Third year is definitely not easy. It can be very overwhelming spending all day and night in the hospital and having to run home to study. No worries, instead of wasting a rotation figuring out the right study materials, just scroll down. I got you ;)
What helped me on each rotation:
1. Spend the first 1-2 weeks of the rotation learning the most important pathology and appropriate treatment you'll encounter. You can either use a textbook or Case Files if you already feel comfortable with the subject.
2. Spend the next 2 weeks getting through Case Files or Pre-Test Self Assessment and Review to test/ add to your knowledge. Case Files presents common cases with several follow up questions. Pre-Test presents questions followed by explanations. Personally, I found Pre-Test the most helpful because I preferred starting with a textbook or a resource that outlined high-yield concepts instead of Case Files. By using Pre-Test, I didn’t waste my UWorld questions if I didn’t feel 100% prepared and knowledgeable on the material.
3. Focus on UWorld Questions the last 1-2 weeks to prepare for the shelf
4. USMLE Step 2 Secrets - THIS!!!! This is an excellent resource for your shelf exams and last minute Step 2 CK preparation. Read through the appropriate section before your shelf to refresh your memory on the high-yield topics.
5. Go home and create a mini presentation for a different case each day.
This may seem tedious because you’re already spending a lot of time reading or doing questions. However, this will help you better understand your patients and impress your residents or attendings. You can do this using UpToDate and keep everything on an index card. Focus on important history, presentation, physical exam, imaging, and most importantly treatment. If you keep the case on an index card, you'll be ready to skim the info before you see the patient again or be ready for any pimp questions coming your way (since you probably got the questions wrong the first time).
The resources I found most helpful:
1. Step up to Medicine - Step up to Medicine is a long book but it definitely touches on everything you will encounter on your internal medicine rotation. You have seen the majority of information already, but it provides specific details that are expected from third year students.
2. Medicine: A Competency-Based Companion - If you’re looking for a book similar to Case Files I highly recommend this book. I thought this book was amazing because it told you everything you need to know about each part of the patient encounter. For example: questions you should be asking during the history, appropriate review of systems, everything that should be included in the physical exam, and differential diagnoses to consider.
3. UWorld- Although medicine is one of the longer rotations eight weeks or even 12 weeks you don’t want to procrastinate because there are so many questions.
4. Online resources – One amazing resource is Online MedEd. They do a fantastic job of explaining key topics you will definitely come across during medicine. I would suggest watching these videos if you are unsure about a specific topic while you are reading your main resource (i.e Step up to Medicine). Sketchy Medical (you can’t forget about Sketchy Micro & Pharm!) is great to use as a reminder. Pharmacology was not my strong suit when I started my medicine rotation and I needed a great way to remember exactly when each medicine was utilized.
1. Dr. Pestana's Surgery Notes - Just like your surgery presentations, this book is short, sweet and to the point. I highly recommend reading Pestana’s week one to understand everything that you will encounter during your surgical rotation. You can breeze through this with no problem.
2. Surgical Recall - An absolute must! This is a resource you’ll need for all the pimp questions (...and there will be pimp questions) that you’ll get in the OR. Make sure you read the sections pertaining to the cases on the OR schedule the night before and when you're sitting in pre-op.
4. UWorld - WARNING! When you’re doing your UWorld questions you HAVE to do medicine questions as well. If you only do surgery questions you will not be prepared.
1. First Aid for the Obstetrics and Gynecology Clerkship - First Aid is exactly where you want to go if you want the basic gist of this rotation. It's not very in depth but it's perfect if you don't want a long resource.
2. Blueprints - Blueprint is definitely the most thorough but it is very long. This is the book you go to when the residents tell you to "go home and read". It will cover a lot of things in great detail and if you can remember and reiterate the information to your resident I’m sure they’ll be impressed.
1. Blueprints Pediatrics– Peds is one of the most difficult rotations because etiology, presentation and treatment are based on age. The way a 1-month presents with meningitis is much different than the presentation of a 16-year old. Blueprints is a great resource to guide you through this rotation. Unfortunately, you don't have much time so open this up on Day 1.
4. Find a good mnemonic to remember vaccinations and developmental milestones.
1. First Aid for Psychiatry- Regardless of whether you’re interested in psych, this will be one of the most interesting clerkships. You’re probably already very familiar with the high-yield concepts in psych so run through First Aid quickly. Also, be sure to remember the important mnemonics like DIGFAST and SIGECAPS so you can perfect your Mental Status Exam.
2. Online resources- Once again, drugs are a big part of this clerkship so review Sketchy Pharm if necessary.
1. Case Files- For most people this rotation is extremely short and there isn't a large amount of new pathology you’ll come across. This was one of two times I solely depended on Case Files. You most likely already know about the major pathology. You just need to solidify the treatment.
2. Pre-Test- Once again you have limited time so go through half of Pre-Test (or all if you're able to finish) and move on to UWorld questions.
3. UWorld- The most important thing to remember is don't procrastinate. Before you know it it’ll be the last week before the shelf. Just start studying as early as possible.
1. Case Files- Honestly this was my last rotation and I just completed Ob/Gyn and Peds so I was already comfortable on all aspects of family med. I skipped using a main resource and I went right to Case Files. If family medicine is one of your earlier rotations, pick up Step Up to Medicine to refresh high yield topics you'll see in the office.
2. AAFP practice questions - These questions are much better than reusing UWorld internal medicine questions. I don’t think it’s worth going through the same questions you would go through in your medicine rotation. The AAFP questions will give you a good understanding of the questions you’ll see on the shelf exam. There are hundreds so you'll have more than enough practice!
Basic rotation tips
1. Be involved in everything
This is the first time you’re seeing all the concepts you just spent two years learning. This is the first time you’re going to deliver a baby. This is the first time you’re going to stick your hands in someone's intestines. When an opportunity presents itself during rotations just grab it because it will be a meaningful experience, even if that means you have to come in early or stay late.
2. Shelf exams are important but so is the actual experience
A lot of people in my class were very focused on the shelf exam. About halfway through the rotation they would start to leave for the library midday to go study and didn't return. Obviously honoring is the goal, but you have to remember that one day (one day soon) you will be a doctor. You’re going to see patients and need to know how to treat them. Everything doesn't come from UWorld questions. You actually need hands-on experience to understand how to be a real doctor.
P.S - The residents notice who's present and who isn't. I guarantee if you are present and excited to be around the closer you get to your shelf exam they'll let you leave earlier to go study.
3. Write down your patients
It’s so much easier to understand a concept when you've seen it firsthand. I always wrote down the patients we saw and their treatment plan. I remember my first congestive heart failure patient, my first Ehlers-Danlos patient and the first patient who died from cancer. When you write down your it'll be much easier to remember everything associated with their condition and will help you answer the right questions on the shelf.
4. Work harder at the end of the rotation
Everyone can be excited and on time for the first three weeks. The last 2 to 3 weeks are when you begin to get tired, cranky and thinking about calling out sick. This is a time when you need to work harder, show up earlier and stay later to prove to the residents and the attendings that you are one of the best medical students.
Good luck with 3rd year future docs!