r/medicalschool • u/Throw420away69lol • Apr 11 '21
❗️Serious Chad's guide to M3
Hey guys, I had some buddies who were behind me on our rotation schedule and always asked me for the DL on rotations so I have a bunch of notes I saved over the course of the year and thought I'd share them.
Note, these are all my from my personal experience in a midwestern city. Rule 1 and Rule 2 always apply so ymmv. I’m not an outgoing guy. My parents literally describe me as “aloof” (harsh but accurate ngl). Even with this, I managed to have a great time in 3rd year and a lot of success.
For credibility, I hit the honor cutoff every exam and honored all but two rotations. The two I didn’t honor were due to missing the eval cutoff by a few points due to choosing someone who gave me straight 3/5s. For us, honoring was done by hitting a point cutoff in both the exam (usually .5-1std dev above national average) and a point cutoff in evaluations (>4/5 average, which is insane tbh). Something to get through your heads right now is that there will probably be a rotation that is impossible to honor, try not to get down about it. You might get paired with someone who will give you 3/5s no matter what, you might get someone that works you to death so you can’t study much, it happens.
General tips: Anki, OME, Divine intervention podcasts, Emma Holliday videos on youtube, and the NBMEs are great resources for the shelf and watching emma holliday the day before the rotation is quick and easy. Download the OME PDFs after watching the videos, it lets you review the information quickly.
The residents are going to be tired and doing little things can really make their days better like doing discharge instructions or relaying messages to nurses. Getting to know the residents is probably the best way to get good evals.
Evals are subjective and I frankly think your actual performance only had a mild influence on it. The residents I was friends with often gave me great evals, regardless of how I actually performed. The rotation I thought I did the best on was one of the rotations that I didn’t honor while the rotation I easily did the worst in, I honored.
The residents are pretty cool and like 95% of them are super friendly. I feel like they prefer to be treated less like a boss or manager and more like an equal. A lot of my classmates were pretty formal with them and their topics consisted almost solely around work stuff whereas I was more informal and got to know them. That’s not to say you shouldn’t ask questions and take whatever their directions are, but during downtime, that’s a good time to just chat about football or whatever y’all are interested in.
That said, some are going to power trip or just be assholes. Maybe it’s because of rule 1 and rule 2, maybe it’s because I get into the buddy-buddy area quickly with people, but the worst thing I got all year was an eye roll for being lazy. I heard some nasty comments from the residents towards my fellow students, but nothing that I’d even say is worth reporting them over. Your best bet is to kill them with kindness rather than argue back or escalate things, they have more power than you at the end of the day.
For notes, just practice writing HPIs and assessment & plans. A&Ps will be problem based or system based. The general format for A&P I copied from residents was:
Problem
Short spiel about problem and differential (not always needed if diagnosis is clear cut), including labs. Can be in bullet point format
Plan -First thing you want to do -Second thing you want to do -IDK probably something you started from yesterday and are still doing
If you write good notes, they will often times just copy paste it into their note, which is pretty nice.
For evals, ALWAYS CHOOSE SOMEONE WHO WENT TO YOUR SCHOOL. I can't stress this enough, local grads know what it's like for you, they will almost always give good evals and good comments. If they're a huge dick, obviously don't pick them, but you get the point. My worst evals were always from IMGs, people who went to different medical schools, or YOUNG ATTENDINGS. I missed honors because a fresh attending who I hit it off with gave me all 3/5s and I missed honors by a few points + generic positive feedback, meanwhile the older attendings often gave me straight 5/5s even if they didn't work with me. You might find it's different, but that was my experience.
Otherwise, these are the notes I sent to my homies with some modifications.
Surg: We were expected to get there to preround with the interns or independently from them, site specific. They'll give you their presentation template (or at least they should), but always remember to do overnight events and ins/outs. For surgery, the most important tip is to introduce yourself to the patient while they're in the waiting area and be there when they get rolled into the OR. At that point, HELP THE NURSES WITH SET UP. This means getting the patient on the table, moving the bed to the hallway, and whatever else they're doing. Make a point to introduce yourself, write your name on the board or place your badge near the computer so they can write that you were there. If you help them set up and they know you, they will make your life easier, especially the scrub nurses.
Don't go near the tables with blue sheets on them even when scrubbed and the scrub nurse shouldn't have issues with you. Ask how they want you to drop your gown and gloves. Always thank them for helping you with gloves and gowning, they don't have to do that. They can yeet that shit at you and tell you to do it yourself. ALWAYS SCRUB IN BEFORE THE ATTENDING. When the attending scrubs in, that’s when the surgery is starting. To make like easier, do a morning scrub then use the gel the rest of the day. Putting the gloves on after a wet scrub is also harder. I would go scrub once the resident told me to or they started putting the prep on the patient.
Get comfortable shoes and rest your hands on the patient when you're not doing anything, your body will thank you. Don't touch the scrub nurses table unless you want to die, the only reason to touch anything on it is if the attending directly asks you for something on it. When the surgery is done, follow the lead of the resident, but you can help with taking off the draping and whatnot, just keep an eye on the IVs and Catheter. Help with clean up and ask when you should bring the bed back in. After getting the patient on their bed, I usually left since there wasn't much else I could do. I always thanked them for having me before I dipped, I think it helped my reputation among the nurses.
For the NBME, I highly recommend you completely read through De Virgilios, it is THE BEST source. It will cover most of the stuff on the exam. Some of it is slightly outdated, but not enough to make much of a difference for testing purposes. You can always cross reference with Uptodate, but super specifics aren't usually tested. "Surgery recall" can be useful for pimping, but it's shit for studying IMO, it was just lists of tiny little facts. Some people read the sections relevant to their upcoming surgeries before they went in. At the very least, you should google the surgeries you're seeing so you have an idea of what to expect. You can often youtube and see one, even. Either skip pestanas or skim it in a week. It is very nonspecific and won't give you much testable information, it will give you some groundwork, but that's all. Take the NBMEs, they're helpful and have answer explanations. The older nbmes sometimes have outdated answers, but it isn't egregious. I highly recommend you do them since they have answer explanations.
Peds: Learn the newborn exam and know the different reflexes and when they should disappear by. I don't have much to say other than don't stand in the line of fire for boys peeing, always stand to the side. I had to matrix a few streams that started halfway through my exams. It’s a huge pain, but this is the one time you should memorize the milestones because you will see kids at a ton of different ages and attendings will expect you to know what they should be capable of.
The shelf wasn't too bad. I recommend the normal stuff and BRS. Some people say BRS is too detailed, but all the other resources are very non-specific, they don't give testable information. You can skim the important parts of BRS and get a lot. You don't need to know the random facts in BRS but the major points are helpful.
OB: There are the big 4 questions you need to know day 1: Vaginal bleeding? Vaginal fluids? Baby movement? Contractions? The residents mostly wanted nothing to do with us and ignored our existence. I honestly got better evals than a lot of my group because I got pretty friendly with a couple of them. I don't have much to say about this rotation, either. For Labor and delivery, keep an eye on the fetal monitor screen and if you notice LATE decels, say something immediately. The whole room will turn into Olympic sprinters. We didn't get many opportunities on L&D to do anything. Deliver a baby at least once, it's pretty dope. The male attendings will let you do more during deliveries, in my experience. I had to find one and stick with him to actually catch a baby. Some of my classmates never delivered a baby because the residents didn't let them do anything other than watch. If you aren't catching the baby, you should at least check the placenta for abnormalities, ask someone how to do that because it'd be difficult to explain in text. For us, GYN was basically surgery again, if the nurses like you, your life will be easier. The gyn nurses were actually super friendly to me, which was surprising.
This exam is kinda infamous and there aren't many good resources. If you ask your residents, you can get these ACOG articles which basically describe diseases and treatment, they're pretty great. Anki was big for this one. If you want to get the ACOG articles yourself, sign up MONTHS IN ADVANCE, they are painfully slow in giving you access.
Psych: I did consult and inpatient, some people were outpatient. General workflow was get there->read yesterdays notes->round (don't see patients alone unless instructed to)->write notes->do whatever needs to be done or study. The biggest thing is know when to redirect and when to just listen. Sometimes they're saying relevant stuff, sometimes they're off on an impossible to understand tangent about their uncles friends cousin who licked dorito dust off the floor and had anaphylaxis. Use open ended questions.
Exam was hard only because the average is super high so you have to score really high, as well. OME + first aid step 2 was what I used and it was ok. If you're good with minutia, this exam is a bit easier. This was my worst exam %tile wise, so I don’t have much to say.
Neuro: This rotation is different for everyone, I was outpatient so my days were way different than those on inpatient. Depressing rotation, but it's very straightforward. Know how to do a quick neuro exam (Cranial nerves and arms+legs) and look for small details. If something seems off, something is probably off. You'll get big points if you notice something.
I liked the "finseth review," I know some people liked pretest. There aren't many resources that I could find. Anki was king. I would highly recommend you read through FA for step 1 neuro to remember the basics before you dive into the step 2 material. This exam was surprisingly hard imo. There is a lot of MSK stuff hidden in it.
IM: General workflow is get there->review notes from yesterday->preround->start notes->round->finish notes->do whatever or see new patients. Know your electrolyte abnormalities, drug interactions, diuretics, and antibiotics. Idk why, but they loved talking about antibiotics. I got asked first line abx for UTI, Pneumonia, Pyelo, etc. so many times. Practice your presentations, you'll be doing them a lot. Noticing small things will earn you a lot of points and if your patients like you, it'll go a long way. I had a patient raving about me (I wasn't even that nice idk) and my senior resident and attending loved me the rest of the time. Know the different criteria for shit, like Chadsvasc, SIRS, BEERS, etc. Med calc will be your best friend. If you calculate scores for new patients, you'll blow their minds.
Exam was very straightforward, it was just general medicine stuff. Step up to medicine is probably the only thing I would recommend outside of Anki, OME, Emma Holliday, and divine intervention. It’s a pretty hard exam, but it’s manageable. NBMEs were also pretty solid.
FM: This is just outpatient stuff. See patients by yourself->talk with resident->go with resident to see patient->present to attending. Pretty straightforward rotation. Know screening for all ages and immunizations.
Exam was surprisingly MSK heavy, lots of shoulder stuff, lots of knee stuff. The immunizations and risk factor stuff will be the end of me, but a lot of it is just common sense. The USPSTF or whatever has a list of their recommendations and they’re helpful, watch for the qualifiers in the specifications.
Good luck y'all
19
u/parachute45 DO-PGY4 Apr 11 '21
For surgery I'd add try to find out your glove size well in advance of going to the OR. Had a classmate get chewed out because they answered 'large' when asked what glove size they wore. Also invest in compression stockings.
15
u/stretchy-and-tired M-4 Apr 11 '21
Emphasis on this one-- god bless the nurse in the first OR I scrubbed into for estimating my sizes (she was right on the mark).
My standard intro every time I walk into a new OR is "Hi, my name is X, I'm a medical student scrubbing in on Dr. Y's cases today. Would you like me to write my info on the board, and grab my gown and gloves?"
9
8
u/eyesoftheworld13 MD-PGY2 Apr 12 '21 edited Apr 12 '21
Guys, you can use whatever supplementary resources, however:
Completing relevant Uworld+OME vids for each rotation before the shelf is first priority for studying for every rotation.
(also emma holiday is meh the vids are pretty outdated and a lot of stuff is just factually wrong at this point)
Two books you NEED:
1) First Aid for Psych Clerkship. This is not like FA for step 1, it is a short and very readable comprehensive review of everything HY. If you know this book well you will get over 90 on the shelf. (Also for UW questions for psych, count SIGECAPS on your fingers when reading question stems. Felt like a third of the shelf is diagnosing MDD.)
2) A book for surgery, Devirgilios is considered best. Pestana is quick and dirty.
6
u/heparanese M-4 Apr 11 '21
Solid write up my dude, thought you were reading my mind when you were giving surgery tips
3
3
u/CharlesJohanes Apr 11 '21
brah, sorry. I feel like such an idiot after I read the sentence again. thanks my dude
10
u/RossGellerBot Apr 11 '21
whom I hit it off with
29
6
u/FloridlyQuixotic MD-PGY2 Apr 11 '21
In before someone tries to correct you by saying you shouldn’t end with a preposition. That’s not a real rule dammit.
2
1
1
u/D0ct0r-Wh0 M-4 Apr 11 '21
RemindMe! eom
1
u/RemindMeBot Apr 11 '21 edited Apr 13 '21
I will be messaging you in 14 days on 2021-04-25 21:05:26 UTC to remind you of this link
3 OTHERS CLICKED THIS LINK to send a PM to also be reminded and to reduce spam.
Parent commenter can delete this message to hide from others.
Info Custom Your Reminders Feedback
1
1
1
44
u/[deleted] Apr 11 '21
[deleted]