It’s been too long.. Clerkship Reflections/Wedding Post
Mar 31, 2015
I hope all is well out there in cyber-land. I have been very busy with the wonderful challenges and joys of 3rd-year and I haven’t had much in time to post. Now is a good time, however, because in 2-months I will begin my 4th year. Whoa… where did the time go? So much has happened this year both personally and professionally so (as I often do) I will try to share a bit of both in a few different posts.
Something that I think would be helpful is if I posted a reflection on each rotation, resources that I used to study for the NBME shelf-exams. So, here goes nothing. I will recount them from my most recent experiences to those that are for distant in my memory!
Neurology: I had the wonderful pleasure of working at Riley Children’s Hospital for 2-weeks of outpatient Pediatric Neurology and 2-weeks inpatient. Each student has a preferencing opportunity and I elected for the pediatrics route. In general, we are very fortunate to have such tremendous faculty members in this department… they really inspire us to learn, become excellent clinicians and sharpen our skills. Outpatient was a great opportunity for me to see a variety of patients with genetic conditions (such as Neurofibromatosis, Muscular Dystrophy ect.), metabolic disorders, primary seizure disorders, headaches and so much more. In this environment I improved my ability to perform a detailed, thorough and efficient neurological exam and take an appropriate history. On the inpatient (consult service) I stepped into a different environment where I (along with great leadership by 1-2 residents and 1 attending) fielded every neurological consult in the hospital. At times, we had 20 patients that we were actively following and my team relied on me to see patients independently, follow-up on lab/imaging results, triage patients in the ED….. I was busy but this is the environment that I enjoy the most. As a part of the clerkship we were required to take “call” till 9pm on 2 occasions. I did my call at Eskenazi Hospital and worked with 1 resident to field neurological emergencies that came into the hospital. These were the moments that I enjoyed the most as I had an opportunity to face potential disaster head-on, contribute to a team and see a tangible result in improved patient outcomes. I loved it!
NBME exam: 100 questions, typical CBE style. In my opinion, this exam was more straight-forward compared to others that I have taken and USMLE-world questions, Blueprints Neurology and a BRIEF review of neuro anatomy/physiology were sufficient. IUSM provides excellent lectures throughout the clerkship that helped too!
Psychiatry: This is a rotation and field that we (as medical students) have very limited exposure to in a typical didactic setting in comparison to all the subjects that we cover. HOWEVER, it is true that psychiatric illnesses are a huge part of every field in medicine. To be a well-rounded physician you must understand psychiatry to some extent. As such, I approached this rotation at the VA with full-intentions of becoming apart of the team, learning as much as possible and I had the hope that I would help someone along the way. I worked predominantly on the inpatient ward with 1 opportuniy/week to see patients in an outpatient setting. We saw, treated and managed everything from Major Depressive Disorder, Substance abuse to frank psychosis and Schizophrenia. In this population PTSD was also a very common illness that many of our patients suffered from. I loved this rotation for several reasons and I believe that we need to shine a BRIGHT LIGHT on mental illness because, like any other disease process this is not a choice that these patients have made to be and remain ill. Further, it is vitally important that medical students approach this rotation with as much (if not more) interest, enthusiasm and effort as they do any other clerkship.
NBME exam: 100 questions, typical CBE style. Timelines and inclusion criteria for the major mental illnesses as presented in First Aid for Psychiatry along with USMLE-world Qbank were plenty! I was surprised, however, by the length of some of the question passages! I found myself rushed for time toward the end of this exam. Keep your eyes on the clock!
Family Medicine: “Be the kind of Doctor that you always wanted to be”- Random signs in hallways of IUSM.
Family Medicine is the practice of medicine that you think of in the most typical sense! You see just about everyone in the family treating the young and old and depending on your level of training you may even deliver babies. At IUSM many of us are sent to a rural location for this rotation as access to family medicine clinics within Indianapolis is fairly limited. I spent my 4 weeks in Hagerstown, IN with a wonderful private practice clinic. We would see 20-30 patients a day and I had the opportunity to split half of them with my attending! I would see the patient, perform the physical exam and present each patient to Dr. M with a 2-4 item differential diagnosis and plan for treatment! As medicine is always a PRACTICE I wasn’t always spot-on with my suggestions but I certainly learned a bunch from this experience. Moreover, something that I really enjoyed about this field (and location) is that in family medicine you can treat entire families that grow to love and trust you for the work that you do. These relationships were special.
Family Medicine Exam: At IUSM (unlike other institutions) we take a departmental exam based on a series of cases (fmCases) that highlight the diagnosis and management of many, many illnesses. This exam is NOT to be taken lightly. Historically students underestimate this exam and struggle. With adequate studying of those cases, however, you can score better very high!
Pediatrics: This was (to this point) my favorite clerkship. I started with 1 month of Inpatient hospitalist medicine and ended with 1 month of outpatient Pediatrics. Every student will do 1 inpatient month and 1 outpatient month at IUSM. Overall, Pediatrics can be difficult because those little people have different vital signs, illnesses and the most challenging… they can’t often communicate with you as (some) adults typically do. Inpatient was intense as we had 16-25 patients on our team of 3 residents, 3 students a 1 attending each day and each student was expected to carry 4 patients daily. Each morning, we would round on our patients and we students had the opportunity to lead “family-centered rounds” which basically entails talking about the patient’s night, health (vitals, medications, labs/tests) and daily plan in front of the patient and their family using a combination of common and technical language. This was stressful at first! But overtime we all became more skilled and eventually led with little help from our wonderful residents. On outpatient pediatrics I was with a wonderful Pediatrician that allowed me to see and write notes for 10-15 patients daily and come up with a plan. One of the biggest compliments that I have ever received came on my final day of this rotation when Dr. K stated that he wished that I could be his (future) grandchild’s Pediatrician.
NBME Exam: 100 questions, typical CBE style. This exam covers a very broad scope of pediatrics including (but not limited to) rather esoteric metabolic diseases, strange infections and your typical cold-like illnesses. I used USMLE-world qbank and First Aid for Pediatrics and select questions from Pre-Test. Study hard and it should go well!
ObGyn: Let’s deliver some babies! That was my only thought before starting this rotation and I was….. wrong! The field of Obstetrics and Gynecology encompasses so much including (but not limited to): the diagnosis of gynecological malignancy, STD management, prenatal and postpartum women’s health, delivering babies, public health etc. At IUSM you spend approximately half of your clerkship on Obstetrics and the other half on Gynecology. During Ob your hours are far less predictable, you are required to work 1-week of nights (5pm-5am) and you’ll participate in several vaginal deliveries, c-sections. This was enjoyable but I was exhausted :( During Gynecology we worked predominantly in a triage-type setting seeing new patients that were evaluated for routine pap-smears, contraceptives and much more. This was an opportunity (with more predictable hours) to learn the crux of ObGyn. Overall, I was nervous being a male in a female-dominant field involving a very sensitive content-matter but it was my experience that in showing confidence, professionalism and respect I was able to provide great patient care and I received wonderful feedback from patients and my team. Additionally, I was surprised to find that this field was MALE dominated in the not-so-distant past!
NBME Exam: 100 questions, typical CBE style. I used USMLE-world qbank and a high-yield review of ObGyn Physiology, Pathology, Diagnosis and Treatment for this exam.
Surgery: Ever seen Grey’s Anatomy? Kinda like that. But instead of sitting on the couch enjoying my favorite snack and the company of my wife I was working 80-hours/week and dog-tired far away from the comfort of home or my wife. I witnessed death. I met some of the most compassionate people that have every walked this earth. I was stretched in ways that I never before imagined…. and I survived. I was a fresh 3rd-year medical student meeting my team at 5AM to round on patients… that meant that I had to have looked my patient’s up and seen them myself beforehand. In addition, I had to print all of our patient’s rounds-reports out, fold them into a neat hamburger-like configuration and write each set of labs, vitals and medications down so that they were easily accessible on rounds each morning. I saw patients each day that had committed the worst crimes known to man, yet… as I committed to do 3 years ago I served them without regard to their indiscretions. I grew as a student and person on this rotation. As a part of this clerkship we also had an opportunity to do 1 month of 1-2 surgical subspecialties; I chose Ophthalmology and ENT. I chose those because I wanted to experience content that would be valuable to my future career in a primary-care field! I truly enjoyed both of those (very specialized) rotations.
NBME Exam: 100 questions, typical CBE style. I used USMLE-world qbank (internal medicine AND surgery), Pestana Notes (quick read and MUST), Step Up to Medicine. This exam was my very-first NBME of the year and I had no idea how to prepare so I studied just about everything and anything that I thought could help. In general, I think this is a great approach as this exam encompasses topics from just about every specialty.
Anesthesia: Drugs, Intubate, Drugs, Intubate. I did this rotation at a rural outpatient surgical-suite and got to intubate 95% of the patients that we saw from 7AM-11AM daily during mostly quick ENT surgeries. I had the opportunity to refresh my memory on commonly-used medications, ventilation settings during this rotation! A strong review in basic physiology and pharmacology goes a long way on this rotation!
Exam: This exam is a 20-30 question departmental exam. They provide a PDF study-guide that the exam is based on. Know that well and you’ll do just fine.
During my month-long vacation month and Christmas/Thanksgiving break I married this sweetheart. I’m so thankful for her and all that she does to understand the life of a medical student :)