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

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