family Med: This is quite the hodgepodge test. Asthma, CHF classifications, and derm were the big things I wished I had studied better, specifically, the presentation of acral lentiginous melanoma in non-caucasians. Oh well. OB/Gyn: Make sure you have some basic knowledge of female urogynecology, which isn t quite covered during the rotation. I remember wishing I knew how to approach wound infections and dehiscence after taking this shelf. IM: Do as many USMLE World questions as you can, if you have it. Use the question book they give you, which is pretty good too. The most common cause of perforated esophagus is iatrogenic. Surgery: Similar in some ways to IM. You don t need to know the obscure or detailed surgeries your attendings will love to discuss, or the names of all the different types of hernia repairs. Usually, just know when to perform surgery vs. watchful waiting (or CT, MRI, etc). In general, swallowed foreign bodies below the diaphragm should be left alone, and those above the diaphragm can be retrieved, using some kind of catheter or endoscope. Stuff like that. Gold Humanism Honor Society 45 Guide to Clinical Clerkships 2011

47 Gautam Mankaney What books should I buy? How can I be sure to do awesome on my shelf exams so that I have higher chances of getting Honors on all my rotations? By now, you may have noticed that during your first two years of med school, each student had their own personal study style. Some relied on the course packet and lectures, some lectures and books, some books, among other permutations. Yet, you passed your first two years. Med 3 is the same. Of course, there are books that have been more beneficial than others, and I will list what I used for each rotation below. But first, I want you to know that I learned a majority of the material from reading on Uptodate.com about conditions that my patients had and learning from my residents and attendings. The most common books used for the various rotations were Pre-Test, FirstAid, CaseFiles, Blueprints and, USMLE2 bank questions and it seemed as though everyone had their own preferences. Pysch Pre-Test, First Aid. Neuro Blueprints, Case Files OBGYN Case Files, Online Questions from ACOG website (they will give you this) IM USMLE2 bank Questions, MSKAP Questions, Step Up To Medicine (only as a reference!) Surgery NMS Case Book, USMLE2 bank Questions, Pre-Test. Half the students used the NMS textbook, half didn t. Family Medicine Questions from website they will give you. Case Files, Blueprints Peds Case Files, Blueprints, USMLE2 bank Questions A good guide to go by is to read for an hour each day. I generally spent the first two weeks studying for rounds (learning how to deliver presentations and about the most common medical problems my patients were having), which also counted as shelf studying. I then spent the rest of the rotation shelf studying, anywhere from 30mins-60mins/weekday and 2-3hrs on the weekends. Jeff Peck General Suggestions: Questions are a great way to learn. For this reason, I used USMLE QBank, which has a couple thousand questions. I used this for all the rotations. It was particularly helpful for surgery questions. I haven t yet taken the peds or ob/gyn shelf exams, so I can t speak to how applicable the questions are for those areas. Also, I m generally impressed with the Case Files series; so going through those for each rotation would be helpful. Finally, try to study a little every day. Just minutes will help you in the end. Cramming is no longer possible in third year. Planning ahead is vital. Neuro/Psych: First Aid for Psych and Blueprints for Neuro were good reference books. I ve heard that Pre-Test for Neuro is helpful as well. Gold Humanism Honor Society 46 Guide to Clinical Clerkships 2011

48 Internal Medicine: Use the MKSAP book they give you. I also went through a lot of Step-Up. Do as many questions as possible, so use Pre-Test or QBank. This is a difficult shelf exam. Surgery: I went through the entirety of NMS Casebook and Pestana Review. I also used the NMS textbook as a reference tool. Surgery Recall is good for pimping questions in the OR, but it s not something you should use in studying for the shelf. Family Med/Ambulatory: I used Case Files, Pre-Test, and Step-Up as my study tools. Peds: I am currently on this rotation, so I can t speak to it based on my own experience. I m using Peds Blueprints, Case Files, and Pre-Test, which seem to be good. OB/GYN: I haven t done this yet, so can t offer an opinion. I hope these thoughts help. If you have any questions, feel free to contact me and I ll do my best to help you out. Good luck and have fun. Roma Moza Ob/Gyn Surgery Resources Blueprints Case Files ACOG Questions Oral Exam: Case scenarios and PDF (provided to you through Carmen) NMS Casebook Surgery Recall Pestana Review USMLE World Questions Study Tips Use Case Files for day reading at the hospital during down time. Read through Blueprints in the evening (excellent resource for Ob/Gyn). Do not get nervous about your oral exam, read through the 20 case scenarios they provide you with (the 3 questions in your oral exam will come from there). Surgery Recall is good for reading in the day when you just want to read factoids. NMS Casebook is a good read and easier than the NMS Surgery textbook (although if you have the dedication to read the textbook, do so). Internal Medicine Neuro ****Step-Up to Medicine**** MKSAP Questions/Pre-Test Blueprints Pre-Test Do questions and Pestana review towards the end of your studying for a quick review. is a great resource for reading up about your patients and operations that you will be observing. Read Step-Up to Medicine. If you can get through this entire book, you are golden. Read during the day during down time and you will find ample free time in the week!! Gold Humanism Honor Society 47 Guide to Clinical Clerkships 2011

49 Psych Pediatrics Family Medicine First Aid for Psych (can also read Blueprints if time) Pre-Test Case Files Pre-Test Nelson Textbook of Pediatrics Case Files Ambulatory Section of Step Up to Medicine AAFP Questions First Aid for Psych is a nice review and relatively quick to get through 2-3 iterations through the book would be sufficient for shelf studying. Know your drugs especially SSRIs and anti-psychotics with their appropriate side effects. You can try to get through blueprints, although it is a bit dry/difficult read. Case Files/Pre-Test go quickly, and Pre-Test is a good indication of the level of difficulty of the shelf exam. Use Nelson s as a reference to read about patient pathologies/diseases not as a study textbook. Consider it the outpatient version of Internal Medicine. Management of chronic disease, etc. Make sure you do questions and don t underestimate the volume of knowledge required for this exam. Additional Study Tips: Read starting from Day 1. This will be VERY hard to adhere to, but will be a great pay-off as the shelf exam comes closer. Do not read in order. Read things based on what you saw that day. o Nothing will stick better than seeing a patient with post-partum hemorrhage and then reading the chapter about it later. Rounds. It may seem like they take forever on certain days, but actively think as they discuss patients. Why is this patient going on lasix? What do they think the differential diagnosis on this patient is? What are they ruling out? o If you actively think during the day and ask questions about patient management, you will learn a plethora of information without realizing it. Gear yourself into test-taking mode in the last 1-2 weeks prior to the exam so you understand the time management required for the exam. If you have any questions, please feel free to contact me roma.moza@osumc.edu Gold Humanism Honor Society 48 Guide to Clinical Clerkships 2011

50 Gold Humanism Honor Society 49 Guide to Clinical Clerkships 2011