Sponsored Links
Results 1 to 7 of 7
Like Tree5Likes
  • 3 Post By houmd
  • 2 Post By PnS11

Thread: Houmd's "How To's": Clinicals

  1. #1
    houmd's Avatar
    houmd is offline Elite Member 7229 points
    Join Date
    Nov 2009
    Location
    Chicago, IL
    Posts
    2,510
    Downloads
    26
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts

    Houmd's "How To's": Clinicals

    Advertisements



    Hopefully I can answer a few questions about clinical sciences that can help students in the future from running into the same confusion and problems that so many of us did due to lack of information.

    When to start clinicals
    Haven't taken step 1 yet? I'm actually shocked that this is a common question. The best time to start clinicals is as soon as you can after step 1. It has come to my attention that the school has been allowing students to complete rotations in the states through some recent loophole. This is a TERRIBLE idea. I understand that many students feel scared, ashamed, or embarassed that they haven't passed step 1 yet. This makes them feel like they should be moving forward when they are stagnant, and then the idea pops into their head that they should try some clinicals and then study for step 1 at the same time and maybe they'll be learning more from clinicals. This couldn't be further from the truth and I can't advise enough against it. Clinicals do NOT prepare you for step 1. There is a reason that step 1 is a requirement for rotations and that you're not supposed to go into them without it. The farther you get away from basic sciences the harder it is to take and pass an exam that tests on basic sciences. I GUARANTEE you that you will not be learning about things like G-protein mediated pathways during your clerkships in a way that will prep you for step 1. If this is you, I recommend you look at my other guide here to my step-1 guide, and correct whatever it is that you aren't doing properly before moving forward.

    So you've taken step 1 but haven't gotten your results back? The school will let you begin the paperwork for clinicals as long as you have passed the exam and schedule 12 weeks of rotations pending your score. But until you get a passing score you cannot move further. Since anything involving paperwork takes awhile, you are best to start as early as possible. When you exit the prometric center they will give you a piece of paper that says you took the exam. The procedure now to set up clinical is:

    1. Email [email protected] for an MD6 invoice.
    2. Pay the tuition and fees, and make sure she sends you an updated cleared invoice
    3. Send this updated invoice (and a scanned copy of the paper saying you took the exam) to [email protected] and tell her you want to start clinicals.
    4. There are several clinical coordinators to choose from but odds are you will just be assigned one unless you specifically requst another. At this time of writing I believe there are 4 to choose from (3 when I started). Each one has requirements for you to begin scheduling rotations through them but they are mostly the same. Talk to your classmates or get information at the clinicals fb page, which a lot of people access to discuss rotations to give you an information as to which coordinator you want, or if you don't mind paying multiple registration fees and more paperwork register with all of them for the maximum access to rotations.
    5. Once you have decided on a coordinator, informed brittney which one you want and sent in the above information on #3, the school will send out paperwork to the dean to have him authorize a "Letter of Good Standing" this is something that is required by the coordinators and is essentially the paper that says they will get paid. Your letter of good standing is only valid for as many weeks as you have been authorized, and thus if you have your original 12 weeks, you can't schedule anything outside of 12 weeks.
    6. Once this letter of good standing is authorized and sent to a coordinator they will require a few things in paperwork before you can start. This includes but is not limited to:
    USMLE information (even if pending)
    Blood titers for:
    Hep B, Varicella, Measles, Mumps, Rubella
    Two-Step Tb test (or chest xray if reactive)
    This stuff can take a few days or so to get the results for depending on where you go so you wanna get these when you can in order to start in a short amount of time. I'd recommend getting the blood drawn the day after your exam or so just for the sake of getting it done faster (and keeping your mind off of the questions you might have gotten wrong)
    7. Now that all the paperwork is completed you may start clinical rotations. Please don't PM me asking or openly ask where rotations are, because they are CONSTANTLY changing. When I started to when I finished saw a drastic change, as it did for all those before me and those it will after me. What we have today will be different tomorrow.

    Note:
    Everytime you need to schedule another rotation you will need a new letter of good standing, this means repeating steps 1-6 above, and can obviously take some time. So, it is in your best interest to pay for a few semesters ahead of time in order to never have any issues getting back to back rotations, or wasting your time sitting around doing nothing while waiting on paperwork.




    What should I read to prepare? I feel like I don't know anything
    So this is pretty much where you are expected to be sitting right now. Totally unprepared for any real human encounters, unsure of yourself in any non-multiple choice format.

    Having passed step 1 you already have quite a bit of knowledge, and that will be the strong basement foundation for clinical medicine. It is now time to organize that knowledge into a systematic method of developing differentials, testing to rule things out, and treating patients while recognizing them as human beings and not "the appendectomy in bed 24."

    First thing I recommend doing is reading over the history taking section of this outstanding review to ICM from a UCSD physician which recognizes many fears faced by medical students and teaches you how to get over them:
    A Practical Guide to Clinical Medicine - Charlie Goldberg, MD

    And another thing to observe would be the First Aid for Step 2 CS. This book can help you think of questions to ask and differentials and testing to consider based on chief complaint.

    Review any H&P videos you can find, and practice on your friends. Do NOT let insecurities get in your way of a good H&P (more on this later.)

    Core concepts for all rotations

    #1: You are a professional: The supreme rule is that at all times you must be as professional as your 45 year old attending. You are not some teenager wearing a white coat for the sole purpose of instagram. At all times you represent the profession of medicine when you wear that coat and at all times you should treat the profession with the respect it deserves. In accordance with rule #1:
    -Always show up on time, never be late, and never leave early without direct permission. If a disaster happens or something occurs call-in as soon as you can to let them know. No-call/no-shows in the professional world get people fired. Your attending or your attending's staff should never need to guess your whereabouts.
    -Always show respect. This goes to everyone you encounter. Sir and Maam should now be in your vocabulary if they weren't before. From the attendings, residents, nurses, medical assistants, janitors, and most importantly the patients. If you are seen as a professional respectful medical student, people will be much more interested in teaching you and helping you when you need it.
    -Dress professionally. This should go without saying but there are enough lunatics in medical school that seem to think being a hipster or a thug as a medical student is acceptable so long as you wear a white coat on top of it. This is certainly not the case. Unless specifically told otherwise, show up to each rotation wearing business professional (dress shirt, slacks, tie, etc).
    #2: Use common sense Medical students do a lot of dumb things, but some are just embarassing. I have personally witnessed an actively wheezing patient be told she had clear lungs because the student used the diaphragm of the stethoscope to listen to her lungs over about 5 layers of clothing in winter. (hint: place the stethoscope directly over skin, have pts take off their jackets and overshirts and go under the shirt). There are MANY situations where students do weird things but I don't feel like diving into that category too much. Just always ask yourself, is this something my attending would do? And if so, if this HOW my attending would do it?
    #3: Don't be afraid Fear is what makes you miss out of opportunities to learn. The best attending I ever had would ask us what we didn't know and what scared us. The next thing we knew we were forced to learn and do them repeatedly until we realized how bizarre our fears really were. Going into clinicals and doing things on real human beings can be terrifying, but it needs to be learned and it is expected of medical students. When given the opportunity practice on each other, things like injections, iv placement, phlebotomy, etc etc. When given the opportunity to do anything knew always take it, this is your period to learn and you are allowed to make these mistakes now while in med school, but if you go into residency making medical student mistakes then you'll be in bad trouble.
    #4: Don't be embarassed This particularly pertains to anything sexual. Guess what, men have male genitalia and women have female genitalia. No matter what society has done to try and convince you otherwise, we all have these parts, and all of us are humans. Being a human means having pathophysiology. I have seen SO MANY patients not get the care they needed because people were too embarassed to do rectal exams, pelvic exams, male genital exams, or breast exams. I'm not in anyway trying to be offensive but this is predominantly with the more religious types in that they neglect patient's genital care because of societal pressures to pretend the opposite sex doesn't exist for some reason. This HAS many times caused missed diagnoses. If you're afraid of touching testicles in a male h&p then you will miss all your testicular cancers. If you're afraid of doing rectal exams you will miss all your prostate cancers, etc. When you take the health and life of another human being into your hands you are responsible for everything that happens to that person, and you become responsible for every missed diagnosis. I personally was most upset when we had to send a child for orchiectomy due to the fact that his regular pediatrician for many years never checked to see if his testes descended.
    #5: Learn as you go A lot of people seem to forget that they are in clinicals to learn, if you already knew medicine then you wouldn't need med school. As far as what to read you need to know everything about the cases that you had seen that day. Once you finish for a day if you had a COPD patient, a heart failure patient, and an asthmatic, you need to go home and read everything that you can about those conditions. Learning about patients and their conditions as you see them will make this information stick much easier than memorizing lines from a book.
    #6: Be a team player Make sure to get along with everyone on the team and NEVER throw anyone under the bus for personal gain. Teamwork is a skill that gets you very far in healthcare, and no one likes a gunner.




    Clinical skills vs clinical knowledge
    Another thing to remember is that you are still a medical student. As mentioned above, if you already knew it all then you wouldn't need med school. You are expected to make mistakes in third year, a LOT of mistakes, and that is okay. You aren't expected to know the final diagnosis of all your patients nor are you expected to know how to manage and treat each patient right away either.
    Third year clerkships are more about learning how to take an adequate history, perform a proper physical exam, understand sterile technique, and developing a system for creating a differential diagnosis. Being able to figure out the next best step is the best thing you can do in third year. As you get more organized in your thinking, technique and diagnostic skills you will get more comfortable managing patients and soon enough you will realize that you are learning a lot more than you ever have.



    more to come....PM me if you have information you would like me to add or discuss...


    Last edited by houmd; 04-28-2014 at 07:01 PM.
    DrHonorMed, fancyloaf and nalah1 like this.

  2. #2
    medicineitis is offline Junior Member 517 points
    Join Date
    Nov 2013
    Posts
    84
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    It would be nice if you also discuss electives and the right time and prep for taking step 2, the pocket books for clinicals and study material for step2 CK and CS.
    Does the school allow to set up your own cores? We keep on seeing this add for medicalrotations.org and was wondering if this is better than others school is affiliated with. Thanks.

  3. #3
    PnS11 is offline Senior Member 6123 points
    Join Date
    Feb 2012
    Location
    rub my tattays
    Posts
    902
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Some students might also wonder what books to use. You mentioned FA Step 2, which is almost an automatic like the Step 1 book, but many students recommend DIT again. DIT is good for Step 1 but many people shy away from it and write it off as simply "someone reading First Aid to you." It's hard to argue with that, for the most part, but it is still some quality stuff. Their questions often test high yield concepts and the videos are actually pretty easy to follow along, unlike some Kaplan instructors.

    That's for Step 1.

    But for Step 2, the amount of people suggesting DIT Step 2 almost triples. Forums always suggest getting their Step 2 program and sing its praises. I never used it, but maybe someone can shed some light on it and determine whether it is a solid program or not.

    Otherwise, you should have a textbook for each rotation you do, and a question book (like Pre Test) to review the concepts and whether you've learned them correctly or not.

    I have never heard anyone recommend Kaplan Step 2 videos. You can download them online but I couldn't watch more than 15 minutes combined of their videos. It's too dry.

    And finally, there's the Master the Boards (MTB) that many people use in preparation. This may actually be more commonly used for Step 2 than the First Aid Step 2, book. But that's another given.

    It's no different than studying for Step 1. You'll need to buy UWorld again for Step 2 and keep doing questions and do constant, proper evaluations of your skills with a CS NBME.

    In relation to the first point of "you are a professional," that is definitely true. I had to chuckle when I once searched "Windsor ValueMD" on Google, and one of the four main links was how Windsor was a "scam." It's safe to say that any one worth a damn that searches the school up like that will definitely question the school and its students. I know I've been critical of the school, but no more than any of the respected members on here, but that truly might be a thread that blows it for future students.

    So it reminded me also of how the school's reputation is reflected simply by how the student dresses. It's always best to go dressed in your best. I love wearing scrubs because it lets me be lazy and not worry about much when getting dressed in the morning. But even if your attending tells you that scrubs are OK but still wears dress clothes himself, it's best to emulate him rather than "floating" within the constraints of the dress code. Leave the scrubs for the surgeons that have a reason to not get their clothes dirty. In a clinic or even in a hospital setting, dress up properly. Guys and girls, both. If there's one thing that doesn't need to be modernized in medicine and needs to remain in traditional form to its roots in medicine, it's dress code and bed side manner.
    DrHonorMed and houmd like this.

  4. #4
    houmd's Avatar
    houmd is offline Elite Member 7229 points
    Join Date
    Nov 2009
    Location
    Chicago, IL
    Posts
    2,510
    Downloads
    26
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by medicineitis View Post
    It would be nice if you also discuss electives and the right time and prep for taking step 2, the pocket books for clinicals and study material for step2 CK and CS.
    Does the school allow to set up your own cores? We keep on seeing this add for medicalrotations.org and was wondering if this is better than others school is affiliated with. Thanks.

    I agree with much of what PnS11 stated.

    the only other things I would add would be for Step 2 CS, the ONLY two things you need are FA for step 2 cs and a good study partner. Go through all the cases twice together, practicing timing.
    Step 2 cs is intended to determine how well you manage time & stress. The topics are all vague and could be any number of things. I notice though that students often get the misconception that they have to get the diagnosis right, even though there is no correct diagnosis. So if you find yourself freaking out trying to think of the best diagnosis, then calm down.
    This exam is about english speaking skills, data gathering skills, counseling, and documentation.
    You should first go into this exam knowing that chief complaints will be vague, that SP's will try to waste your time, and there is physically no way you can ask all the intended questions, do all the necessary physical exams, and counsel on all important topics within 15 minutes. It's just NOT possible and you have to manage your time to do the more important things first.
    If you walk in knowing the fact that you simply cannot finish everything within the time limit, and that the testers expect that, then you should feel a LOT more comfortable on exam day.
    All you really need is a week to prepare and you'll be just fine. You can practice with a partner through the first aid CS book and use the template provided on the USMLE website to practice your note typing skills here.
    Also, note that the results for CS take between 1-3 months just to come back, so if you're applying for the match in any given year you need to take it by June 15th to feel absolutely certain you'll have that PASS come in before Sept 15th.

    Pocket books aren't super necessary during clinicals, however I highly recommend Maxwell's Pocketbook. It is essential for medical students and has basic info that I referred to on many rotations. Here is a link so you know what it looks like.



    The school will allow you to set up your own cores if you are able to, and if you sign a waiver saying you understand they aren't affiliated with the school. Illinois Residency Licensure requires that cores be affiliated with your school either verbally or written. This is also IF you can set up your own cores, many of us have tried and most of us have failed in doing so.

    Odds are any medical coordinator that advertises heavily and has a poor website is worse off than what you'll get with Windsor's coordinators. I don't know anything about medicalrotations.org but I wouldn't recommend them.


    As PnS11 said, Kaplan videos for step 2 are a WASTE.
    I did well on Step 2 CK and used this format:
    1. UWorld 1x tutor mode(started at the beginning of rotations)
    2. DIT + Step up to Step 2 (the book DIT uses)
    -As I finished each section, I redid every UWorld question on that topic (finished Uworld a second time in tutor mode)
    3. UWorld timed mode 3-4 blocks/day (finished a third time) - only reviewed incorrect questions at this point.
    4. Use NBME's and spam Score Estimator to help you estimate your step score. Most of us found that the UWorld section on medfriend's is the single most accurate score predictor. Most NBME's for step 2 are outdated and their margin of error may be larger than they predict. Under NO circumstance should you do NBME form 3. That one is absolutely terrible, and a complete waste. I've never heard of it being accurate for anyone.
    Last edited by houmd; 05-07-2014 at 10:59 AM.

  5. #5
    PnS11 is offline Senior Member 6123 points
    Join Date
    Feb 2012
    Location
    rub my tattays
    Posts
    902
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by houmd View Post
    I agree with much of what PnS11 stated.

    the only other things I would add would be for Step 2 CS, the ONLY two things you need are FA for step 2 cs and a good study partner. Go through all the cases twice together, practicing timing.
    Step 2 cs is intended to determine how well you manage time & stress. The topics are all vague and could be any number of things. I notice though that students often get the misconception that they have to get the diagnosis right, even though there is no correct diagnosis. So if you find yourself freaking out trying to think of the best diagnosis, then calm down.
    This exam is about english speaking skills, data gathering skills, counseling, and documentation.
    You should first go into this exam knowing that chief complaints will be vague, that SP's will try to waste your time, and there is physically no way you can ask all the intended questions, do all the necessary physical exams, and counsel on all important topics within 15 minutes. It's just NOT possible and you have to manage your time to do the more important things first.
    If you walk in knowing the fact that you simply cannot finish everything within the time limit, and that the testers expect that, then you should feel a LOT more comfortable on exam day.
    All you really need is a week to prepare and you'll be just fine. You can practice with a partner through the first aid CS book and use the template provided on the USMLE website to practice your note typing skills here.

    Pocket books aren't super necessary during clinicals, however I highly recommend Maxwell's Pocketbook. It is essential for medical students and has basic info that I referred to on many rotations. Here is a link so you know what it looks like.



    The school will allow you to set up your own cores if you are able to, and if you sign a waiver saying you understand they aren't affiliated with the school. Illinois Residency Licensure requires that cores be affiliated with your school either verbally or written. This is also IF you can set up your own cores, many of us have tried and most of us have failed in doing so.

    Odds are any medical coordinator that advertises heavily and has a poor website is worse off than what you'll get with Windsor's coordinators. I don't know anything about medicalrotations.org but I wouldn't recommend them.


    As PnS11 said, Kaplan videos for step 2 are a WASTE.
    I did well on Step 2 CK and used this format:
    1. UWorld 1x tutor mode(started at the beginning of rotations)
    2. DIT + Step up to Step 2 (the book DIT uses)
    -As I finished each section, I redid every UWorld question on that topic (finished Uworld a second time in tutor mode)
    3. UWorld timed mode 3-4 blocks/day (finished a third time) - only reviewed incorrect questions at this point.
    4. Use NBME's and spam Score Estimator to help you estimate your step score. Most of us found that the UWorld section on medfriend's is the single most accurate score predictor. Most NBME's for step 2 are outdated and their margin of error may be larger than they predict. Under NO circumstance should you do NBME form 3. That one is absolutely terrible, and a complete waste. I've never heard of it being accurate for anyone.



    Are you saying setting up your own core rotations essentially bars you from IL licensure because while the school may approve of it, after you sign a waiver, it is still not affiliated with the school and therefore making you ineligible for an IL residency?

    That is the first I've heard of that and I've never heard Dr. Marg**** put a stipulation on setting up your own cores.

    I realize this is different from setting up electives, which seems to be a more common thing to set up on your own, for some students. But if one is fortunate to have built connections while doing a Peds in Atlanta and decides to do an IM in Atlanta that isn't through the school, they've just shot their IL residency chances in the butt?

  6. #6
    houmd's Avatar
    houmd is offline Elite Member 7229 points
    Join Date
    Nov 2009
    Location
    Chicago, IL
    Posts
    2,510
    Downloads
    26
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by PnS11 View Post
    Are you saying setting up your own core rotations essentially bars you from IL licensure because while the school may approve of it, after you sign a waiver, it is still not affiliated with the school and therefore making you ineligible for an IL residency?

    That is the first I've heard of that and I've never heard Dr. Marg**** put a stipulation on setting up your own cores.

    I realize this is different from setting up electives, which seems to be a more common thing to set up on your own, for some students. But if one is fortunate to have built connections while doing a Peds in Atlanta and decides to do an IM in Atlanta that isn't through the school, they've just shot their IL residency chances in the butt?

    If there is no affiliation agreement whatsoever between the school and rotation site then it effectively bars you from residency in IL. This was in fact a requirement on my IL residency license application as well, listing all my cores (except FM) and marking whether or not the school had a written or verbal agreement with the site. That form had to be filled out by the school and not myself. It has been a rule longer than Dr. Marg**** has been around but seems like it wouldn't be hard to get around since a verbal agreement is eligible for this as well.

  7. #7
    PnS11 is offline Senior Member 6123 points
    Join Date
    Feb 2012
    Location
    rub my tattays
    Posts
    902
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by houmd View Post
    If there is no affiliation agreement whatsoever between the school and rotation site then it effectively bars you from residency in IL. This was in fact a requirement on my IL residency license application as well, listing all my cores (except FM) and marking whether or not the school had a written or verbal agreement with the site. That form had to be filled out by the school and not myself. It has been a rule longer than Dr. Marg**** has been around but seems like it wouldn't be hard to get around since a verbal agreement is eligible for this as well.
    "Verbal agreements" and "Windsor" aren't always the most trustworthy. Still, I know Dr. M seems like an honest man and if he agrees to it, it should stick.

    It just took me by surprise and now I'll need to scramble a bit to avoid losing such an important state for residencies. We already can't do NY and CA, no one really needs this on their plate either.

Similar Threads

  1. Houmd's "How to do well in Basic Sciences" Handbook
    By houmd in forum Windsor University School of Medicine
    Replies: 42
    Last Post: 08-29-2014, 09:47 PM
  2. Houmd's "How To's": Step 1
    By houmd in forum Windsor University School of Medicine
    Replies: 6
    Last Post: 05-23-2014, 11:14 AM
  3. our school email addresses- "rossmed.edu" or "students.rossu.edu"
    By UconnBBall in forum Ross University School of Medicine
    Replies: 4
    Last Post: 06-05-2013, 01:10 AM
  4. "Cost U Less" - New "CostCo-Style" Store Opening Across The Street From SMU Campus
    By The Big Dance Is Coming in forum St. Matthews University School of Medicine
    Replies: 1
    Last Post: 11-08-2007, 12:38 AM
  5. Replies: 0
    Last Post: 03-17-2006, 01:34 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •