One students Perspective of Med 3

…Scheduling, Boards, Hospital, Call, Rounds, Presentations, Career, Letters, Interviews, Match, Doctor?

Disclaimer

The following slides were made and edited by Students, not faculty! The content is meant to give a general feeling for each of the rotations. For accurate information on requirements, expectations, grading, etc. for a given clerkship, read the information received from that clerkship. If any of the information here conflicts with information from the clerkship – go with the clerkship! You’ll receive ample instruction about expectations and the most current information during an orientation that takes place at the beginning of each clerkship.

STRESS

You are entering a challenging part of your medical school training

It’s OK to be nervous

Objectives

Scheduling for 3rd Year What is life like on rotations? Is 4th Year equally as terrible?

Two absolute truths

1) No schedule is perfect – You can make a very good argument for just about any schedule.

2) In two years, you will be doctors …unless you are doing a PhD, MBA, MPH, International Health, etc

First Decision

The first major decision often made when choosing a career path is will you do a surgical specialty or a medicine specialty.

Surgery or Medicine? Both? OB/GYN Neither? Radiology

I want to do Surgery (inc sub-specialties)

Try to do OB/GYN and Medicine first– OB – There are a lot of pelvic surgeries done on

your months. You get a feel for the OR (where to stand, how not to get yelled at, learn to tie knots)

– Medicine – The surgery shelf exam has typically been heavy with Medicine content. It has a lot of post-op complications commonly seen on the floor.

I want to do Medicine

A few schools of thought– 1) Consider doing PEDs before – Children’s is a

great Hospital, you’ll learn to do H&P’s, manage less complicated patients – unless you want to do PEDs, than you could switch those

– 2) Also consider doing Family Med before – learn how to manage common problems usually seen on Gen Med floors

What about OB?

Consider trying to do surgery beforehand. Knowing how to handle yourself in the OR will be important on OB.

Also Medicine would help prior– OB patients are traditionally not complicated

(young women with 1-2 chronic issues at most), but knowing how to manage would be useful.

Scheduling

July/August – first time, nice weather September/October – football season November/December – shortest rotations January/February – grind March/April – What about 4th YEAR?!! May/June – potential burnout

Does it Matter When?

It can help to have some rotations at some times, but really each has it’s benefit at any one position.

Typical Day on Each Rotation- Surgery

Arrive – 5:30-6 AM– You’ll get an orientation, but previous students

have:– Pre-round on your patients– Vitals!– Scrub in/assist on cases – Repeat for 2 months

Surgery

OR- Time in the OR is dependant on each rotation.

Rounds– Very different than most other rotations

Patients identified by operation type and how many days ago it was. Ex – Mr Smith is a 75 y/o male POD3 s/p partial sigmoid colectomy with anastamosis.

May get a few questions on rounds, most are in the OR I/O’s and Fever curve

Surgery

HOME Usually left between 5-6, however not every service is

like this

Call– 4 calls in two months

Cover all traumas, any emergent surgeries, H&P’s You will learn call is totally dependant on your residents

Medicine

Hospital– Arrive at 6:30-7 AM

Pre round for an hour on your own patients Round with residents until 9:30ish Round with attending

Medicine

Rounds Know everything about your patient Too much info the first few days until you get a feel for

how much is appropriate. Be attentive, ask questions, learn the physical exam Usually only attending time for the day, so be on top

your game for two hours

Medicine

Rounds For Learning – you do not need to know the answer to

every question Differential and plan – only gets easier as the year goes

on Ask your residents – Hey, what do you think about

decreasing the prednisone dose on Mr. Smith? Mrs. Jones is using a lot of SSI, can we start Lantus?

Medicine

Home Also service and time dependent – 5:30 usually? Read about your patients

Call 4 Calls in two months Cover codes, new admissions to your service, help out

PEDs

Hospital Arrive around 7AM Pre-round, write notes, round again Lots of lectures at Children’s You’ll likely receive lots of teaching Leave between 4-6 (service/resident dependent) Call is 4 short calls per MONTH – leave at 9 or so? H&P’s

Neuro/Psych

Hospital Arrive 7-8 AM Round and discuss Leave usually before 5 Short calls Two shelf exams at the end of the rotation

OB

Hospital Arrive by 6AM Pre round Round with attending Scrub in on cases, deliver babies Home by 5 Call is site dependent Oral exam and shelf Clinical skills Workshops for the last 1.5 weeks

Family

Site Dependent Arrive 8-8:30 See patient, present patient, see patient again Do this 15 times Go home at 4-5 No call No weekends

Goals

Learn as much as you can How to talk to patients Procedures Comfortable with managing simple things Writing notes and orders CXR and EKG Presenting on rounds

Honors, Letter, Satisfactory

Every rotation is different Pay attention to the syllabus Study for the shelf (1 hour a day?) “Learn how you learn” Do well on the shelf, do well on step 2

Team

You want to succeed – if the team does well, you will do well

Play well with others Make your resident or intern’s life easier by contibuting Satisfactory with a good evaluation is much better than

a letter with a poor one

4th Year

Career choice first Away rotations Everything else Interview Rank Match

4th Year

Letters of Rec?? Many students don’t worry about it right now Use this year to figure out what you want to do If you have a great rotation, OK get one You can always go back in July and August

Take Home

Don’t worry, it’ll work out Work hard This is the most rewarding year of med

school Get to know your patients