Best advice for being a good 3rd year med student / how to get honors in 3rd yr

Best advice re: how to be a good medical student. This is absolutely what I wish they told ppl going into 3rd year. It’s copied directly from a reddit post by “LUIS DE FUNES” so that if reddit goes down this advice will still be preserved (redditpostlink)

I got H in all clerkships, and can share some keys to success that worked for me. Apologies for the incoming wall of text. This is something I wrote months ago in a word doc like halfway through 3rd year, and now I guess is the time to drop it. To answer your question, I would have done things pretty much the same, I’d just worry a little bit less.

I guess this is about rotations in general. The way I have been navigating the hospital is by treating it like a game, where the ultimate goal is getting honors. You can use skills in your toolbox like medical knowledge and social engineering/EQ to score points with your evaluators. If you keep your radar on, you can find so many ways to not only get the most out of your learning, but also to be always on point.

Any time you first start working with a new intern/resident/attending (preferably one you’ll be sticking with for a while), be attentive to what scut work they do. Be proactive in taking some of it over for them! But tread carefully because you want to avoid creating extra work for them. So for example, my first day with a certain intern I saw that she had to copy and paste a bunch of stuff into a discharge summary, and call the PCP. Easy stuff, but tedious, therefore it is practically made for an M3 on a silver platter. So the next day, I came in a few minutes early and started on that for a patient who I knew would be leaving that day. For the things that aren’t so easy to just do on your own after watching it done once, ask them if you can do that task for them. Worst case they say no, but are appreciative of you asking.

Also, any time you are working with someone new, pay attention to their habits, no matter how small. I pay attention to the glove sizes people use so that I can pull them if I’m closer to the glove boxes than they are. I also pay attention to where a person moves when they are in a patient room, and it helps me predict where the doc will go next. This way I can smoothly move out of the way before I am actually in the way. Also if a doc does the same procedure often, figure out in what order they do it, so that you can hand them things or get out of the way when needed.

Read all the time. Specifically, read directly about your patients. This may be controversial, but don’t study for the shelf during downtime. I only study for the shelf when I go home. During the day, whenever there is a lull in patient care, I’m always on UpToDate about whatever is going on on the floor that particular day. This is the best way to nail pimp questions, and also interns/residents/attendings do notice that you are reading about patients. I’m of the strong opinion that attendings couldn’t care less about whether you are studying for your shelf or not – that’s why the shelf grade exists in the first place, to take care of that aspect. Reading about relevant things shows that you care about what you are leaning in the hospital. (Maybe I’m wrong and overthinking it, but studying for the shelf in plain view has always felt like a no-no to me. Somehow it feels to me like I am not present and in-the-moment).

Every time you have a patient, look up some research on their condition. Even if it is bread-and-butter, most cases have something unique about them, or have research that is very recent that the team might not be aware of. Then take the article, summarize the pertinent facts in a little paragraph in an email, and attach the paper. Send to everyone on the team. I’ve been given advice by upperclassmen/interns to do presentations to the team on this kind of research, but I’ve found that in reality there may be no time to do that, and sending out an email with your commentary accomplishes that much easier. And it can be done from home.

Find out what unique things you can do to help out the team. Most recently, I was at a community hospital where the interns and residents rotate through as well, so they are not caught up on all the protocols that the hospital has. We had a patient once who was on a protocol that spanned a whole packet, like 15+ pages. I overheard the intern and resident talking about how they should go through that protocol once they wrap up things for other patients. So while they did that, I went through the protocol myself and created a 1-page Word document where I essentially summarized the most important points in the protocol that the medical team was responsible for (there was a bunch of other stuff for other teams too, so I didn’t include any of that). Then printed out copies for everyone on the team. They kept referring to my document the whole week. I’m not saying do exactly that, just saying that it’s helpful to always be on the lookout for ways to make things easier for people – medical students have more time than anyone else in the hospital, so we can do this kind of stuff no problem. Many times I have done something and it ended up being totally useless. But this one time I hit a jackpot. You miss 100% of the shots you don’t take. As long as what you’re doing isn’t going to create more work for someone else, go for it full force.

If you’re at an outpatient setting, figure out how to get a hold of the EMR and the patient records. If I am ever at an off-campus site with a different EMR than the one I have access to, I talk to a nurse or MA – 100% of the time if you are polite and approachable, they will help you out and may even let you hop on to their account. Then I print out the most recent note for every single patient I might see that day, and read them ahead of time to learn about the patients. This is not a HIPAA violation. You are a medical student whose job it is to learn from every single patient, such that you can then provide the best level care. This way, when an attending says “would you like to see the next patient?” you can go into that interview armed with a lot of knowledge about everything pertinent to their follow-up. This scores major points imo.

Also another thing about outpatient settings – I’ve heard lots of people complain about how working one-on-one with an outpatient doc is too much like glorified shadowing. Obviously that’s the way it is – PCPs and specialists are very pressed for time, so they don’t have the time to let you ask questions or do the interview. Two things help with transforming your glorified shadowing into actual clerkship material. First, is being informed as I said above. Once the doc realizes that you are caught up about their patients, they may let you actually lead part of the interview because you won’t be slow. Second, nothing is stopping you from examining the patient while there is a lull in the visit. If the doctor is charting in their computer, or if it is a pediatric patient and the doc is talking to the parent, you can start listening to the heart and lungs, and do whatever else is pertinent to the visit. Feel this out, but most of the time the docs that I have been with have been very welcoming to that, and have commented to me that it shows that I care about learning while respecting the busy nature of the visit.

In the OR, be cool, stay quiet, and don’t ask too many questions. Keep your back straight. If you are retracting for a long time, use the weight of your body to retract rather than your arm muscles – this helps prevent strain. Always be aware of your body positioning. Walk around the OR slower than you think you need. Move your hands a little slower than you think you need. Doing these things will allow for greater precision, and you will appear much more composed and relaxed in the OR, which is a good thing in terms of showing clinical competence.

Never say no to anything. Any time you are offered to go down to talk to radiology/go in with a consult to the pt/offered to see a new procedure/asked to do an errand/asked to get food for a patient/literally anything, always say yes and do it.

Along the same lines, volunteer for everything. If you are rotating with a group of students, gauge the situation – if people are being hesitant when the attending asks “Which one of you wants to be the first to do ____,” jump in and raise your hand! But always gauge the situation first. Which brings me to my next point.

Don’t step on anyone’s toes and don’t make anyone look bad. While this includes interns/residents/attendings, there usually isn’t much of an opportunity to mess that up because their responsibilities don’t often overlap with yours. So this rule mainly applies to peers – medical students, PA students, nursing students, etc. Don’t do stuff for their patients. Don’t answer their pimp questions. Also, my modus operandi is to talk everyone up who deserves it. If I enjoyed rotating with someone, I’ll always make sure the team knows why I thought they were a great person to work with. If another medical student or PA student teaches me something, or if they did something that I really liked for their own patient, and it somehow comes up, I’ll absolutely make sure that they get the credit they deserve. Especially if the student isn’t particularly outgoing or assertive.

Treat everyone as your work colleague. Keep the relationship very professional, but part of a professional and cooperative work environment involves the interpersonal stuff like work-appropriate small-talk. This is the same across any industry. Your interns/residents/attendings/nurses aren’t your friends, but I’ll absolutely remember if one of them goes away for the weekend, and I’ll absolutely ask them how it was/did they enjoy it/etc. Being liked doesn’t mean you are everyone’s friend, it just means you navigate the relationships just like you would in any other professional team.

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