Advice from my 3rd year of medical school

Today’s inane images of the day:

I had a moment of social media fame with Arianna Huffington and two phenomenal AMWA ladies.

I was an AMWA National Conference Co-Chair and had a stressful, albeit rewarding year planning the 99th Annual Meeting.
We got plenty of snow here in Michigan – including in April.
A scene I became very well-acquainted with while on Internal Medicine (if you couldn’t tell, this was taken on the inside of a parking structure).
I made many trips over the Rockies to Los Angeles to visit a special someone.
I gave my first presentation at a conference.
After laboring over away rotation applications, I finally scheduled one!
There were countless trips to Starbucks this last year – can someone call up Starbucks Corporate and let them know that I’m providing free advertising? (This is a green tea frappuccino for those that are curious.) 

I will be completing all of my core clerkships as of June 5th, 2014. Doesn’t that seem ridiculous? I swear it was just yesterday that I sat on my soapbox dishing out advice from my first semester of medical school (I actually wrote that entry almost 2.5 years ago… wow). Anyway, enough on how quickly time flies… let’s talk about tips for 3rd year (i.e. clinical clerkships, clinicals, rotations):

1. Ask questions.

I am not advocating that you sit at the front of each resident lecture and mindlessly raise your hand to ask a question that you already knew the answer to (that very well may be detrimental to your grade and potentially your career). What I advise is to ask thoughtful questions concerning management or alternative treatments on patients you are following or rounding on. Not only do these types of questions show that you’re paying close attention, the process leading up to the question and hearing the answer will reinforce the material. Of note, think ahead of time who the most appropriate team member would be to ask – there are definitely M4-, Intern-, Senior-, and Attending-level questions. Your best approach may be to start with the M4, since we genuinely want to see you all succeed, we were just in your shoes and we have no impact whatsoever on your final grade.

2. Make time to read at least one resource from cover to cover for each clerkship.

Initially, I wasn’t doing great on shelf exams. I wanted to blame it all on my “test taking skills” – but that didn’t get me very far. What I noticed as the year progressed was that when I vowed to read one review book from cover to cover, that I miraculously scored in the “Honor” range. While some review books are better than others for specific clerkships (maybe I’ll be inspired in June to write clerkship-specific advice), in general, all of them contain the same basic material. So if you’ve already read a couple chapters of a book, just stick with it rather than buying another resource and never getting past the introductory chapters.

It’ll be harder to read on some clerkships more than others – however, if you just devote at least 30-60 minutes each day to reading your selected review book, you’ll likely get through it all. I personally tried to read for 20 minutes each day, then hit the books hard on days off, but this takes a lot of discipline since days off are sometimes hard to come by (i.e. it’s really hard to study when you’ve been “on” for 14 days straight).

3. Buy a 1-year subscription to the USMLE World Step 2 Question Bank.

Buy the 1-year subscription to UWorld Step 2 question bank during your first clerkship and make sure you do all of the questions pertaining to the rotation you’re on. With this longer subscription, you are allowed to reset it once – so because I am planning to take Step 2 CK in June, I will refresh my qbank before studying and will not have to buy an extension. This may not be feasible for you (depending on whether you will have time to study and how much time you actually allot to study for Step 2), but it’s an added bonus that I am able to use this resource for clerkships and Step 2 for a single fee.

4. Professionalism counts. Big time.

Our grading structure is Honors, High Pass, Pass and Fail. In order to achieve Honors, you must get Honors for both your shelf exam and your clinical evaluation. It is this second portion where professionalism matters. That means that you should always be early, you should be well-groomed and dressed (M2s rocking the Step 1 beards – you will probably want to clean that up a bit before starting), and you should be enthusiastic. Keep in mind that everything you do will be evaluated, so maintain your professionalism until you are off-campus (even then, you’ll find that the Beaumont community is rather small and suddenly you’ll run into hospital personnel at grocery stores, restaurants, etc).

5. Reflect upon what you liked and disliked during or immediately after the clerkship.

Our PRISM reflections take care of this, but in general, I think it’s good practice at least to do it in your mind. Some of you will find that certain clerkships surprise you. Many of you change your mind about what specialty you want to pursue a couple of times. And many of you will eventually find the one that just seems to click. Regardless, it’s good to think about each clerkship on a broader scale because it may come in handy later in the year if you’re torn between specialties.

6. Start thinking about away rotations early in your second semester.

We got our notification to register for VSAS in late-January. Sometime between February and May, most VSAS schools will release available away rotation options. And many schools will not be on VSAS at all. In general, I’ve found that scheduling away rotations is really quite painful. Oftentimes the application is tedious (lots and lots of immunization record forms, proof of many different certifications I didn’t know I had, lots of enrollment letter requests from the Registrar, etc). And dates! Dates are a huge issue. Our clerkships run from the 1st of the month to the last day of the month, regardless of the day of the week. Many schools start with the 1st Monday of the month and run 4 full weeks. Some schools run on a completely different block schedule that starts in the middle of the month. Anyway, the point of all of this is that if you start looking into the schools you’re interested in earlier in the semester and prepare copies of all of your necessary documentation, it’ll come in handy later on.

7. Keep a list in the back of your mind about potential letter-writers.

If you had a great experience with an attending, consider asking him or her for a letter of recommendation. If you don’t yet know what specialty you want to go into, you can let them know that you will be asking for a letter later in the year when you have confirmed your specialty choice so that they know to write down notes for themselves.

8. If you are rotating on the specialty you plan to apply to, start drafting your personal statement.

Although this may seem premature, I cannot stress enough how easy it is to forget the little things you love about a particular specialty. Even if you’re not writing coherent sentences when you are “drafting” your personal statement, any thoughts or reflections on the clerkship will go a long way when it’s suddenly the end of the year and you have to convince residency programs through a single page of paper why you’re a stellar candidate for their program. Start a Google Document now and add to it throughout the year. In general, try to answer what specifically about the specialty you enjoy, what type of training you want (community vs academic), where you want to go with your career (fellowships? MBA?) and general feelings about the specialty on why you fit.

9. If you are sure of your specialty, meet with the Program Director.

Program Directors are brimming with valuable information on your specialty. They can explain what programs look for in candidates, help you determine how competitive you are, help you identify weaknesses in your CV and write a letter of recommendation on your behalf. If you’re confident in your specialty choice, it works in your favor to meet with the Program Director at some point prior to applying.

As for you OUWB-almost-M3s finishing up Step 1 – just a few little things to keep in mind as you start APM5:

  • Scan a copy of your mask fit certificate and card immediately after receiving it – you may need it to apply to away rotations
  • Keep those little ACLS cards in your white coat – they are golden during codes
  • Ask the Class of 2015 for advice!
Colleagues, is there anything else that you’d like to add to this list?
[Hopefully this blog entry will be the cure to my insomnia!]