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Trucking along through my third year of medical school, my next clerkship rotation was Psychiatry.


-Logistics-
Timeline: 6 weeks

During this clerkship, we were allowed to request being at our local state hospital, the university hospital, VA consult team, or another local VA hospital that had a larger and more intensive psychiatric program. I requested to complete this rotation at the later VA location. Here, our rotation schedule was divided between 3 weeks of outpatient clinic and 3 weeks on the inpatient service.

Other: weekly lecture/case based study with quiz; NBME at the end of the clerkship

Hours:

Every day, we started at 7:45am with a morning lecture on different psychiatry topics. After this lecture, we went off either to outpatient clinics or to the inpatient service. On outpatient, the attending or resident we worked with varied from day to day and this influenced when we finished in the afternoons. Typically, we were done by 3:00-4:00pm. On inpatient, rounds were usually finished before lunch and then we worked on notes and usually were done for the day by 2:00-3:00pm. Some days, depending on what we were doing and the number of patients that were seen, we were able to finish earlier than this. This location was much more laid back, being separated from the larger systems we had a choice of rotating through, so we generally had more time off than students had at other locations.

-Responsibilities-

Due to the delicate nature of the mental health issues that we often saw, there was a lot of shadowing during this rotation. This occurred more on outpatient. Sometimes, we were allowed to see patients by ourselves, but usually we just observed the resident or attending doing the interview. On inpatient, we rounded with the entire team all at once (attending, resident, students, social worker, APRN). While seeing each patient, it was our responsibility to conduct the interview, with other members of the team chiming in as needed. After rounds, we completed the notes on the patients we each personally interviewed.

-Study Resources-

First Aid for the Psychiatry Clerkship: This was a good summary review of the psychiatric conditions we needed to know, along with their diagnostic criteria and treatment options.

UWorld questions: UWorld questions are always great to help grasp the types and format of questions that will be asked on board exams.

-Atmosphere-

My Psychiatry experience was very relaxed and stress free. The residents and attendings really enjoyed teaching and often took time during the day to go over frequently tested topics. While there wasn’t a whole lot we could do on our own, we did learn a lot from both these lectures and from observing the interactions between the resident or attending and the patients.

Have you done a Psychiatry clerkship? What was your experience like? Do you have any other questions about what my time on Psych was like? Feel free to leave your comments and questions below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

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Started back after Winter Break with Ob/Gyn.

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My face after our labor simulation…

-Logistics-
Timeline: 6 weeks

During this clerkship, we rotated for 3 weeks on different Gyn teams (1 week Benign Gyn clinic, 1 week Benign Gyn OR, and 1 week Gyn Onc) and 3 weeks on L&D (1 week L&D day shift, 1 week L&D night shift, and 1 week on Antepartum).

Other: weekly lecture/case based study with quiz; NBME at the end of the clerkship

We also had one labor simulation lab, as well as attended Gyn Grand Rounds and High-Risk Ob conferences each week.

Hours:

The hours greatly varied from week to week depending on what service we were on. Approximately the hours were: Benign Gyn clinic: 8am-5pm; Benign Gyn OR: 5:30am-4pm; Gyn Onc 5:30am-4pm; L&D days 7am-3pm; L&D nights either 3pm-11pm or 11pm-7am; Antepartum 6am-5pm.

-Responsibilities-

During clinic, we would typically interview patients on our own, present to a resident, and then do the physical exam together. We were taught how to do speculum exams and Pap smears on our own and observed endometrial biopsies and LEEPs. On the surgery services, we were responsible for following 2-3 patients to present to the team and then attend all the surgeries for the day. Surgeries included everything from hysterectomies and cold knife cones to D&Cs and excision of tumors. On L&D service, we spent time in triage, which was like an ED to evaluate acute problems in pregnant patients after 24weeks, and attended vaginal deliveries and C-sections.

-Study Resources-

Blueprints for Ob/Gyn: This book was a detailed but concise summary of Ob/Gyn. The chapters were pretty easy to read through but did not lack on the important information.

UWorld questions: UWorld questions are always great to help grasp the types and format of questions that will be asked on board exams.

-Atmosphere-

Ob/Gyn was definitely a busy 6 weeks. There was so much variation covering both Obstetrics and Gynecology and going between so many different services, including both clinic and the OR. Doing so, however, meant that we got to see so many different things and learn a ton!

Have you done an Ob/Gyn clerkship? What was your experience like? Do you have any other questions about what my time on Ob/Gyn was like? Feel free to leave your comments and questions below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

My third clerkship of M3 year and last rotation of the fall semester was Internal Medicine.

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-Logistics-
Timeline: 8 weeks

During this clerkship, we rotated on 4 different medicine teams for 2 weeks each. The teams were split between the VA and the University hospital.

Other: weekly lecture/case based study with quiz; NBME at the end of the clerkship

Each week, we also had simulated encounters. These were where we walked through critical cases, like hypertensive emergency, pulmonary embolism, and others, with a simulation mannequin. We were allowed to go through the whole case in our teams of 5 students. Each student had a different responsibility, from taking the history, doing the physical exam, monitoring vitals, and pushing meds. After the simulation was over, we would discuss what happened with an attending and talk about why we made the decisions we did and what we could have done differently.

Hours:

We usually arrived around 6:30-7:00am in order to pre-round on the patients we were following. Rounds usually started around 8:00-8:30 and lasted until about 11:00, depending on how big the census was.  In the afternoon, we would usually have lectures or conferences until about 3:00.

-Responsibilities-

Each day, we were responsible for following 2-3 patients, which included pre-rounding, writing progress notes, and sometimes putting in orders and calling consults.

-Study Resources-

Step Up to Medicine: This book is super helpful during medicine! The helpful hints and key points are easy to go through to help refresh your memory on the important facts of certain topics. It is very concise, however, so might need some supplementation on topics that are less familiar.

UWorld questions: UWorld questions are always great to help grasp the types and format of questions that will be asked on board exams.

Emma Holliday Ramahi’s Review: This video review, which can be found on the UT San Antonio COM website, is a great study alternative to just reading a textbook. It is a quick, high-yield review that is great to watch the day before a final.

-Atmosphere-

It might have been due to being at an academic institution, but our Internal Medicine clerkship was very “intellectual” (for lack of a better word) with lots of conferences discussing research papers and the latest journal articles. While these were sometimes interesting and I understand the importance of staying up to date on the latest recommendations, I would have enjoyed more time to spend with patients. I always find myself learning the most just from talking with patients and finding out direct from them about their symptoms and any potential complications. In all, however, I definitely did learn a ton during my Internal Medicine rotation.

Have you done an Internal Medicine clerkship? What was your experience like? Do you have any other questions about what my time on Medicine was like? Feel free to leave your comments and questions below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

My second clerkship during third year was Surgery. This was a big change from Pediatrics, but with more responsibilities, it also helped me feel more and more like I was becoming a doctor.

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-Logistics-
Timeline: 8 weeks

At my school, we were on two different surgery teams for 4 weeks each. We were allowed to submit our preferences and then were divided up by a lottery system. I was on the General Surgery and Pediatric Surgery teams. A few services that other students rotated through were colorectal, surgical oncology, cardiothoracic, and trauma.

Other: weekly lecture/case based study with quiz; NBME at the end of the clerkship

Hours:

The hours varied depending on how many surgeries were scheduled for each day and whether we had lectures/quiz. In general, though, we got to the hospital between 4:30-5:00am for rounds at 6:00 since the first case in the OR was typically at 7:00. We were usually done by 4:00-5:00 in the afternoon. The hours also greatly depended on what service you were on.

-Responsibilities-

Each day, we were expected to show up with enough time before rounds to make the list (basically a master list of all of the patients with the most recent vital signs and lab results) and pre-round on 3-4 patients. During rounds, we presented to the chief resident or fellow. Then, when the cases started going in the OR, one student was always expected to be in every case. There were also 2-3 days of clinic per week where we saw post-op patients and new patients for OR scheduling. More so than in other clerkships, Surgery was very hands on. We were allowed to sew, staple, take out stitches and staples, place NG tubes and Foleys, and assist in the OR.

-Study Resources-

Surgical Recall: This book is a MUST for Surgery! I would recommend getting an ebook format to put on your phone. Then, you can pull it out to read a little in between OR cases. This book came in very handy when I used it to read about a specific surgery before attending it in the OR. I definitely got a few “pimping” questions right because of this book!

UWorld questions: UWorld questions are always great to help grasp the types and format of questions that will be asked on board exams.

Emma Holliday Ramahi’s Review: This video review, which can be found on the UT San Antonio COM website, is a great study alternative to just reading a textbook. It is a quick, high-yield review that is great to watch the day before a final.

-Atmosphere-

Surgery is definitely a unique beast. It is a very fast paced and active medical specialty. Even though it felt like I never left the hospital and didn’t have time for much else besides eating and sleeping, I enjoyed surgery more than I expected. I loved being able to have more responsibilities and do more procedures. While being in the OR with certain attendings was a bit intimidating, I found that the more time I spent in the OR, the more comfortable I felt (mostly being less nervous about doing something wrong and breaking sterile field 😳).

Have you done a Surgery clerkship? What was your experience like? Do you have any other questions about what my time on Surgery was like? Feel free to leave your comments and questions below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

I am so excited today to have Dr. Majestic, an Emergency Medicine physician out of Orange County, California, talk about what her life is like in the ED. Be sure to follow her on Instagram, @dr.majestic_md, and Periscope, @DrMajestic, where she posts about different health topics and has some wonderful tips on how to integrate more healthy habits into our busy routines.

EM Guest Post


 

Each medical student will ask themselves a hundred times in medical school, “what field is the best fit for me?” This can be one of the hardest decisions in your lives! I know; I’ve been there.

I chose Emergency Medicine at the last minute, when I thought I was choosing Plastic Surgery. These fields could NOT be more different! In the end, my younger self knew what she was doing and who she really was. She knew that my personality would fit perfectly into Emergency Medicine.

My week starts like this. What day is it? Is this even the beginning of the week? Well, it doesn’t really matter because I’m probably working nights and weekends. I need some coffee.

You know you are an Emergency Medicine physician when you are testing a patient’s orientation and you, yourself are non-oriented to date and time. I always have to look at my watch.

So the truth of Emergency Medicine is, we work day shifts, night shifts, weekends, holidays; typically switching from days to nights on a whim. It was a brutal transition. But once the body is trained to expect this kind of change, it’s doable. I have my very specific sleep mask, earplugs, black out curtains, and noise machine so that no matter what time of day I am sleeping, my brain thinks it’s time to sleep! Ha! Got you Emergency Medicine, so there.

Working in the Emergency Department is like an art, an art like no other. It really is different than any other field. It combines a business and efficiency model with a mixture of really tough, high acuity medicine. I am required to provide good medical care. I am also required to provide fast medical care. Contradicting, to say the least. Hence, the art form.

My typical day consists of seeing many different patients; we don’t turn away anyone in the ED, so depending on who decides to waltz through that door, will determine my fate.

Sometimes I feel like an actor, because it’s physically impossible to feel all the emotions I see in a day. I have to turn on my happy for the patient that gets good news, and then turn on my sad for the patient’s family that receives the worst news they will ever be given.

I care for children, adults, and elderly, dead, alive, I’ve even had a patient try to persuade me to care for their animal. That’s where I have to draw the line.

On a daily basis I see very sick patients and very healthy patients. I run to take care of a trauma patient between delivering news of cancer to another patient. I pull things out of orifices you probably didn’t know existed. I have had the most astound conversations with people, all the while trying to hold back my laughter, smile, or tears. One minute I am suturing a laceration from a beer bottle to the face, the next I am reducing a shoulder dislocation. I counsel patients on drug use, alcohol, and diet recommendations, right before pulling a roach out of a child’s ear. Yep, it’s a dirty job. It is NOT for the faint of heart.

I have learned to live off of protein bars (there are some great ones out there), little water, and infrequent bathroom breaks. I am a master at juggling phone calls, while signing prescriptions, and doing squats at the same time. I have to take advantage of a free minute whenever I can!

The ED pace is set to fast, faster, or lightning fast, and it isn’t slowing down anytime soon.

If you aren’t comfortable with vomit, blood, poop, other bodily fluids, and gore like you could never imagine, perhaps the ED isn’t for you. If you like taking care of large volumes of patients and not having to see them back (except for the regulars), you may prefer the ED. We do a lot of procedures on a regular basis while taking care of some seriously complicated medical cases at the same time. We know all the consultants, as we are the ones they never want to hear from. That is generally because we are taking them from some important family event to see a patient. We typically take the brunt of everyone else’s frustration. Sometimes the patients have been waiting for hours, or are in pain, or just having a bad day. Thick skin is a definite requirement in the ED, and it definitely has made me a stronger individual.

Some say we emergency physicians are jacks-of-all-trades, masters of none. In reality, we are required to be masters of all, and make no mistakes. There is great liability in Emergency Medicine, to make the right decisions and make them quickly. When my shift is over I am physically and mentally drained. But when I go home, I know that I can relax. There is no ‘call pager’ going off to call me back in. On a daily basis, I am reminded of why I should be grateful with my life, and just how precious life is. Emergency Medicine is no walk through the park, but I wouldn’t have it any other way.


 

Have you ever considered the field of Emergency Medicine? What do you think you would enjoy about life in the ED? What other specialties are you interested in? As always, leave any questions or comments below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

 

Setting up a Smart Book

With the massive amounts of information that has to be learned in medical school, I have found it difficult to keep track of everything. The best way I have discovered to help me learn more efficiently is by using a smart book. I started implementing a smart book into my study routine while studying for Step 1 and have continued using it throughout third year so far.

Smart books especially come in handy when working through practice problems. I tend to use my book mostly when doing UWorld question blocks. The idea behind a smart book is to learn from the questions you have missed and actively work towards getting similar questions right in the future. Using this strategy is one way to help incrementally improve your score on standardized tests and board exams.

While there are a variety of ways to set up a smart book, I set mine up in a question and answer format. By setting it up this way, I found it much easier to quiz myself and keep myself accountable for learning the information.

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To start your smart book, all you need is a notebook. Super easy, right? Then as you are answering practice questions from Uworld or any other question bank, whenever you miss a question, add an entry to your smart book with just the information that you needed to have remembered in order to answer the question correctly. Your entries should be short, concise, and bulleted to only include the key information from the question.

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Of course, I had to color code everything! (I honestly think I have a problem.) The point of a smart book is for your entries to be random. This way, going through your book is more similar to an actual board exam where all of the subjects are mixed together. However, sometimes, I want to go over just the subjects that I know I struggle more in. This way, I would more easily be able to find those particular subjects based on their color.

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The key to successfully using your smart book is repetition. The entries are the condensed information that you didn’t remember while answering practice questions, so it is vital to ingrain these points into your long term memory. Therefore, it is important to read through your smart book often so you are training your brain to start answering the questions correctly. While studying for Step 1, I would read through my smart book every evening as the last thing I did during my study routine. Slowly, I found myself remembering key points I wrote down in my smart book while doing UWorld question blocks and was able to answer more and more questions correctly.

Do you have a smart book? How is yours set up? Are there any other study tips/ideas that you just can’t live without? Let me know by leaving a comment below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.

My third year of medical school and first time being in the hospital and actually dealing with real patients began with Pediatrics. Here is a breakdown of what that clerkship was like for me.

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-Logistics-
Timeline: 8 weeks

4 weeks inpatient- 2 weeks on a general peds team, 2 weeks on a specialty team (I was on the pulmonary team)

4 weeks outpatient- 1 week in the general peds clinic, 1 week in various specialty clinics, 1 week nursery, 1 week night float

Other: weekly lecture/case based study with quiz; NBME at the end of the clerkship

Hours:

Inpatient- ~6:30-4:00 everyday and every other weekend

Outpatient- ~8:00-4:00 with no weekends; except for nursery and night float

-Study Resources-

First Aid for Pediatric Clerkship: As always, the First Aid series of books are great. This book gave a great overview of the most common pediatric points to know for boards and was an easy and quick read.

UWorld questions: UWorld questions are always great to help grasp the types and format of questions that will be asked on board exams.

Emma Holliday Ramahi’s Review: This video review, which can be found on the UT San Antonio COM website, is a great study alternative to just reading a textbook. It is a quick, high-yield review that is great to watch the day before a final.

-Atmosphere-

The atmosphere in a children’s hospital is unlike anywhere else. One of my brothers is special needs and therefore has spent lots of time in various children’s hospitals. Even though there are sad times and one would think everyone would be depressed from being around so many sick kids, all of the workers, from doctors and nurses to housekeeping and cafeteria workers, are so cheerful. Kids are the best, always being so optimistic and joyful, and it is hard to not be happy while being around them.

I loved my time on pediatrics!! I had been thinking about it for a while, but after completing this clerkship, I know without a doubt that I want to pursue a career in pediatrics. I loved my time on inpatient and can totally see myself being a hospitalist in a children’s hospital one day!

Have you spent any time in a children’s hospital? What was your experience like? Do you have any other questions about pediatrics? Feel free to leave your comments and questions below.

Being a pre-medical student automatically means a hectic life.  Luckily, following Doctors of Tomorrow is easy!  Sign up to get alerts of new posts sent directly to your email.  You can also follow Doctors of Tomorrow on Facebook, Twitter, and Instagram.  Look for all of these links on the right hand side of the homepage.