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Did We Talk About CLINICAL ROTATIONS ?
Family Medicine
Overview
One month in a family medicine clinic in Houston working with our department faculty. Family Medicine test is mainly a medicine test with a little of Ob/Gyn and Pediatrics mixed in very hard if you have not had Medicine. Work Monday – Friday, usually 8-5. No call, no weekends, enjoy! Lectures on orientation day and second and third Wednesday afternoons. Usually have a 1-2 hour lunch break – depending on clinic – bring your lunch unless you want fast food every day. You usually see patients before the doctor sees the patient and then you write a progress note and present patient to doctor in clinic.
Resources
Tips
Internal Medicine
HY Topics
Resources
Resources
Appleton and Lange Review for Medicine
Blueprints Medicine:
great for a firm basis of pathology and knowledge for reference, not a quick read.
Case files Medicine
gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. Not recommended for medicine given the availability of more comprehensive and in depth resources.
Dynamed
good resource for info on specific diseases ( www.uptodate.com)
First Aid Medicine
First Aid for Step 1
often reviewing your basic pathophysiology will pay dividends on clinical medicine exams.
Goljan Rapid Review Pathology:
very useful for quick reference of pathology. Just because it is year 3 does not make this useless! Many of your attendings will ask you basic physiology found in this book.
Kaplan Notes Medicine
found online or in the shared dropbox, this is not an adequate depth you need but still valuable.
MKSAP MS review
extremely high yield. This is available for free via shiffman. Highly recommended as its depth and breadth are wonderful for medicine. The questions are not phrased in step 2 style like usmleworld but it has its own advantage on being more readily accessible. There is a student version that is preferable over the one intended for medicine residents.
– for practice questions
Maxwell’s Pocket Manual (little red book)
Medfools
has things that help organize patient information
NBME exam
very helpful, some questions seemed to appear on the shelf however no explanations. Typically people perform much better on the actual exam than the Medicine NBME. This holds true for the STEP 2 NBMEs as well.
NMS Medicine Casebook
while the NMS medicine book companion is great as a reference, this book is more useful as a combination prep for your hospital work, the shelf and step 2. It is still dense but with the time commitment is has a very high yield. One of the best big comprehensive prep books out there after MKSAP and Uworld.
focuses on management/next best step; has case variations which help you differentiate between similar presenting diagnoses)
Online Med Ed videos
– excellent for the shelf and Step 2 CK
Pathoma
worth reading over for the major organ sections at least once since every shelf exam will build on basic pathology knowledge. If you used this during step 1 preparation, reading over it should be more of a review process.
Pharmacopeia or phone with Epocrates
Pocket Medicine
this book will become your best friend!
Pretest Medicine
– for practice questions
will provide questions on all the areas of medicine but not in SHELF format.
Given the availability of USMLE world and MKSAP, not recommended.
Step Up to Medicine
This is also extremely dense but it is unlikely that the exam will have anything not covered in this book.
I preferred the question format of MKSAP and the explanations but for those that want to read a book similar in style to First AID, this is for you.
Secrets Step 2
A useful book to cover very high yield topics when tired. It is in no way comprehensive on any topic but it will point you in the right direction for the topics worth looking into further. However, MKSAP goes into greater depth but Secrets covers all the subspecialties on the exam for a quick read in between usmle world questions.
UTHSC San Antonio
HY Internal Medicine video and pdf
UWorld medicine questions (~1300)
The more of the questions you can get through the better. Of all the Usmle world step 2 question banks, this is the most reflective of a shelf and of step 2. Making the question review process an active rather passive experience will yield higher benefits, such as writing out in a word document the explanations provided and how your thought process led you to the correct or incorrect answer.
try to get through as many as you can
Uptodate.
For your patients
the more you read on your patients the better your overall preparation.
Download phone app so that you can look up stuff during downtime
Tips
Misc
Call Nights
Packing List
Websites
(best references for those nights on call):
1. www.uptodate.com – download the app on your phone and look up DDx/management based on chief complaint before you go see your patient
2. www.medfools.com (PN/soap note outlines)
3. www.pubmed.gov (impress your attendings with articles) log onto pubmed through pub med
Year-Round References
Neurology
Overview
Two weeks each at two different sites: MHH Stroke Service, MHH Adult Inpatient, MHH Adult Consult/ER, MHH Pedi Neuro Inpatient, MHH Pedi Neuro Outpatient, MHH Epilepsy Monitoring Unit, LBJ Consult o hours vary by site. Stroke can be very long, but normally if you’re assigned to it, the coordinator will give you a lighter other half of the rotation o most services do work weekends so you will work 6 days a week Some sites will go to morning report daily, others won’t. Everyone except lbj goes to noon conference daily. All sites go to Pedi Neuro Grand Rounds on Fridays 8-9am and Adult Neuro Grand Rounds Fridays 12-1pm.
Lectures on Wednesday mornings.
Call
2 call days (1 weekday 5pm-10pm, 1 weekend 8am-8pm) Schedule generated by Chief Medical Resident, but can switch with other students (with coordinator approval).
Work with on call resident to see all consults and admit for all services (Adult, Pedi, Stroke).
Neuro doesn’t have its own interns (they rotate as Medicine or Pedi prelims), so you effectively get to function as the intern! You may see all consults before the resident and will write up preliminary H&Ps in Care4, help with writing orders, etc.
Templates for all notes should get emailed to you by the resident on call your first night (or you can get them from classmates). These make H&Ps much less of chore than in Medicine.
Will round with and present new patients admitted to your service the next morning at morning report.
No post-call days.
Even if you’re not on stroke, you should have the opportunity to see possible stroke patients in the ER
on these nights and learn about TPA eligibility. May also get to see LPs.
Sites
Very busy service. Can be long hours (6.30-5), but you learn a lot.
Basically function like the intern—see your patients first thing in morning, write notes, present and write orders for co-signing on rounds, follow up labs, etc. Most attendings try to give you study time in the afternoon, but will often end up following up on things and seeing new patients much of the time.
Get to work with some national big-wigs
Get great practice on your neuro exam.
Learn a lot about reading CT and MRI’s for differentiating types of stroke and other injuries.
Stroke manual (~200 pocket-sized pages) available for purchase from coordinator—read it before you start on the service. It covers all the protocols for evaluation, diagnosis, treatment, and managementbasically everything you’ll need to do with any patient. If you know it well, you can shine on the rotation.
Teams generally round together, but varies by attending. Hours can vary widely based on patient load. Generally arrive by 7am to see patients, then round with attending in morning (and afternoon, if necessary). For new consults, depending on attending, entire team may see them together, or part of team may split off to see them separately. Can stay as late as 5-6 pm. MHH Pedi Inpatient
Depending on attending, arrive around 7-8am, see patients, round in the morning (and sometimes into the afternoon). See consults in the afternoon. Hours generally not as long as adult inpatient, though, with fair amount of down time.
You will have to present a topic at grand rounds; good for your CV.
MHH Pedi Outpatient
Pretty much 8-5.
Get to work directly with Drs. Mancias and Butler. You’ll see patients, present to your attending, and then go back to see them together.
Have collaborate with other student to present a case a Pedi Neuro Grand Rounds Can see lots of rare pathology and disorders.
MHH Epilepsy Monitoring Unit
You have the opportunity to evaluate patients for possible seizure focus resection of a seizure focus You will be exposed to EEGs and various diagnostic tests done to assess appropriate surgical candidates LBJ Consult Business depends on case load, so hours can vary greatly.
Lots of kids from Mexico and Central America with rare diseases—potential for a zebra party!
Quentin Mease/UTPB Clinics
Will work with a variety of neurology faculty in an outpatient capacity both at our Quentin Mease location and also at our UTPB location. You will see the different subspecialties in neurology at these clinics.
Busy clinic on T/Th afternoons.
Resources
Finseth Neurology Review – amazing! Very high yield and succinct (notes written by a neuro resident) Stroke Manual—must have if you’re on Stroke service!
Case Files Neurology—moderately-sized presentations of major diseases. Average for the series.
Blueprints Neurology—relatively quick overview, but not much depth. Questions in back are pretty good.
In-A-Page Neurology—as advertised. Useful for a brief overview of common pathology
Step 2 Secrets Neuro Section—short and sweet with key signs/lab values/presentations of bread-and- butter cases.
Pre-test Neurology—pretty hard questions. Possibly one of the least useful in the series. USMLE World—geared more for Step 2 CK, but good explanations, as always.
penlight, reflex hammer, Q-tips—first two are essential tools of the trade!
Tips
Start studying day one—this is a very short rotation with lots of information. Unlike the longer rotations, you can’t slack on studying and be sure that you can still cover a lot of material!
Probably the hardest shelf exam for the majority of people. The cases are tough because you have to sif through a lot of layers: Is it a medical, psychiatric, or neurological problem? What does parts of the neuro exam are most pertinent? If there’s a lesion, where could it be? etc.
If you’re on stroke and you think your patient is having a major change in exam findings (i.e., is developing a new fixed and dilated pupil), contact your resident immediately!
Try to examine imaging yourself and figure out what’s going on before talking with the resident or reading the radiologist’s report (this is often a necessity, as MRI’s may not get read for hours).
And did you hear that if you’re on Stroke, you should READ THE MANUAL BEFORE STARTING!
Psychiatry
Overview
Three weeks of adult inpatient psych (HCPC) Three weeks of specialty service (hospital consult service, child & adolescent psych, addiction, psychopharmacology, etc.)
Only one call shift on a weekend, otherwise usually 8:00 a.m. To 4:00p.m. Monday-Friday 3 calls over two months – one 12-hour shift on a weekend 8 to 8 – and for two weekday calls go to HCPC at 4:30 pm and ask the receptionist to page the on-call resident Video exam: you watch a short videotaped patient interview. After watching you write a soap note and differential diagnosis for the patient.
Standardized patient encounter for evaluation at end of rotation.
Lectures are once a week from 1-5pm on Wednesdays and are required. Grand rounds wed at noon is required.
Hot Topics: Pay attention to the required lectures, they are excellent. The topics you are told are high yield are in fact high yield.
Paying attention to neurotransmitters and pharmacy MOA are huge, as are illicit drug intoxications, normal bereavement vs. adjustment disorder, schizoaffective vs schizotypal vs the other schizos,.
Psychopharmacology: what neurotransmitter are you impact
Schizotypal vs schizoaffective vs schizoid vs schizophrenic
Personality disorders very high yield to know in depth
Dementia sub types and pharmacological treatment for Alzheimers, alcohol abuse, diabetes, thyroid causes, vitamin deficiencies.
Time course of medication onset and clinical utility, antidepressants can take weeks!
Neurotransmitters of toxicological substances as well as medications.
Normal Grief vs depression vs adjustment disorder
Pediatrics-know what is normal and what is actually a problem, don’t be afraid to prescribe kids on this exam
Thirty percent neurology questions
General knowledge of the applicability of Alcohol, Smoking, and Diabetes (the big three of medical school) to the exam in question. Always good for 5-10 questions on the shelves.
Regarding Step 2: A minority of Step 2 questions, Reviewing First Aid for Psychiatry in a day may be the most useful way to prepare come exam review time.
Inpatient Month
at HCPC in a specific unit (requires a key to get in and out of the unit) work every day in the morning have to get a key ($25 fee for lost key) in order to access anything in the building – even the bathrooms are locked.
Specialty Month
work with patients in a hospital consult service, or at hcpc child or specialty unit. work hours vary by location
Resources
For TBL, required readings in Andreason and Black (some modules have alternative readings in Kaplan and Sadock’s pocket book) Appleton and Lange question book Case Files Psychiatry Pretest Psychiatry First Aid Psychiatry or High Yield Psychiatry or BRS Psychiatry (not Psychology!!!)
Psychiatry Pocket Book and the Psychiatry Drugs pocket book can be very helpful Kaplan and Sadock’s pocket handbooks
First Aid for Psychiatry -the best book out there. Read it at least once, twice is very doable. Combined with the course pack is normally enough to honor if you pay attention to your patients.
WSU Psychiatry Course Packet -well written with useful questions, extremely high yield.
Lange Psychiatry Question book Lange psychiatry. I did two chapters, chap 3 adult psychopathology and chapter 4 somatic treatment and psychopharmacology. Both very high yield topics.
Up To Date -for your patients-the more you read on your patients the better your overall preparation.
NBME exam: very helpful, some questions seemed to appear on the shelf however no explanations.
Case files Psychiatry– gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. For psychiatry this is not a good idea.
Blueprints Psychiatry: great for a firm basis of pathology and knowledge for reference, not a quick read. Not recommended given the utility of the top resources.
Pretest Psychiatry: will provide questions on all the areas of psych but not in SHELF format.
USMLE World Psychiatry -not all encompassing but reading the explanations as always is to your benefit.
Tips
HCPC is a unique experience as a large (200+ bed) free standing psychiatric hospital affiliated with a medical school; take advantage of this opportunity to learn psychiatry--you will probably never encounter patients like this again.
Always be aware of your surroundings - these patients are at this hospital for a reason and you always want to protect yourself because some patients can get violent. Do not leave objects on the unit with which patients can hurt themselves During your rotation your attendings will ask you for dosages of drugs – you don’t need to know them for your written tests Know your drugs, know your drugs, know your drugs; and know delerium/dementia vs true psychosis (remember these tests always relate back to internal medicine) Written test is challenging – it is not easy – so please study.
Surgery
Overview
High Yield Topics:
Routine
Usually get to work at 5:00 a.m. And work until about 5:00 p.m.
One day off a week (on weekends)
Grand rounds and M&M on Thursday mornings (have lectures after this)
Attendance is mandatory for grand rounds, m&m, and all lectures
Call
Look for call rooms are the same as medicine
If you are bored, wander down to the trauma bay; there’s always something for students to do down there (suturing, casting, etc); or hang out with the anesthesiologists—they might teach you how to intubate/start lines
Work on one of several teams – purple, gold or silver
Get a lot of or time, very hands on (some months more than others)
See thoracic, vascular and pediatric surgery in addition to extensive general surgery
Always have supplies in your pocket (4x4s, tape, suture removal kits…can obtain from supply room)
Good for working with influential faculty
Work long days and call is hard but you get great experience
clinic is very exhausting!!
Usually free lunch especially on clinic days
Trauma
Very hands-on, fast-paced, and get to do a lot of procedures in the er/or
Students are crucial to the service (the floor is yours!)
Work very long hours, work most weekend days
Good for test because you learn management of surgical patients
Get to see amazing surgeries, lots of or time
Learn to follow ICU patients!!!
Lots of OR time
Learn to manage critically ill people
Mostly work with residents and fellow
Resources
Pestana Notes - notes as published by Kaplan, definitely read at least twice -it includes sections on all the surgical subspecialties that are all given 2-3 questions on the Shelf.
Up To Date-For your patients-the more you read on your patients the better your overall preparation.
USMLE World Internal Medicine Subsection GI-The surgery exam is basically for an internal medicine resident to know what is a surgical patient and what they would need to ask surgery to do, there are no actual details of surgery or anatomy on the actual shelf.
Oral Exam Study Guide-prepare the cases and this will serve double of prepping you for the oral cases and your exam!
MKSAP questions on GI. -extremely high yield since this is a medicine exam effectively.
NMS Surgery Casebook-while the NMS surgery book companion is great as a reference, this book is more useful as a combination prep for your oral cases preparation, hospital work, the shelf and step 2. It is still dense but with the time commitment is has a very high yield. One of the best big prep books out there.
Surgical Recall-This has tremendous utility as a surgical medical student but none for the actual exam. Always reference before entering the OR but this will not help for the SHELF which tests medical management, the exam is very similar to Internal Medicine. Very useful for surgical nomenclature and “pimping”
Abernathy’s Surgical Secrets-Very similar conceptually to surgery recall, available for free via shiffman year 3 resources online
NBME exam: very helpful, some questions seemed to appear on the shelf however no explanations. Typically people perform much better on this than the actual surgery shelf.
Case files Surgery– gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. Not recommended for surgery.
Blueprints Surgery: great for a firm basis of pathology and knowledge for reference, not a quick read.
Pretest Surgery-will provide questions on all the areas of surgery but not in SHELF format.
Pathoma: worth reading over for the GI sections at leaste since every shelf exam will build on basic pathology knowledge. If you used this during step 1 preparation, reading over it should be more of a review process.
Kaplan Notes Surgery-found online or in the shared dropbox, this is the same thing as Pestana notes, the most high yield little book.
Goljan Rapid Review Pathology: very useful for quick reference of pathology. Just because it is year 3 does not make this useless! Many of your attendings will ask you basic physiology found in this book.
First Aid for Step 1-often reviewing your basic pathophysiology will pay dividends on clinical medicine exams.
Step Up to Medicine-emergence-you need to know how to manage a patient emergently as a first year surgery resident handles medical management and ICU work.
Schwartz Surgery-If struggling with a topic, access major texts via accessmedicine via shiffman
Essentials of Surgery-Not useful for the shelf. The Wayne exam is drawn from this books clinical pearls, a document floats around that has these compiled. This book is also available via shiffman for free.
Tips
Anatomy for the course and the steffes exam. Very minimal on the actual shelf exam.
Before an operation look up the landmarks, know any eponynmous anatomical structures.
Know the blood flow, lymphatic drainage, and nervous system relation for pimping.
Steffes exam: at least review the clinical pearls from OR and rounding in essentials of surgery. Document floating around.
Oral exam study guide is very helpful for the rotation, better than casefiles for the rotation.
Always prepare for your surgeries!!! Know you anatomy – bust out your Netter !!
Always know what surgeries you are going into the next day so you will be prepared! (not always able to know especially at LBJ)
Scrub into as many surgeries as you can; take advantage of call nights.
Be in the OR if your patient is in surgery; don’t scrub into other student’s cases unless you have their permission.
Be nice to the scrub nurses/techs; they are capable of making your month miserable if you make them mad.
Practice, practice, practice—nobody becomes a surgeon over-night.
Surgical recall is a good resource to read up before cases. A lot of pimp questions come from that
Wheel your patient to PACU with the anesthesiologist when the case is over—they notice
Always show initiative (ask to suture and tie knots, volunteer to assist in surgeries)
Have supplies in your pockets (tape, 4x4s, suture removal kit, etc); rounds go faster
Test is hard (mostly a medicine and trauma test – have to diagnose diseases and decide medical vs. Surgical management)
DON’T DO ANYTHING STUPID!!!
The unfortunate mistakes made by those who went before you. . .
Don’t lie!—If you don’t know, or didn’t do something say so!
Don’t pimp your attendings, don’t pimp your residents, and don’t pimp your fellow students; they will not like you.
Don’t answer your fellow students’ pimp questions unless the attending “opens” the floor. It is their time to shine, not yours!!! This does not go unnoticed by attendings or your colleagues
Don’t make your intern or residents look bad; if you know something about a patient, tell them; they will make your life miserable if you surprise them during rounds.
Stay off your phone during rounds unless someone specifically asked you to look something up, otherwise it looks like you are texting your BFF, even if you are reading up-to-date. The people who are grading you take note.
Don’t be that person that snoozes 10 times in the call room. If your alarm/pager goes off, get up!
Don’t return pages in the call room while other people are sleeping. This is rude.
Don’t be known as “stinky;” please remember your toothbrush/deodorant.
Don’t pass out in the operating room—tell your attending/resident you’re light-headed and sit down; if you’re going to pass out, fall backwards, not forward.
Please don’t ask patients where they are going after hospice (yes, this has happened.)
Don’t offer a placenta to a resident, they are yours to deliver so enjoy!
Don’t ask for a letter of rec the first day of a rotation; you do not know your attending and your attending does not know you.
Don’t cry on rounds or in the operating room, everybody makes mistakes and we’ve all been yelled at; just learn and move on.
Don’t argue with your attendings/residents/nurses/patients.
Please don’t look things up to prove your attending wrong, this will not make them happy.
Don’t ask questions if you already know the answer—i.e. “so is that beating structure above the diaphragm the heart?”—this will only make you look stupid, and will invite a royal pimping session.
Don’t be a surgery/delivery hog; your team will not like you.
Please don’t be that person who wears their surgical cap in the LRC or scrubs out to dinner; we’ve all done surgery, nobody will be impressed.
Don’t call in sick unless you are actually sick; remember your attendings are doctors.
Don’t let patients out at HCPC, even if they offer you a good bribe (seriously, the patients are good at pretending they’re employees).
Don’t be rude to any nurses/scrub techs/ secretaries/course coordinators, it will get back to your attending and will show up in your grade.
Don’t argue your eval after the test; do it before or it will not change.
Really important: please don’t drive home if you’re tired; stay and take a nap, especially if you’re at LBJsleepy students and 610/59 do not mix well. If you really have to go home, get a coffee or an energy drink before you head out, and figure something out to make sure you don’t fall asleep while driving.
If you have a problem with someone, esp a faculty member or resident, don’t start sending e-mails. Go talk to the course director in person. Make sure your emails never even hint bad vibes about anybody, because, trust us, they can get sent to the whole department.
Be enthusiastic about every rotation. You never know what you may find you love
Ob/Gyn
Overview
Department of Obstetrics and Gynecology Student Handbook
6 weeks at either Hermann, St. Josephs, or LBJ (you will be assigned to a hospital by the coordinator no student preferences – no switching sites) Usual day is 5 a.m. To 5:30-6:00p.m. (long days) Do not work on weekends unless you are on call. Always wear scrubs to work and always bring an extra pair just in case you get covered with baby goo!
Call
You get to make your own call schedule with the students on the first day of your rotation o Herman and LBJ has a night float system so one week you work Mon-Fri night, take call on 1 or 2 weekends o 5 calls over the six weeks at St. Joes Usually no sleep on call for OB (if you sleep you will miss stuff – interns will not page you for deliveries) Always get off post call after board check out (~7:00 a.m.) Stick with your intern because they always know what is going on. The last thing you want to do is miss a delivery. Carry a pair of sterile gloves in your pocket so you’re ready when they call for a delivery (babies come fast) When you hear “delivery doc” paged overhead, RUN, cuz that’s you!
Hermann Hospital OB/GYN
2 weeks of OB and 2 weeks of GYN 1 week of “nights” during your OB weeks, weekend call covered by all Hermann students 1 week of clinic Good rotation to take if you are interested in OB/GYN – a lot of influential faculty at Hermann GYN month is mainly seeing GYN surgeries and following post-op patients Wednesdays are very busy on GYN month – expect to be there late Required to attend Tuesday afternoon conferences on 3rd floor MSB
St. Joseph
3 weeks of OB and 3 weeks of GYN Take OB call for all 6 weeks – do not sleep on call Dr. Harms has extra teaching sessions – very helpful, great teacher! Faculty, residents and nurses are very nice and helpful. Very positive environment Clinic only a few half-days per month
LBJ = Baby Factory!
The 6 weeks are divided into 2 weeks of OB, 2 weeks of GYN, 1 week of subspecialty (MFM or GYN Onc) and 1 week of nights. Lots of labor and delivery Good rotation if you want to see and help with a lot of deliveries Do not sleep on call Don’t be afraid to try your Spanish; you will be fluent in OB Spanish by the end. Three most important words: “Empuje!” (Push); “Mas!” (More); “Fuerte!” (Hard)
Resources
Case Files OB/GYN – must have – read through it at least twice!!!
UWise questions on APGO website. The information to access them will be on the blackboard website for the rotation.
Download an app for calculating gestation
o “Cuando fue su termina regla”? (Roughly, when was your last period?) First Aid for OB/GYN clear and concise.
Pretest OB/GYN – practice questions; many answers are controversial so be careful BRS for OB/GYN – good for resource and to read while you have down time Step 2 Secrets—just the OB/GYN section
Tips
OB/GYN uses a lot of abbreviations (I mean a lot) – if you don’t know what the abbreviations stands for don’t be afraid to ask one of the residents.
Being interested always takes you a long way. They like to see that you taking initiative and being proactive. (applies to any rotation!)
Always keep track of what’s going on the patient delivery board.
Always stay by your patients that are in labor – you never know how fast they are going to progress. Go to Dr. Harm’s review at the end of the rotation – you will actually be surprised when you take the test to find that a lot of what he tells you is on the test.
Always prepare for your surgeries for gyn. Know your anatomy.
Have your residents teach you how to tie sutures during down time – very useful.
Get experience during clinic doing speculum/vaginal exams – you need to know how to do this in most specialties (FM, Medicine, etc.)
Ask to do things during surgery and deliveries if you are interested.
If you have OB/GYN before surgery, use it as a month to practice your surgical skills—this will carry you a long way during surgery.
You are very well prepared for this test by the end of the rotation – concentrate on case files and go to Dr. Harm’s review.
Pediatrics
Overview
Four weeks inpatient (Hermann or LBJ) Four weeks outpatient (pediatric clinics) certain days in specialty clinics at UTPB so pay attention to your schedule. (note: you are able to rank your choice for inpatient and outpatient) Three days off during you inpatient month Noon conferences daily; don’t touch the food unless explicitly invited to do so Weekend off between four week blocks No call, and no weekends on outpatient Inpatient day usually starts around 6:30 a.m. And you get off by 3:00 (resident and hospital dependent) Clinic days are 8 a.m.-5 p.m.
Some required assignments during the month including typed H&Ps Stickers: should be in your pocket at all times (esp. Dora, Spongebob, Sesame Street) Required to do eight online cases (CLIPP)
Call
Call only during your inpatient month.
Have to take 4 calls in one month Make call schedule with the members of your team – usually one to two med student on call for your team per call night Your team is on call every 2 nights – you have to make the schedule where you are on call the night your team is on call.
Pick up 2 patients as your own on call, continue to see new patients with team
Children’s memorial hermann
Teams composed of 4 medical students, 2 interns and 1 upper level Sometimes able to sleep on call
o call rooms are the same as medicine (5th floor robinson see im above for codes) Patients are sick with interesting, rare childhood illnesses – heavy patient load Three days specifically in the nursery No clinic included in rotation Free food occasionally at noon conference – have to be there – do not be late; you are not required to go to noon conference when you are post call!
Usually get off by 2:00 p.m. (resident dependent)
LBJ
Teams composed of now one team with 1 senior and 2-3 interns Smaller patient load Usually get to sleep on call
o call rooms are hard to find and describe. Need key from nurses station, they can direct you! Children present with “bread and butter” pediatric cases Lots of nursery time – you perform the newborn exams Clinic every other day during the week – only in the afternoon (crazy busy, but you learn so much!!)
Don’t get off until 5:00 p.m. Or later on clinic days. Students present patients on rounds A lot of patients speak Spanish especially in clinic
Resources
BRS Pediatrics – very comprehensive and excellent UWorld Pediatrics questions UTHSC San Antonio – HY Pediatrics review First Aid Pediatrics and NMS are long and detailed Case Files Pediatrics Pretest Pediatrics and Appleton and Lange – excellent for practice questions o **Case Files and Pretest Pediatrics were written by our faculty at UTHealth. Your attendings are the authors, so your pimp questions often come from these books. do not buy the Harriet Lane Handbook – mainly for residents – if you are going into pediatrics you will be given one as an intern. Pediatric Advisor: http://www.med.umich.edu/1libr/pa/pa_index.htm (good for parent handouts in English and Spanish)
Tips
Wash your hands before and after every patient!!!!! And clean your stethoscope with alcohol swabs.
You will get sick during pediatrics – kids are germy!!
Always ask the parent to leave the room at some point when you are getting a history from an adolescent patient so you have complete privacy with the patient. You must assure confidentiality and then ask the adolescent patients about home life, drugs, and sex, safety, etc.
It is amazing how much kids will yell and scream when you walk into the room. It is always good to have stickers or toys in your pocket that can distract them so you can do your physical exam.
You can get cheap stickers for you team from smilemakers.com; the kids will love you!
Learn how to do proper pedi-exams; you will not get good at looking in ears if you never try. Ask the residents/attendings to show you their tricks for getting the kids to cooperate.
If you’re bored on call, wander down to the newborn nursery—they always need help with the newborn exams.
Brush up on current cartoon affairs—the kids love it when you can discuss with them some of the more important issues in life like Sponge Bob Square Pants and Dora the Explorer.
Have fun but don’t forget to always be professional.
If you decorate your stethoscope/badge with stickers or other items (which is highly encouraged to build rapport with the kiddos) don’t forget to remove them before starting other rotations-- .medicine attendings and surgeons are not as amused.
The previous point is more important than you may realize right now, so get those stickers off your badge.
The test is hard so make sure you study!!! A lot of the test is knowing how to manage and diagnose acutely ill patients—lots of 17/18 year olds with adult medicine problems and 2 year olds who took grandma’s pills.
Pedi H&P’s are different than adults. Report all I’s and O’s, med doses, etc in mg/kg Do not buy a pediatric stethoscope!!! Your adult one will work just as well.
Most learning opportunities this year will happen when you are on-call; so if you snooze, you lose. Nudge your interns/residents to teach you something. **all the quizes except Ob/Gyn and psych are basically tests on medicine — so know your drugs (side effects/interactions) and acute management of critcally ill patients (fluids/lytes/acid-base/endocrine).
How honoring works -you can honor a clerkship and also honor the year. -honor a clerkship by honoring the shelf and outstanding evaluations -To honor Year 3 either honor six of the required 11 months -or if you add up the points from the eleven months, 35 and greater means you honored, 2 points per month of satisfactory, 3 for clinical/academic commendation, 4 per month of honoring. This allows someone to honor only a month or two and still earn comprehensive honors for the year. Eg. Clinical commendation in surgery is 3x2 months=six points. -Your elective is not computed but is on your transcript for programs to see The honoring rates for each rotation for 2013-2014 are in the graph below for reference.
Presenting information discrepancies-you will find the history you get will be contradicted by information the attending or senior resident gets from the same question. You did nothing wrong, this is because patients have more time to think over the question and may remember new or different information.
Do you have to stay late? -if you’re senior resident or attending says you can leave, you should listen, it proves nothing by staying, its because they have work to do that you cannot contribute to. -but staying late and helping with tasks related to patient care are always appreciated, calling in social calls, picking up labs, etc.
You never have to pick up food/coffee for anyone-this is harassment.
Basics of Presenting: Different attending’s have different interpretations methods, but a general outline for presenting in the SOAP style will not fail. You should consult Maxwell’s pocketbook always, Wayne should provide a copy
Pre-round on your patients, look on uptodate for anything you don’t know
Never report a value you do not understand because you WILL be called out on it.
S-subjective, anything the patient said, how things went overnight, etc.
O-objective, always start with VITALS! Then physical exam, head to toe is preferable.
A-can be said in one sentence
P-usually safest by organ system: CV plan, Lung plan, Renal plan, etc.
The plan ALWAYS includes if they can be discharged or when on inpatient and when to be seen again for follow with outpatient visits.
It is always easier to be successful on a rotation if you pretend you want to go into the field and care about your patients, you will learn more which leads to knowing more and looking better to your team.
-The goal of third year is to learn to take an excellent history and present it well. You will learn how to manage patients on your own in residency. Try to learn as much as you can regardless of what field you choose.
-Regarding choosing a field, whether you like your rotation or not, keep in mind that a specialty may be very different at another institution or with different personnel or organization structure so please don’t write anything off too quickly!
Useful planning tips for Year 4 Scheduling -there are “light” rotations useful during interview season when you cannot afford to take a month off. These include: independent study research with a mentor or personal doctor friend, mentor, family friend; anesthesia at harper, radiology dmc (not ford), interventional radiology.
-DO NOT do a required rotation during heavy interview season.
-Try to take any required work BEFORE match, it is much harder to work afterwards.
Did We Talk About APPLYING to Medical School ?
Without external influence (mentoring, programs, etc...), the biggest predictor for standardized test scores is income.
The Influence of Parent Education and Family Income on Child Achievement: The Indirect Role of Parental Expectations and the Home Environment. Davis-Kean, Pamela E. Journal of Family Psychology, Vol 19(2), Jun 2005, 294-304
The relationship between income and subjective well-being: Relative or absolute? Diener, E., Sandvik, E., Seidlitz, L. et al. Soc Indic Res (1993) 28: 195.
The relationships among achievement, low income, and ethnicity across six groups of Washington State students. ML Abbott, J Joireman Research Center Technical Report No. 1, 2001
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APPLYING TO MEDICAL SCHOOL
1 - MCAT
1 Advice.
Do Questions.
Don't worry about # you get right.
Be happy that you just identified a knowledge gap.
200 Practice Questions: +1 Percentile: Link
Google Drive MCAT Files I
Google Drive MCAT Files II
2 - Enroll In Pathway Programs
3 - Additional Websites To Check Out
4 - Personal Statement & CV
5 - Remember. Fake it till you make it. It works.
NIH Medical Research Scholars Program
The Medical Research Scholars Program endeavors to be the premier training program for future clinician-scientists that advances health by inspiring careers in biomedical research.
By engaging students in basic, clinical, or translational research investigations, a curriculum rich in didactics and professional development, and a robust mentorship and advising program,
MRSP prepares its Scholars to become tomorrow’s leaders in medicine and biomedical research.
Eligibility
The 12 month program is designed for students who are U.S. citizens and permanent residents who have a strong interest in conduction basic, clinical, translational, population health research and are currently enrolled in their 2nd, 3rd, or 4th year at an accredited medical, dental, or veterinary program.
Dental and veterinary students: due to the integrated nature of the third and fourth (clinical) years, participation in the MRSP is recommended after you have completed your second or fourth year in school.
Curriculum
Academic leadership training.
Assigned and dedicated tutor
(year –long)
Access to NIH Clinical Center courses \such as Introduction to the Principles and Practice of Clinical Research and the Ethical and Regulatory Aspects of Clinical Research.
Lectures
on seminal basic, translational and clinical research topics that highlight the continuum of discovery,
as well as include issues in bioethics, science policy and emerging technologies.
Training in clinical protocol development and the conduct of human subjects re‐ search.
Participation in clinical rounds focusing on the research patient population in the NIH Clinical Center.
Scholars participate in the full continuum of biomedical research—from bench investigations to population health.
Dedicated lectures highlighting the continuum of discovery, to include bioethics, science policy and emerging technologies,
Interactive case-centered Clinical Teaching Rounds with investigators presenting their research with participating patients and families,
Journal Clubs.
Training in clinical protocol development and the conduct of human subjects research.
Monthly networking sessions with national renowned great teachers.
Workshops in career-life balance, CV-writing, and interviewing
Housing
The MRSP is a residential program and participants are required to live in the housing provided.
Housing options include: One‐bedroom and studio apartments for single students are also located on the NIH campus.
Married couples will reside in one‐bedroom apartments located on the NIH campus.
All rents include utilities (gas/electric, and water), and apartments are furnished with the basics for living.
Students are expected to provide their own linens.
No pets are allowed.
Benefits
Annual Stipend
Furnished residential housing
Relocation Allowance
Funding support for conference travel, scientific courses, and textbooks
Deadlines
The application cycle tends to be from October to January.
Did We Talk About RESIDENCY ? Click Here.
R1
Step 3: Interns, you’re over halfway through intern year, but that also means you need to complete and PASS the USMLE Step 3 before July. It is a program requirement to pass before advancing to R2 year. If you have not yet taken or passed Step 3, please let the chiefs know now!
R2
CA Medical License: You must have your California Medical Board license before you start R3 year (or else you will be delayed – that’s a state rule)!! R2’s should have their license or your application in process right now. If not, please alert the chiefs now and search your inbox for “shameless bolus.”
PGY-2’s: Start applying your CA License!
Save the Date: Afternoon of Wednesday, October 8, 2014We will be having a Licensing Fair for all residents ready to apply for their California license (that means you PGY-‘s). Come with your applications (complete or incomplete) and questions even if you’ve already submitted your application. We will work on providing notary services!
To get started on your application, visit the Medical Board of California online.
And search your email inbox for “shameless bolus of useful information” for more details & tips.
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R3
Job Search: Graduating in June? Now is the time to start thinking about and applying for jobs. The chiefs and program directors are here to guide you and get you connected. Please get in contact with us and think about what kind of career you see yourself in.
ABIM: Register now and choose your test date of choice. There are only six exam dates coming up in August 2015 for the medical board exam. Search your inbox for details. Regular registration closes February 15, 2015.
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TERMS
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…is….by….
…is….with…
M I S C
T O O L S
W O R D S
W I S H L I S T
M E N T O R S
Pineapples
baby oils
barbell collapsable
beddit
imac mini
magsafe
miniscope digisafe
mirror lululemon
tonal
.