Third Year Gems

Well, my friends, I’m officially a fourth-year medical student. Honestly, it is still surreal to me. Time has literally flown by. It feels like yesterday I was freaking out about my physics final or waiting for my MCAT score to come in.

My first two years of medical school felt in many ways an extension of my undergraduate career. Yes, there was way more information to learn and the stakes were higher, but I felt at home in my studies. I was able to master much of the material and take exams with confidence. To say it bluntly, things were much more black and white. The correct answers were there in front of me.

Third-year has been so much different. They always say that, but you don’t really get a taste of it until you do it yourself. This year has been a year of growth for me – mentally, physically, and academically. I’ve had to do things that I did not want to do. I’ve had experiences that made me hurt so much inside. But, I’ve also gotten to do things that have truly made me so happy. I wouldn’t trade this year for anything. I’m going to save some of these reflections for later, but I wanted to be sure to make a post before the new third-years start rotations! Let me preface this with the fact that this post is going to be more “non-academic” things aka not information on how to ace exams. I will have a small blurb at the end for this. PS THIS IS LONG.

 

What should I have “ready” before my first day of clinical rotations?

So, to be honest, you could go in day one and be totally unprepared and things would still work out. But, if you are a planner like me and want to have a few things to keep you busy these are some things to think about.

  • Get your white coat all ready to go. Less is more, seriously. Your shoulders are going to start hurting.
    • Tools: stethoscope, pen light (and if you are on neuro reflex hammer, tuning fork, sharp safety pin)
    • Learning materials: paper, pens, +/- ipad mini  (some rotations I used my ipad, others I didn’t)
    • Snack (esp. if you are on surgery)
    • $$ (esp. if your team gives you minimal time to eat aka not enough time to run to your locker to get food)
    • pager/cell phone (make sure to exchange #’s or pager with your team on day 1, ask them how they want you to reach them if you need to avoid any confusion or irritating them!)
  • Get an H&P template ready if you want to really be on top of things. Basically, just write one out in your own format that works for you and then make a bunch of copies. You can just grab these each day and put them in your coat. Same thing applies for progress notes. This makes it easier when you go to present your patients. You can purchase these types of things also from Medial Basics.
  • Put your rotation schedule into your planner. Being late never looks good.
  • Make a list of “to do” items for your first rotation. For me, I started making a study plan in advance and that really helped me. This was basically figuring out all the things I wanted to do to study plus the rotation requirements and then splitting them up in the weeks that we had for the rotation.
  • Purchase any books you are going to need in advance. It sucks to get started late just because you are waiting for things to come in the mail.
  • Familiarize yourself with the hospital you are working at — aka the floor plan. Some rotations you will be in a small segment of the hospital, which makes it easy. But many other rotations like internal medicine your patients can really be anywhere!
  • Go shopping! Some rotations require that you wear dress clothes nearly every day. I definitely didn’t have enough prior to starting third-year and the last thing you want to do is spend extra time in the morning scrambling to find something to wear. Some of my go-to pieces are below.
    • Coach Olive Loafers like these. I have a few pairs that I found at TJMaxx for half the price. They are comfy enough to get me through the day and also super cute with minimal “breaking in” time.
    • J.Crew Lexi Pant – here. These are comfortable and go with everything. For $40 plus a student discount, they are worth it!
    • If you start with surgery check my post here for shoe tips.
    • For tops, anything not low cut and breathable works. I wore a lot of tanks so that I didn’t sweat too much and I always had my white coat on so it wasn’t “unprofessional” looking.

What can I do to stand out on my rotations?

There are lots of ways to stand out as a member of your team during your third-year. And no, this is not by gunning your other classmates. To be honest, this makes you look worse. I’ve seen students straight up throw other people under the bus in attempts to make them look good. Sadly, this just makes you look like a jerk. Don’t be this person.

If you want to ‘look good’

#1 Know your patients. Take some extra time to talk to the patient and the family to see what is important to them. Spend time looking at their chart and familiarizing yourself with their medications/diagnosis. If you have a patient on your service for a few days, take some time to find a research article relating to their care and present it to the team. It doesn’t have to be anything fancy, but you can tell your attending that you read an article last night about X and wondered if you could share the poignant information with the team. This will benefit everyone. Even if this information is something the attending already knows, maybe the intern doesn’t. If your attending doesn’t want you to share the information, this probably isn’t someone who values team-based learning (unfortunately).

#2 Ask how you can best help the team. If you aren’t busy you mind as well see how you can help the team. Some people may not need help, others may want you to go see a consult.

#3 Always be open to trying new things. OK, I’m kind of a scaredy cat, but this year I forced myself to ALWAYS say, “I’ve never done that before, but I’d love to try!” Inside my head, I was scared I’d mess up stitching the fascia or pass out while helping place a PICC line. But, you know what, you don’t know what will happen until you try. And people know that you are not a pro at any of these things. Don’t be that person who looks like they are “too good” to do something, when they may just be nervous. Go for it!

#4 Ask questions. The best way to learn the material is learning it with your patients as examples. Yes, you can probably learn things from the book, but they stick better in real life. And, no you aren’t annoying. Just find the right time aka when you are walking from room to room during rounds to ask questions. I wish I had done more of this early in my third-year. Often I didn’t want to look dumb because I didn’t know what an abbreviation stood for or didn’t know the generic of a brand name drug they kept name dropping. JUST ASK! It takes two seconds and it shows that you are interested. ESPECIALLY, ask when you feel like something isn’t adding up. If you feel like you read X, but now the team is doing Y, ASK!! Seriously, there is always a reasoning behind things and you don’t want to miss it! If it doesn’t seem like your attending/residents have time that day, jot the questions down and look them up in the evening. If it still isn’t making sense, ask the next day for clarification.

Any other gems?

Advocate for yourself! Every school is different, but I realized early on that it wasn’t easy to form connections with attendings because I often had the same doctor for less than a week! I knew for family medicine I really needed to have some good mentors. I e-mailed my course director and asked if I could be put with the same attending for a longer period of time. They were happy to help me out. So, if you aren’t getting what you need- ask for it!

Keep in mind that you will need letters of recommendation. Try to build some relationships with attendings in the specialty you want to go into and also some others that relate to yours.

Get used to not being able to have an exact schedule all the time. This was a hard transition for me because often times you don’t know what time you are ‘done’ for the day or you just stay until the doctor says you can go. You don’t have as much control over your schedule compared to 1/2 year, but at the end of the day, it is what it is. Take advantage of any days off or half days to schedule any appointments you need (or just do this before you start rotations).

There will always be someone who is smarter than you, scores higher than you, or sutures better than you. Don’t determine your self-worth based off someone else. Comparison is the thief of joy. Aim to do your personal best.

HAVE FUN! Seriously, third-year is amazing. Yes, it is very challenging, but it is also rewarding.

Don’t sacrifice your happiness for anything. This year has been difficult, but I’ve managed to be the happiest I’ve ever been in my life. I get emotional just thinking about it. Happiness has always been a ‘journey’ for me in many ways. As I’ve gotten older I’ve realized the things that truly matter to me and this has been a beautiful thing.

Obligatory information on studying for rotations

Find out what works for you and stick to it. For me, I primarily used Case Files, Online Med Ed, UWolrd Q’s, and NBME exams to study. This was a little bit different for some rotations like internal medicine I used Step Up to Medicine and for family medicine I used Q’s from University of Virginia and AAFP. Get an early start on reading and then have the time closer to your exam more question heavy. The shelf exams are more difficult than exams during 1/2 year because the right answer generally isn’t as obvious. Practice dissecting the questions and looking for what they are really asking about. Know the “next step” in any workup and how the book/exam answer differs from the real life answer. For example, in the ER sometimes they order a bunch of things all at once. The exam will ask you what the next best diagnostic test is.

Told you it would be long. Feel free to e-mail or message me any other questions you have! I’m happy to help!!

X/O A

{Pediatrics, Updates & More Step 1 Tips}

{Updates}

Happy Halloween my friends! I started my surgery rotation last Monday and man was my first day a whirlwind. I got to see a laparoscopic cholecystectomy {when they take the gallbladder out}, a level one trauma patient, an incision and drainage of a hematoma and even put my first foley catheter in.  By the end of the day (730PM) my feet were aching and I was starving! I made a quick pit stop at Target and grabbed a bucket and Epsom salts LOL! Surgery so far has been grueling, but exciting. Yesterday I got to scrub into a wound vac for someone with necrotizing fasciitis! It was exhilarating but super smelly!

I just finished up peds and I absolutely LOVED it and wanted to give you guys a peek into my daily routine and post some tips! BUT, first — engagement pictures, because I miss seeing my hubs with my long hours on surgery. We are still deciding on wedding plans, more to come soon!

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{Pediatric Clerkship: Typical Day}

The set up of the pediatric clerkship is the following: 2 weeks on inpatient floors either in Royal Oak or in Troy, 4 weeks in an outpatient clinic, 1 week in the NICU, and 1 week on a sub-speciality (peds cardiology, GI, infectious disease, heme/onc, etc). 

Inpatient floors: This entailed showing up to the hospital by 630 AM and prepping for rounds. We’d get up to date on all of our patients and then round around 8AM unless we had grand rounds. During the day we had the chance to go to some of our patients’ procedures and keep an eye on the kids on the pediatric floor. We also had noon lectures!

Outpatient clinic: My day started by going to a case review — a lecturer presented a real case and we worked through it as a group. During the case, we reviewed high-yield principles, lab and diagnostic studies. This was SUPER helpful for the shelf exam. Afterward, I headed to the residents’ clinic and saw patients until noon. I’d take a break for lunch and listen to another lecture given by the residents or attendings. I really enjoyed a few of these that covered child abuse and were given by one of our child abuse specialists. I spent the rest of the day in clinic taking care of some adorable kiddos.

NICU: Rotating in the NICU was one of my favorite parts about my pediatric clerkship. We got to be part of the OR team during deliveries of high-risk premies, twins and emergency c-sections. I learned all of the important things to check right after the baby is born including APGARS, getting them all warm and toasty and, obviously checking for the ABC’s. Although there were a lot of sad things during this week {babies born to moms addicted to various drugs}, I also learned a ton about fetal medicine. During this time I learned the newborn exam and completed a tested encounter on one of the adorable new babies. My days on the NICU went from about 6AM-3/4PM.

Subspeciality: I spent a week with the infectious disease team and rounded on lots of little sick buggers. Some had serious infections {even a case of atypical Kawasakis}, while others had minor viral illnesses. It was super interesting to spend time with the ID docs because I got to round on the floor and spend time in their clinic at Beaumont as well!

One of the topics from Grand Rounds!

One of the topics from Grand Rounds!

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How adorable are the pediatric floor doors?

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On our first day of peds we did a scavenger hunt that included finding as many Beau the Bears as we could!

{Step 1 Tips}

  1. Nail down a schedule as early as possible. Below you’ll see a snapshot of three weeks of my schedule — don’t be intimidated. Just make something that works for you and ensures you will hit all the topics and questions you need to get through. Keep in mind I also prepped before my dedicated time by trying to study my weakest subject areas — immunology, biochemistry, and pharmacology. Don’t forget to pencil in any dates that you can’t study {personal events, etc} and time to exercise, eat and sleep!

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Link to my full study schedule: step1studyschedule

2. Pick your “golden” resources and stick to them. DO NOT try to use tons of resources during dedicated study time because you will very quickly get overwhelmed. Stick with what has worked for you over your first two years of medical school and don’t get intimidated by what your classmates are doing — remember, everyone has a different way of learning. For me, my main resources were UWorld, First Aid, Pathoma and Sketchy Micro.

Well, that’s all for now lovelies. Stay tuned for a giveaway soon and some more life updates during my time on surgery!

X/O A 

{How to Study for Anatomy}

Hi, everyone! Hope you are all having a lovely day. In Michigan, it’s quite a hot one today! I will be spending some time studying on my back porch in the sunshine! I was super lucky and got done with my floor patients around noon today, holla! I recently got some questions about two specific courses at OUWB called AFCP and BFCP. These courses are basically an anatomy course and a foundational science course. I gave some advice to a friend, so I thought I’d share with everyone my tips on how to study for anatomy. This advice will probably be applicable to any school that has a course dedicated to gross anatomy and works with cadavers.

A little background — I worked in a cadaver lab for three years at the University of Michigan and really enjoyed my time there. This sounds crazy to anyone not in medicine, right? Who likes to spend time with corpses? Well, for me, I learned a lot about the donation process and donating your body to science. I have such respect for the people who are selfless enough to give their bodies to science to help us learn.

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LOL, this is from before my MSK exam. My friend fixed him, don’t worry. On that note, let’s get started.

#1 & #2

You really need to have a great anatomy atlas to refer to. When I took anatomy we were given the Netter’s atlas, which I highly recommend and basically is a little mini-bible for anatomy. Find a copy here. The second item that is super key is the  Grey’s Anatomy Review questions, which can be purchased here. Honestly, I would say these two books [or two similar books] are absolutely essential and worth the $$.

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#3 In regards to anatomy lab

Don’t waste time in the lab! Many schools, including OUWB, spend extensive numbers of hours in the lab dissecting. Some people complain and say they don’t learn in the lab, BUT you need to set yourself up to learn. I recommend coming prepared to the lab so you get the most out of it. For me, this entailed looking up all the structures I knew I would be dissecting/looking for that day. I would use Netter’s and highlight away and even sometimes black out terms and write them in myself. I would look up anything I wasn’t sure about including muscle actions, bony processes, etc. The more familiar you are (you don’t need to know them by heart), the more you will get out of the dissection. Secondly, some schools, including mine, have several students dissecting each body. Meaning some people aren’t necessarily dissecting every time they go to lab. My lab group had these “extra” people pull up lecture notes and quiz the group on key concepts or, if everyone was clueless, that person would try to teach the information to us while we dissected. This was super helpful because many questions came straight from lecture notes on our written exam.

#4 In regards to the lab practical

Many schools require students to take a lab practical that entails walking up to a body, being prompted with a question (and usually timed) and then you answer and move to the next body. We had roughly 50 questions on our practical for each midterm/final for anatomy. For this what you want to do is be sure to see as many bodies as you can in the lab. For our school, there were about 20 bodies that were fair game for the practical. Once you start dissecting you will see quickly that everybody is SO different. The general pattern is the same, but you will want to be oriented to as many bodies as you can. Outside of lab time head into the lab and practice finding structures on a few bodies that you didn’t personally dissect. This will help immensely! I always went in with friends who were in different lab groups and we would quiz each other on the bodies. Also, if your class is willing to work together to set up a mock lab practical, that’s what my class did!

One other tip for being successful on the lab practical is to make sure you know which structures are fair game. For OUWB pretty much everything is — we get questions about muscles, nerves, muscle actions, bone landmarks, radiology images, etc. DON’T FORGET THE BONES! Bones are such easy points if you’ve looked at the images even just a few times. But, remember to try to orient yourself to each bone in several views. For example, I got a scapula on a tray once and they asked what a specific bony prominence was, but the scapula was rotated in a way that wasn’t exactly “normal.” I had to re-orient myself to realize what they were asking me!

I hope these tips help; feel free to comment any other questions below!! Oh, PS always study anatomy in the beautiful sunshine, because most of the anatomy labs have no sunlight {except OUWB, #humblebrag}! Wish I had my sunny porch during 1/2 year!

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X/O A

Advice for the Noobs {aka M1s}

Wow, the past four weeks have been an absolute whirlwind. I spent two weeks on night float, another two in the resident’s clinic and now I am working with the internal medicine team on the inpatient floors. Aside from my crazy school schedule I’ve been attempting to study, moved my entire life into our new home and finally am starting to feel settled! I will post pictures of our house soon, I absolutely love it! And more on finances, etc in medical school and how in the heck we managed to purchase our first home in an upcoming blog post.

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On to the REAL topic of this post! So the new OUWB M1’s just started Monday (yay!) and I thought it’d be a good time to get some tips out there for how to start with your best foot forward. I can’t believe my first day of medical school was two whole years ago — time seriously flies.

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As much as I tried to prepare myself for what was to come, you can’t ever truly be 100% ready. There are a lot of unknowns in medical school and sometimes you never see what you could have done better until after you’ve made it through the storm. So, I’ve got some tips for the newbies now that I’m post-step1 and in clinicals.

  1.  Be very careful about what you triage. Every exam is going to have a very large amount of material on it and thus some inevitably gets triaged to the side as “less important.” Although I think this is OK and sometimes necessary, be cautious when picking and choosing what to triage. I can confidently say that nearly all information from years 1/2 comes back either for Step 1 or in clinicals. Focus on getting a good understanding of each disease, it’s pathogenesis and some of the high-yield facts about it. In addition, focus heavily on nailing down microbiology and pharmacology and you will definitely not regret it!
  2. If you are struggling in one organ system get the help you need sooner, rather than later. Organ systems tend to build off of each other so understanding each section is important. Obviously, some topics you will feel weaker at. For example, I have a tough time with renal, but I still tried my best to understand as much as I could.
  3.  Make an impact in at least one student organization or within research. First and second year is really the best time to do this as your involvement may gradually decrease due to the business of 3/4 years. Plan to really invest some time in at least one extracurricular activity that you are very passionate about.
  4. I’ve said this before, but I’d recommend getting some type of long-term study aid. A lot of people I know use Anki cards or Firecracker. I think this is much more important during 1/2 years than clinicals. It’s really hard to remember things when you aren’t seeing patients, so sometimes having a reinforcer gives you that extra time seeing material that you need.
  5. Reach out to your elders {cough, cough me or any other upperclassman}. Seriously, we have been through exactly the same thing you are going through and honestly, we have better advice than advisors who never actually went through medical school. Find a few people that you trust and go to them for advice as much as you need! Don’t be afraid to reach out via Facebook, text, etc we won’t bite!
  6. Don’t stress out  too much. I know this sounds nearly impossible, but just try to keep in mind that school is school. Although it is incredibly important, it is not the end of the world to do poorly on an exam or even fail something. Everyone has a different life path and what matters most is that you are doing the very best that YOU can. Try not to pay attention to other classmates, just do what works for you. I can personally say that one thing I absolutely do not regret is taking time for myself during 1/2 years. Maybe I got a little bit lower grades than other people that put in more effort, but I had a very enjoyable experience (up until step 1 — more on this later). Try to start each day with at least one positive thought and remember that you were chosen to be at your medical school. If all else fails, here is a link to the best motivational clip ever. I watched this right before I took my Step 1 exam: Here.

 

Well, I’m back to studying for my internal medicine shelf. Stay tuned for my synopsis on a typical day on internal med!

X/O A

Flashback to M1: What Would I Change? {Old Post}

Semester two of M2 year is already flying by…how is it the end of January already? Sorry for being so MIA, but I’ve been pretty busy with my Neuro II course and beginning my Step 1 studying. The M1’s at my school are about two weeks into their first organ system based course and I thought it was a good time to do some reflecting on what worked, what didn’t and what I would change. So, M1’s listen up and learn from my mistakes!

Back in November, I wrote a post on all of the awesome materials you need to be successful in the organ system base courses (refer:link). Here’s a few more tips on how to use these resources:

1. Pathoma –> This is seriously the best resource for pathology. I try to listen and annotate this before we start the pathology in our actual course. This gives me some good base knowledge while the clinicians talk. Also, the first three chapters are on topics that may have been covered in the basic science courses, but they serve as excellent reviews. I just relistened to Chapter 1 and lots of things that I’ve learned recently make more sense. If I could go back to the first organ system, I would have taken time to listen to these chapters.

2. Qbanks –> As I said in my previous post I like to work through the RX questions first (easy, medium, then hard questions). This helps me learn the material, so I don’t expect a high average score on these. Next, I tackle the Kaplan Qbank. Same thing here, the questions are more difficult in my opinion and I’m still learning while doing them. For reference scoring an average between 60-70%during the week and a half prior to the exam is pretty good. I ended up scoring in the mid-eighties to high eighties on most of my NBME exam with these type of RX/Kaplan scores. With the rest of the course points I was able to honor many of the courses. BUT, don’t forget to really review what you are getting wrong and learn the material (don’t just gloss over the explanations). If I had extra time sometimes I would redo the questions I got wrong (the interface makes it easy to do this).

3. Sketchy Micro –> Most of my class is totally in love with Sketchy Micro, but I want to remind you that it takes getting used to. The first few sketches I did I felt like I wasn’t retaining anything. Trust me, there is a learning curve, but once you get over this hump everything will come together and you WILL remember all of the important facts about the bugs. I usually started by listening to the sketch and taking notes right next to the printed out picture. I would have to go over this sketch several times (highlighting and quizzing myself). After this, I pretty much had solidified the information and would practice my knowledge by doing questions. As you use sketchy more this will get easier and you won’t have to review the sketches as often.

4. One other resource that I forgot to talk more specifically about in my last post is the Robbins and Cotran Pathology Questions. These are really great if you want extra practice with pathology and if you have time. I’ve attempted to get through them for most of the organ systems, but haven’t always had time. If you have extra time or need more practice these are excellent.

What did NOT work:

-DO NOT OVERWHELM YOURSELF WITH RESOURCES. People in your class are going to like different resources, and it’s key to just pick the ones that work for you and call it a day. Once you do well in your first organ system solidify your resources, and don’t get bogged down with what other people are doing. There are seriously a million resources and you do NOT have time to use all of them.

-Sometimes, sadly, lectures don’t work for me. There are specific lecturers I don’t go to because I cannot learn from them. Don’t do yourself a disservice by forcing yourself to learn from someone or in a way that hasn’t been successful. This is a waste of time, which you can’t afford. One tip I have for pathology lectures is to pull out your first aid or organ systems text and annotate next to each disease based on what’s being said in lecture. Most of the time that lectures line up perfectly, and you can just add a few more key points. The NBME exams are different in that it tests larger concepts, rather than small details. In addition, NBME exams (in my experience) have never tested me on the clinical procedures for each disease. For example, you will need to know the clinical presentation/pathologic finding for X disease but you won’t need to know is it important to get a CT first or give an IV, etc. Your clinical management will be a  focus in your later years of medical school.

What I would have changed:

 On a more global level, I’ve found one big mistake in my studying habits. Step 1 is coming up and I feel like I’ve forgotten a lot of material. I know it’s natural to forget, but I never really did anything to prevent some of that loss of knowledge. A handful of my classmates use a long-term study aid like Firecracker. I really wish hindsight I would have started something like this during my M1 organ system years. Firecracker can be intimidating for a lot of students, because you are supposed to get through a certain number of questions per day, but let’s be honest no one is perfect. BUT, I firmly see now that something would have been better than nothing. Even if you can only do 10 questions a day from that, it would be better than doing nothing. Another resource I’ve been using lately that is similar to Firecracker (but I think cheaper) is the USMLE RX Flash Facts cards. They use the same idea as Firecracker, which is just to ask you questions, give you the answer and then you rate how well you knew that fact.

What I would NOT change:

Second term M1 year and first term M2 year give you more flexibility in your schedule. Even though it’s important to still study hard, this is the prime time to get more involved in student orgs, do something you love, or spend time with family and friends. I definitely did lots of extracurricular activities and was able to see friends often. I wouldn’t change that, because in the future I may not have this much time on my hands to really do things that make me happy. Time literally flies by in medical school and the last thing you want to do is look back and feel like all you did was study, because trust me you can do SO much more than that.

Lastly, it’s important to remember that you are learning a skill and that takes time to develop. My first organ system I did okay, but not as well as I wanted. But, that’s OKAY because I was honing my skills. Your first NBME will be scary because it isn’t something you’ve done before, but just trust your instincts and you will do fine. If you get nervous taking timed, computerized test practice with your Qbank! Good luck, you will all do great!!

  One last thing to leave you with is a quote that I saw on my Momentum home page. This app is really cool and basically just becomes your homepage. It has an awesome new picture background every day, time, to do and main goals + a quote! I love it! Check it out here: link.

OSCE: Objective Structured Clinical Examination {Old Post}

I’ve recently learned that the OSCE isn’t part of every medical school curriculum, but I believe every school has some variation of it. The OSCE is part of our Art and Practice of Medicine course (APM). APM is dedicated to helping us learn clinical skills, like history taking and physical exams. At OUWB we get exposure to the clinical atmosphere very early on by utilizing our clinical skills center in Troy, MI.

During my M1 year we had two OSCE’s, one that was ungraded at the end of semester one, and another graded at the end of semester two. Even though I was pretty comfortable taking a history, I was still really nervous for my first OSCE. I wasn’t sure if I had prepared enough and I didn’t want mess up any of my physical exam skills. After speaking with an M3 and some other classmates, I’ve compiled some tips for success below!

General tips for the OSCE:

1. Wash your hands, do not forget. When standing outside of the patient door I reminded myself to do this.

2. When you introduce yourself make sure to tell the patient your first and last name AND your title. AKA I’m a first year medical student and I’m here to do X today. This helps clarify any confusion and ensures that the patient knows you are not the physician.

3. Practice empathy. Standardized patients (and real ones) pick up on subtle emotional cues like a facial expression or body gesture. If the patient is in extreme pain, your facial expression probably shouldn’t be one of excitement.

4. Validate the patient. What’s worse than having someone who doesn’t believe you? I often tell the patient, “I’m glad you came in today to see me. I can see that you’re in a lot of pain (insert other word) and we will do our best to take care of you today.” This helps reassure the patient.

5. Tie your hair up and use bobby pins if needed. I made the mistake of having my hair in a low ponytail during my OSCE and small wisps of hair kept coming onto my eyes. Anytime you touch your hair, you have to go wash your hands again.

6. If you forget a step and remember later, just do it as soon as you remember. It shouldn’t count against you (except in special physical exams when one procedure must come first).

7. Watch your patient’s facial expression, especially during physical exams. Especially during the GI exam and gynecological exams, we want to make sure our patient isn’t just trying to please the doctor when they are actually in a lot of discomfort. Facial expression usually doesn’t lie!

More for the M1’s:

1. You are still getting the hang of things, but take the OSCE seriously. Even though the first one isn’t graded (and you may be tempted to blow this off), think about your future patients and your instructors who will be assessing your level of professionalism throughout medical school.

2. Practice taking blood pressure, pulse and breathing rate. These seem simple, but it’s really easy to panic if you can’t find the pulse or aren’t able to use the equipment properly.

3. Flu shot–know where the lot number is!! I couldn’t seem to find it because it was in a different spot than where we were shown in the practice. Take a deep breath and keep looking.

4. Try to connect with your patient at a deeper level. Don’t force this, but wait for the right timing. Last year, my patient mentioned that breast cancer ran in her family. I took the opportunity then to show her charms I wear on my stethoscope to support breast cancer survivors and research, because I too have breast cancer in my family. I think she really appreciated this gesture.

5. It’s okay to be nervous. During my eye exam my hand was clearly shaking and I knew the standardized patient saw it. I took a deep breath and just apologized, telling her I was a little bit nervous. She cracked a joke and it made me a lot more comfortable. The standardized patients know you haven’t had a ton of practice, and they also know its better for you to be nervous and make mistakes now, rather than in clinic.

6. Practice “awkward” situations. Sexual histories can be a bit scary at first, but if you practice you will be ready for anything. Some standardized patients will not give you the “typical” story of I’ve been with my wife, and have had only a few partners. Some will challenge you, telling you they have had numerous partners, don’t practice safe sex, etc. This is how things will go in real life, they are just preparing you! What seems “normal” to you, may not be where the patient is as. Practice reacting to statements that are unexpected.

7. Make sure to get a FULL history. Patients are not going to list off all their meds for you with each dosage. You need to probe them! If they tell you they take something for their high blood pressure, the least you need to do is ask, “Do you know the medication name or dosage?” If they don’t know, that’s okay, at least you asked. Don’t forget to ask about those over the counters and herbal medicines!

8. Since the M1’s will have to do a flu shot consultation during their first OSCE (and with the rising anti-vax sentiment), I’d be prepared to counsel a patient who doesn’t believe in vaccines or strongly thinks they cause autism. Practice counseling a patient by being open and understanding, but at the same time getting them the facts about the vaccination and teaching them about the importance of being vaccinated.

9. Ask your M2’s to go through a mock OSCE with you! The best way to practice is to act it out with a partner!

 More for the M2’s:

*although, all the above still applies

1. Time is of the essence. Compared to M1 year, you will be expected to do more than one physical exam plus a write-up in a short amount of time. That being said, if you are running out of time, don’t panic, just get as much done as you can.

What’s the USMLE step 2 physical exam like? Okay, so this is super far ahead, but I figured I’d dabble and see what this entails. There are 12 patient encounters, each lasting 15 minutes. You have 10 minutes after each to write a patient note. During these encounters you will have to decide which physical exams are relevant for the presenting patient. For the full run down check out: http://www.usmle.org/step-2-cs/#format

Helpful sites:

http://www.osceskills.com/ 

In my life…..

Things have been crazy busy and fun!! Last week I got to participate in my first casting clinic & went to Dr. Huang’s home for dinner with the AMWA group. The night was super relaxing and we got a lot of good life tips from her.

I met with some of B’s family for an early Thanksgiving dinner, since we will be out of town for the real thing. It was awesome! We had honey baked ham, scallop potatoes, two different salads, and a brussel sprout dish from Canada. One of B’s cousins also made some awesome drinks, I taste tested most of them! I’m lucky that his family is always so welcoming! We also got to meet a few new people, which is always exciting!

Calling All M1’s: Organ System Studying {Old Post}

As the new M1’s at OUWB are almost near the end of the first semester of medical school, I’ve already started to hear the chatter about winter break. Some students are planning vacations and simply awaiting the relaxation time, while others are trying to get advice on how to prepare for organ system studying. Although I full-heartedly recommend RELAXING during your M1 winter break, I wanted to get this post written ahead of time because there is a lot of budgeting and buying in advance that goes into being prepared come day one of the second semester.

 I’m going to break down all of the key resources that I use to study, along with links and pricing and also talk about my favorite things about each one. Organ system studying is done differently by almost every medical student, so it’s important to find what works for you. The resources I’ve included in this post are used by nearly my entire class, so it’s worth checking into! I’ll also give a brief overview of how I study for organ systems.

Resources (click for link):

1. First Aid 2015: This has slowly become my holy grail. Great resource to check that you know all the high yield things pertaining to the unit. I annotate information from other sources (ie lecture, other texts, etc) in both this book and resource #2. It is a little bit sparser in the information, so I wouldn’t recommend starting studying from this book, rather reviewing with this text. ($45)

2. First Aid Organ Systems: I purchased the two pack, which has a great book for review of basic science (will come in handy for step studying) and the organ system book. ($45)

3. Rapid Review Pathology: Okay, this book will look a little bit intimidating when you first get it. It is basically a bullet point review of all the high yield pathology for each organ system. I usually read through it towards the end of each unit, because it does require some understanding of the material beforehand. ($50) 

4. Pathoma: High yield review of pathology in which you listen to Dr. Sattar and annotate in the text alongside. There are 35+ hours of video and the text includes some awesome images. I’d highly recommend purchasing this! (several packages exist with different lengths of access, but I purchased the 21 month pro which costs $119.95 now)

 5. Sketchy Micro: Anyone that uses this microbiology resource will give it 5 stars, I guarantee. This is an online video source that covers many of the different bugs you will learn during the organ system courses. They use sketches to teach you high yield facts about each bug. Highly recommend! ($159 for 12 months access, $99 for 6 months access)

6. High Yield Embryology: One of the topics I struggle with is embryology so I got this extra text to help me. I find it really useful because its short and to the point. I’d recommend seeking out additional resources for topics you are shaky in. ($32) 

7. Q banks RX and Kaplan: Both of these Qbanks are extremely helpful during the organ system courses. They are a great way to test your knowledge and learn new things. They both have explanations after each question as to why the answer choices are incorrect or correct. I find this really useful because I don’t necessarily need to go back into textbooks to find why something was right or wrong. Additionally, they both give a good break down of how you are doing overall and in each topic area. (Rx- several different packages, but I got the til you pass option which is listed at $299, Kaplan- luckily, our school actually pays for this qbank but if you are buying it you’ll be set back about $199 for the until your test option)

 8. Costanzo’s Physiology and/or BRS physio: Both of these resources are amazing for understanding physiology. I personally use both, but I know people who prefer one over the other. Both are nearly the same resource (written by the same writer), but BRS is significantly shorter and is in more of a bullet point form, while Costanzo is much longer and in paragraph form. (Costanzo – $53, BRS- $43) 

  One additional thing to think about is grouping together with your class to get discounts. I know our M2 class negotiated discounts on both the RX qbank and the pathoma access.

 Okay, so that was a lot of information and these still aren’t all the resources I use. I also use Lange pharmacology cards, occasionally I use the Lippincott’s microbiology cards, and Robbins & Cotran pathology questions (among others). You really have to experiment in the beginning to figure out what resources work for you and then stick to them. Below I’ve outlined the general scheme of my studying. As I’ve gotten more efficient studying for these courses, I’ve been better able to identifying which resources to use more heavily during each system.

Study Plan

1. Tackle physiology by during a first pass (read through once) of Costanzo

2. Start working through histology and embryology using High yield embryo, lecture slides, and first aid organ systems

3. First pass through BRS physio

4. Annotate Costanzo text into BRS physio (this allows me to get a second pass of both)

5. Listen to and annotate Pathoma (first pass)

6. Read pathology sections in first aid organ system (first pass)

7. Annotate Pathoma into first aid (this allows me to get a second pass of Pathoma and pathology in first aid)

8. Go back and review physio and annotate it into first aid (third pass)

9. Start learning pharmacology (pharm cards + first aid) and microbiology (using Sketchy Micro and Lippincott’s cards) (first pass, then I do these periodically until the exam)

10. Read through first aid organ systems in its entirety

11. Read through Rapid review pathology (first pass)

12. Work on Robbins & Cotran questions

13. Read through first aid step 1

14. Make any annotations from rapid review into first aid (second pass of rapid review)

14. Start Q banks, while reviewing all of the above (for q banks I do the RX bank first and do easy questions, then medium and lastly hard….after I do the Kaplan qbank with all of the levels of questions)

15. Revisit lectures I feel will be important or weren’t covered in any of the above resources

16. Revisit first aid organ systems and first aid step 1 (a few more times and one final read through the day before the exam)

 Obviously, this won’t make much sense to M1’s until you actually start organ systems. And in addition, there are some units that are light in physiology (heme/lymph) or heavier (renal and respiratory). So your studying will change depending on the structure and information of the organ system.

What’s new in life? So, we finished up our short endocrine unit this past Monday and some of the girls and I celebrated afterwards at the Rochester Brunch House. It was to die for!

We just started out reproductive unit, which I’m really excited about. My grandpa was an OB/GYN so its something I’ve always tried to keep an open mind towards. I think learning the pathology in this section will be really exciting. I think a lot of the M2’s are feeling a bit “lost” at this point in time. We are kind of in a rut where we keep doing the same thing over and over again (aka studying for each organ system). I’ve been trying to take some of my spare time to do new things and spend quality time with the people I love. I found this quote on Instagram (@typoworld) that I really liked and thought I’d share.

I didn’t take time of in between my senior year of college and first year of medical school, so I’ve been trying to do some “soul searching” lately. It’s important to give yourself a break during medical school and explore a little bit. One of the upcoming events that I’m super excited about is taking a trip over Christmas break. B and I are headed to Arizona (Grand Canyon & family visit), Las Vegas, and Park City, Utah (more family time).

Last, shameless plug to donate to my boyfriend’s Movember fund! Here’s some information on the Movember Foundation: The Movember Foundation is a global charity committed to men living happier, healthier, longer lives. Since 2003, millions have joined the men’s health movement, raising $650 million and funding over 1,000 programs focusing on prostate cancer, testicular cancer, poor mental health and physical inactivity.

Link: https://us.movember.com/mospace/12802221