Tips for Success as a MSIII
Third year is an exhilarating, frustrating, phenomenal, and sleep deprived year of medical school. Here are a few lessons to succeed that I gained along the way.
You should start to seriously think about third year rotations early in the spring of your second year. You should find out from senior students about the general expectations and responsibilities of rotations. There are several books that explain the nuts and bolts about hospital rotations, how your future team will work, and how to succeed. Some titles include: “The Nerd’s Guide to Pre-Rounding,” “250 Biggest Mistakes 3rd Year Medical Students Make And How to Avoid Them,” and “How to be a Truly Excellent Junior Medical Student.” These texts are relatively inexpensive and provide a thorough introduction to the hospital environment. The following are tips that you can start to take advantage of during your second year and take with you throughout third year.
Start reading journals. You should read something every day. Most journals offer affordable rates for medical students and medical school libraries offer online access to hundreds of journals. The New England Journal of Medicine is great for most rotations. Also the American Family Physician, a journal by the American Academy of Family Physicians, has excellent review articles on diseases commonly seen in practice. Naturally, reading emergency medicine journals will start preparing you for your upcoming EM rotation.
Read review books. Most rotations have a test at the end, often a Shelf exam which resembles Step 1 in format and difficulty. You will not see patients with every disease that is covered on the test so you need to be prepared. There are many series out there: Blueprints, Case Files, Underground Clinical Vignettes, First Aid, to name a few. Often you can buy used versions of these books from classmates or from online booksellers.
Get organized. You will pick up clinical pearls from the bedside to the cafeteria line. If you do not write them down they will be lost forever. Buy a small notebook to keep in your coat pocket or use your PDA. Remember, you will not be getting powerpoint slides for your third year education. It is up to you to find a way to absorb and retain the fire hose of information.
It will be a culture shock to be graded subjectively. Since almost all medical students are personable, hard working, and motivated, how does one stand apart to get the highest mark? No perfect answer exists to that question, but I do have some tips.
Know how you are being graded. Get the evaluation forms and assignment list on day one. Take notes during the orientation. Make a list of who will be evaluating you. Make sure you complete every assignment on-time and in good form. The Shelf exam may be only 10%, but it might be your best chance to bring up your grade.
Be proactive. Tell the attending and resident that you want to do well and politely ask them how to do it. I cannot emphasize this enough. If you find out you need 10s on your evaluations to get the highest grade, ask them what is necessary to get a 10. It is much easier to do this early in the rotation than after the grades come back. There is nothing more frustrating than being told you did ‘honors work’ and get marked as satisfactory because the evaluator did not understand the scoring system.
Seek feedback. It can feel annoying to constantly ask how to do better, but this is encouraged. You are a student, after all. Try to schedule a mid-term feedback session to check in with your evaluators. This is a great opportunity to politely remind them about the score you are trying to achieve and get their specific input on how to do this.
Presentations. Do them every chance you get. You will probably be expected to do a few, but volunteer if there is a clinical question that comes up. The presentation will likely be informal, but you should prepare like an admissions interview. Find a good review article, summarize it in a 3-5 minute talk, and practice. Delivery is as important as content. Practice in front of a mirror or your understanding spouse or roommate. You might also bring in copies of the paper for your team.
Know everything about your patient. What was the last A1c? Why are they taking each of their ten medications? What was their last potassium? This information should be on your person and easily accessible. I recommend using ‘crib sheets,’ that are readily available in a variety of forms on the internet. One popular example is “MedFools” available at: http://medfools.com/downloads.php. Copying lab values every day is tedious but you will shine (and help your patient) when you point out the trending down hematocrit since admission and have a plan ready to work it up.
Be efficient. Try to have all the pertinent questions ready when you go into the room. A good resource for this is the book “History and Physical Examination (Current Clinical Strategies).” Learn how to do an efficient chart biopsy to learn more about your patient and to use your time more effectively. Ask others for help with tips for becoming more efficient. For example, one attending gave me a 15 minute talk about how she gets a past medical history from the electronic medical record. That orientation saved me hours of time throughout my rotation.
Help the family. You have the most free time on your team and you are the best person to translate medical terms to laymen’s speak. Use these skills! It is your best chance to really help a patient since you probably will not be making the medical decisions.
Help your team. Your interns will be swamped. Offer to do scut work with a smile. Remember, tracking down old records is still helping the patient. You might only be following one or two patients, but you can still assist with the care of the rest of your team’s census.
Follow your patient to specialists. If you are on your internal medicine rotation and your patient is getting a CABG, ask to go and watch! You will get to learn about other specialties and see some amazing stuff. It is also a nice break from the routine. If a specialist does an exam on your patient, make sure to be there. You can get some great education and learning the language of specialists is particularly important in EM.
The Road Ahead
Third year will be over before you know it. A solid third year will pave the way for a great fourth year and beyond.
Use your MS4s. They can tell you about great 4th year clerkships, away rotations, and leadership opportunities. I recommend checking in with them throughout the year to hear what they are going through. One great question is “What would you have done differently?”
Begin to decide your career path. If you are on the fence about EM or any other specialty, you need to explore the alternatives to make the best decision. The longer you wait to decide on a specialty, the more behind the curve you will get. It is expensive and a waste of your time to switch residences, so be aggressive about deciding on your career choice. Do an elective rotation. Shadow a physician. Go to a conference. Do your best to know your specialty choice before the start of your 4th year.
I saved the most important advice for the last. Be enthusiastic. A bored medical student stands out like a sore thumb. It is hard to maintain this kind of energy 24/7 for your entire third year, so I recommend finding some ways to de-stress when you have free time.
Good luck in your future!
Kevin Jones, MS-IV
MSC - Western Region 4 Representative
Oregon Health & Science University
Medical School, Class of 2010