Posts tagged third year

Specialized Supplies To Keep In Your Pocket

  • Each specialty has their own niche that requires a different set of tools. It is important to always come prepared for what you need to do.
  • Neurology: Tendon hammer
  • Surgery: Lubricating jelly
  • Otolaryngology: Tongue depressor
  • Et cetera...
Case Study.
Studying in the clerkship years is a challenging task. Study times gives way to working time; working time gives way to sleeping time. Somewhere in between we need to create time for ourselves to build our knowledge.
The transition into third year requires quick adaptation to studying on the go. Bring a pocket book or load an ebook onto your phone or tablet computer. If you have few minutes to catch your breath, take out your study material and read a little. 
The best way to maximize your learning in these circumstances is to read around the cases you see each day. Was there something you did not understand about the pathophysiology for patient A’s condition? Not sure what the management plan should be for patient B? Make a case study out of these patients and read around what you do not know or cannot remember. Not only does this help you relate your readings to an actual experiences that help solidify your knowledge, but it will help you manage that patient’s care better. It is a win-win.
Next pearl: ?…Previous pearl: Photos & Videos Prohibited…

Case Study.

Studying in the clerkship years is a challenging task. Study times gives way to working time; working time gives way to sleeping time. Somewhere in between we need to create time for ourselves to build our knowledge.

The transition into third year requires quick adaptation to studying on the go. Bring a pocket book or load an ebook onto your phone or tablet computer. If you have few minutes to catch your breath, take out your study material and read a little. 

The best way to maximize your learning in these circumstances is to read around the cases you see each day. Was there something you did not understand about the pathophysiology for patient A’s condition? Not sure what the management plan should be for patient B? Make a case study out of these patients and read around what you do not know or cannot remember. Not only does this help you relate your readings to an actual experiences that help solidify your knowledge, but it will help you manage that patient’s care better. It is a win-win.

Next pearl: ?…
Previous pearl: Photos & Videos Prohibited…

CTU Team Assemble.
Today with the addition of four third-year medical students, we finally had a fully assembled CTU team. It was a relief to finally operate at full strength and also incredibly humbling to reflect back on where I was a year ago.
It was the students’ first day in third year, and the anxiety levels were visibly high. They huddled together as we rounded on patients together, fresh and green, as if for peer support on this challenging first rotation.
I could not help but think back to where I was only a year ago, in their shoes, nervous and scared of what to do and how to do it. My comfort level had increased so much in a year in so many domains, but more work still remains to be done. I could only imagine what this year would hold.
With third year a fresh memory, I sat down with them at the end of the day to offer any advice I could and go through any worries they had, to which they were grateful to share.
At the end of it all, I offered my reassurance, not because I was being polite but because from my own experience I knew it to be true: “Everything is going to be all right.”

CTU Team Assemble.

Today with the addition of four third-year medical students, we finally had a fully assembled CTU team. It was a relief to finally operate at full strength and also incredibly humbling to reflect back on where I was a year ago.

It was the students’ first day in third year, and the anxiety levels were visibly high. They huddled together as we rounded on patients together, fresh and green, as if for peer support on this challenging first rotation.

I could not help but think back to where I was only a year ago, in their shoes, nervous and scared of what to do and how to do it. My comfort level had increased so much in a year in so many domains, but more work still remains to be done. I could only imagine what this year would hold.

With third year a fresh memory, I sat down with them at the end of the day to offer any advice I could and go through any worries they had, to which they were grateful to share.

At the end of it all, I offered my reassurance, not because I was being polite but because from my own experience I knew it to be true: “Everything is going to be all right.”

When you were doing your internal medicine posting? Did you have a particular clerking format you followed? Any tips or tricks for clerking for a 3rd Year Medical Student? Thanks -an avid follower of your blog — Asked by Anonymous

Hi friend,

Sorry for the late reply. I did internal medicine throughout the year so not quite the typical CTU model. I usually started early in the morning to round on the patients I had seen before, checked if there had been any changes before awaiting consults from my attending.

When I did get consults, one of the first things I did is lay eyes on a patient. If they looked stable, I would usually gather information from the chart - progress reports of the last few days, latest labs etc. - to have an idea of what the situation looks like. I may even quickly reference some material to pre-read around the reason for consultation before talking to the patient. 

The history and physical of internal medicine is the same as any history or physical you have taken but it is in broad strokes to cover a whole slew of topics and differentials. When presenting, make your presentations differential focused. If you have a patient that has chest pain that includes differentials from a lot of systems, describe the patient story (subjective from SOAP) before moving into your rule in/rule out spiel by system. Does he have any cardiac features from this, this, or that differential? Does he have any pulmonary features from this, this, or that differential? And so on. This systematic approach helps the logic flow and shows you are thinking about the differentials.

From there, mention pertinent points of history with non-contributory information left aside unless asked.

The final impression and plan should be a problem list with your thoughts on what to do. At this point as a third year medical student, I think it does not matter if you are wrong about your plan. It is more important to show that you are thinking about a plan and have some reasoning behind them.

Afterwards, I would usually write up the orders and the rest of the consult before dictating. Rinse, lather, repeat.

If you want other tips, you can check out this link or follow my clinical pearls series.

Why Failing Med Students Don’t Get Failing Grades

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

I certainly know from experience that my faculty has long struggled with how to quantify progress and competency for students. It is a constantly evolving process.

Currently, the classifying of our marking criteria as alluded by this article are broadly stroked. You can fail to meet requirements, suggest remediation, meet requirements or exceed requirements. Applied to a whole slew of clinical skills paints a rough picture of where students are but is incredibly vague and subject to opinion. The question remains: how do we assess students accurately and effectively on such nuanced subjects.

Three-Quarters MD: A Year In Review

And just like that, year three passes into my memory, a destination in the rearview mirror. There has been so much to see, so much to process, so much to reflect on this entire year it is difficult to know where to start. Perhaps we should go back to the beginning.

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I Think I know Why...

  • A patient sits uncomfortably short of breath with new onset of atrial fibrillation.
  • Patient: I don't understand how this happened.
  • Doctor: Have you been on any stimulants? Drugs?
  • Patient: Not that I know of.
  • Doctor: Do you drink coffee regularly?
  • Patient: Yes.
  • Doctor: How much?
  • Patient: A dozen.
  • Doctor: A dozen cups per day?
  • Patient: No, a dozen pots.
  • Doctor: ...I think I know why you are in atrial fibrillation.

The Last Meeting

In the quiet conference room overlooking the hospital atrium, we sat down with our clerkship site director for the last time to wrap up some loose ends. It was here, less than a year ago, that we gathered for the very first time as a group to discuss what the rest of the year would entail. Now, we had come full circle, gathered to reflect on our experiences, our growths, and our recommendations for improving the experience for the incoming crew.

For a moment, it seemed casually regular, like our typical weekly sit downs. That feeling was broken when the director closed with some heart felt words that hit home the thought that by the turn of this week, this group will be disbanded and a new class will assemble in our stead.

"I congratulate all of you. You all worked very hard this year and you have come so far. Congratulations on surviving third year. Good luck to all of you on your future endeavours and on your final year."

We looked at each other in nostalgia, at the memories we had collectively collected within these walls. There would be no more small talks with the staff, no more late night walks through empty halls, no more patients to follow up. Though I looked forward to my two weeks off, the thought still made me feel hollow like I had lost a part of myself.

After a brief conversation about handing in our paperwork, logs, and badges, the meeting was over and we were set free. The director came around to shake all of our hands before departing with a final farewell and invitation.

"I will see you when I see you."

This is the End.
While third year is not officially over until this Friday, today was unofficially my last day on rotation. I had the flexibility to plan the course of this last week and decided to end with a day with the internist.
I saw an interesting case entailing the vicious cycle of atrial fibrillation and heart failure driving each other. This was followed by involvement in two cases filled with rare findings and teachings around them. To finish off the day, I had the opportunity to intubate and place a central line. 
It was a great way to end on a high note.
Tomorrow will begin with rounds and a wind down process before ending Friday with the year end barbecue with preceptors and staff. This is the end.

This is the End.

While third year is not officially over until this Friday, today was unofficially my last day on rotation. I had the flexibility to plan the course of this last week and decided to end with a day with the internist.

I saw an interesting case entailing the vicious cycle of atrial fibrillation and heart failure driving each other. This was followed by involvement in two cases filled with rare findings and teachings around them. To finish off the day, I had the opportunity to intubate and place a central line. 

It was a great way to end on a high note.

Tomorrow will begin with rounds and a wind down process before ending Friday with the year end barbecue with preceptors and staff. This is the end.