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Contents

  1. Packing List
  2. Misc
  3. Internal
  4. Family
  5. 4SURGERY
  6. 5PSYCHIATRY
  7. 6NEUROLOGY
  8. 7OB/GYN
  9. 8PEDIATRICS

1 - Packing List

  1. Alcohol swabs (clean your stethoscope!)
  2. Badge
  3. cell phones/credit cards/money disappear quickly from call rooms/lounges
  4. Epocrates Pocket medicine (little red binder)
  5. Foldable clipboard
  6. Gray Matter (free from UTH-MMS)
  7. Guide Cards & Developer (ask nursing staff)
  8. Hand sanitizer
  9. Index cards/notepad
  10. Maxwell’s quick medical reference
  11. Multi-color pen/highlighter
  12. Pager
  13. Penlight
  14. Phone
  15. Reflex hammer
  16. Snacks (especially on surgery)
  17. Stethoscope
  18. Tarascon pocket pharmacopoeia (deluxe edition) or phone
  19. Tongue Depressors
  20. you only need to carry an otoscope/ophthalmoscope with you on pedi or medicine

Call Nights

  • Lock-up your stuff!
  • toothbrush and lots of gum
  • zip-up jacket (especially for OB or surgery); the hospitals get cold at night
  • blanket

5. phone charger

6. midnight snacks/cash for vending machines

7. extra scrubs (you never know what will end up all over you)

8. glasses if you wear contacts

9. books to study

Year-Round References

1. Harrisons and/or Cecils

2. Step-up to Medicine

3. NMS Medicine casebook

4. First Aid for the Wards

5. Boards and Wards; USMLE

6. Step 2 Secrets;

7. Dale Dubin Rapid Interpretation of EKGs

8. High Yield Acid-Base

9. Sapira’s Art and Science of Bedside Diagnosis - is an excellent physical diagnosis reference

10. Case Files

11. Pre-test

Websites

(best references for those nights on call):

1. www.uptodate.com – download the app on your phone and look up DDx/management based on chief complaint before you go see your patient

2. www.medfools.com (PN/soap note outlines)

3. www.pubmed.gov (impress your attendings with articles) log onto pubmed through pub med

4. Remote from library homepage (need username and password); clinical queries gives you an excellent way to search for articles [

5. when in doubt, start google.com (seriously!)

Overview

Resources

1. Pocket Medicine—this book will become your best friend!

2. Uptodate. Download phone app so that you can look up stuff during downtime

3. NMS medicine casebook (amazing book; focuses on management/next best step; has case variations which help you differentiate between similar presenting diagnoses)

4. Online Med Ed videos – excellent for the shelf and Step 2 CK

5. Step up to Medicine

6. UTHSC San Antonio – HY Internal Medicine video and pdf

7. UWorld medicine questions ( ~ 1300) – try to get through as many as you can

8. Case Files for Medicine

9. First Aid Medicine

10. Pretest Medicine or MKSAP MS review – for practice questions

11. Appleton and Lange Review for Medicine

12. Maxwell’s Pocket Manual (little red book)

13. Pharmacopeia or phone with Epocrates

14. www.dynamed.com – good resource for info on specific diseases ( www.uptodate.com)

15. www.medfools.com – has things that help organize patient information

Tips

1. Always know what is going on with your patients especially when you are presenting them during rounds (lab values, vital signs, what meds they are on and what dosages, study results, cultures, consults from other services, etc…)

2. also know the vital signs and lab value trends (ie: ↑ or ↓ from x to y)

3. Ask the nurses what happened overnight with your patients – what happened overnight might not be written in the chart. (they are not always nice, but be polite back because they are a necessary source of information about your patients)

4. Rounds are usually very long so be prepared to be on your feet every day (get some comfy shoesDanskos are a class favorite).

5. It is important to pay attention during rounds on other students’ patients…you never know when you might be asked a question

6. When working up new patients, save some time and get the old records first (most patients will be repeat customers, especially LBJ).

7. Come up with your own assessment and plans in your progress notes - research your patients’ disease and come up with your own plan – even though you may not be right – it looks good to have initiative and you will learn more. Then talk to your residents about what you think and they will help you out before rounds

8. Learn to read chest x-rays and EKGs and how to interpret labs (won’t be on the test but every good doc needs to know how to read these)

9. Pay attention on this rotation; whether you chose internal medicine or not as a career, these months will establish the foundation for the rest of your days as a doctor; every patient you see on any rotation will have underlying medicine issues.

10. Take advantage of your attendings; show them you’re interested in learning; ask them to do break out teaching sessions for your team (ie EKG lectures, acid/base, etc.)

11. Attendings love articles; discuss with them articles relevant to your patients; major brownie points! [11] Internal medicine test is hard so study well!!!!

12. Always protect yourself while in the hospital – TB and HIV are very prevalent at both LBJ and Hermann. If you even suspect the patient might have TB - tell your resident and wear a mask.

13. call room is super cold – bring extra blankets or a sweater.

14. Remember that in Care4/EPIC you can personalize the H&P and progress notes templates; take advantage of this and set this up early in the rotation because you’ll save a lot of time (especially when pre-rounding when you have to write multiple progress notes before rounds)

Resources

1. Up To Date -For your patients-the more you read on your patients the better your overall preparation.

2. USMLE World Internal Medicine -The more of the questions you can get through the better. Of all the Usmle world step 2 question banks, this is the most reflective of a shelf and of step 2. Making the question review process an active rather passive experience will yield higher benefits, such as writing out in a word document the explanations provided and how your thought process led you to the correct or incorrect answer.

3. MKSAP question book.-extremely high yield. This is available for free via shiffman. Highly recommended as its depth and breadth are wonderful for medicine. The questions are not phrased in step 2 style like usmleworld but it has its own advantage on being more readily accessible. There is a student version that is preferable over the one intended for medicine residents.

4. Step Up to Medicine-This is also extremely dense but it is unlikely that the exam will have anything not covered in this book. I preferred the question format of MKSAP and the explanations but for those that want to read a book similar in style to First AID, this is for you.

5. NMS Medicine Casebook-while the NMS medicine book companion is great as a reference, this book is more useful as a combination prep for your hospital work, the shelf and step 2. It is still dense but with the time commitment is has a very high yield. One of the best big comprehensive prep books out there after MKSAP and Uworld.

6. USMLE Secrets Step 2-A useful book to cover very high yield topics when tired. It is in no way comprehensive on any topic but it will point you in the right direction for the topics worth looking into further. However, MKSAP goes into greater depth but Secrets covers all the subspecialties on the exam for a quick read in between usmle world questions.

7. NBME exam: very helpful, some questions seemed to appear on the shelf however no explanations. Typically people perform much better on the actual exam than the Medicine NBME. This holds true for the STEP 2 NBMEs as well.

8. Case files Medicine– gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. Not recommended for medicine given the availability of more comprehensive and in depth resources.

9. Blueprints Medicine: great for a firm basis of pathology and knowledge for reference, not a quick read.

10. Pretest Internal Medicine-will provide questions on all the areas of medicine but not in SHELF format. Given the availability of USMLE world and MKSAP, not recommended.

11. Pathoma: worth reading over for the major organ sections at least once since every shelf exam will build on basic pathology knowledge. If you used this during step 1 preparation, reading over it should be more of a review process.

12. Kaplan Notes Medicine-found online or in the shared dropbox, this is not an adequate depth you need but still valuable.

13. Goljan Rapid Review Pathology: very useful for quick reference of pathology. Just because it is year 3 does not make this useless! Many of your attendings will ask you basic physiology found in this book.

14. First Aid for Step 1-often reviewing your basic pathophysiology will pay dividends on clinical medicine exams.

HY Topics

1. I would really really really try to do all the questions in MKSAP in the first month. Then do them again in the second month. As with studying for step 1 and step 2, Medicine scores go up exponentially with the number of questions you do and work out.

2. Interspersed throughout the rotation, do as many USMLE IM questions as you can, there are a ton. Use your downtime on these.

3. The exam itself is a combo of random step 1 questions,

4. a lot of MI/CHF management,

5. GI (always with the scopes and tests),

6. nephro both fluid management,

7. AKI (understand prerenal, intrarenal, postrenal and then the nephrotic/nephritic syndromes (really that section in pathoma is more than enough).

8. Understanding your electrolyte disorders is huge, being able to read lab results is pertinent to at least half the questions. Often you are given more labs than you need so read efficiently and quickly.

9. Hyperkalemia

10. Hypernatremia

11. Acidosis

12. Alkalosis

13. Read an ABG

14. Then most importantly a LOT of rheumatology was on this exam (including bone disorders, LUPUS (everyone has lupus!), sarcoid (all African american women until proven otherwise), RA, osteoarthritis, seronegatives, etc). The rheum question section in MKSAP is one of the longest and now I understand why.

15. This exam more than any features numerous zebras since medicine is so broad. Do as many questions as you can will pay dividends for the shelf and for your step 2 preparation.

16. Pneumonia

17. Pfts

18. Cap vs hcap for abx

19. Heart stuff

20. Basic ekg probably 1-2

21. Heart failure classification drugs and the treatment regiment

22. Mi interventions in short term and long term

23. Differential for chest pain is the most important thing, likely at least 10

24. PE

25. ER

26. Random step 1 type questions, such as hereditary c1esterase deficiency

27. Heart disease and risk factory

28. Hypertensive emergency

29. Hypertension medications

30. Polio, diseases that have been eradicated

31. Shock and different types of shock and management

32. COPD

33. Compare and treat obstructive vs restrictive lung disease patterns

34. CANCER

35. ARDS

36. Colorectal

37. Lung cancer types

38. Pancreatic cancer

39. Alcohol, diabetes, smoking is related to 30 questions on every exam without question.

40. Non surgical gut issues,

41. Inflammatory bowel

42. Liver cancer, cirrhosis

43. Different hepatitis differential

44. Elevated bilirubin differential

45. LFT differential

46. Pancreatitis-acute presentation

47. Rheumatology is very highly yield

48. Headaches

49. Anemia

50. General knowledge of the applicability of Alcohol, Smoking, and Diabetes (the big three of medical school) to the exam in question. Always good for 5-10 questions on the shelf

Overview

One month in a family medicine clinic in Houston working with our department faculty. Family Medicine test is mainly a medicine test with a little of Ob/Gyn and Pediatrics mixed in very hard if you have not had Medicine. Work Monday – Friday, usually 8-5. No call, no weekends, enjoy! Lectures on orientation day and second and third Wednesday afternoons. Usually have a 1-2 hour lunch break – depending on clinic – bring your lunch unless you want fast food every day. You usually see patients before the doctor sees the patient and then you write a progress note and present patient to doctor in clinic.

Resources

1. Case Files Family Medicine or Internal Medicine

2. OnlineMedEd – preventative section

3. AAFP online questions ( ~ 1,300); register for a free student account, takes 48 hours to get login information so apply early.

4. Step 2 Secrets – broad overview of everything in q&a format

5. Current Medical Diagnosis and Treatment in Family Medicine (CMDT series)

6. First Aid for the USMLE Step 2

7. Rakel's Family Medicine

8. Boards and Wards-small book and good review for Ob/Gyn and Pedi questions

9. Swanson’s family medicine review book – not essential to have – try to borrow – very expensive

Tips

1. Do not blow this month off

2. Start studying day one

3. This is mostly medicine so concentrate on that AND has lots of management/“next best step” (casefiles helps out with these types of questions

4. Know how to manage hypertension, diabetes and asthma – you will see a lot of this

Overview

High Yield Topics:

* Indications for surgery is as far into surgery as any question gets, nothing will be asked about the technical aspect of individual surgeries. There may be questions on different interventional diagnoistics, contrast enema vs scope vs ct, etc.

* Understand the gold standard diagnostic test and the contraindications and what we gain from it and what cannot be ruled out.

* Understand electrolyes, what is normal, how to correct

* Hyperkalemia

* Hypernatremia

* Acidosis

* Alkalosis

* Read an ABG

* Biggest pimp topic, top cause of diseases - Top Causes of SBO, pancreatitis, for example

* Preop/postop management Pestana does this well

* Risks of surgery

* Trauma management

* Very little in terms of actual surgical procedures on the shelf

* Compartment syndrome very high yield

* Trauma algorithmàABC, primary survey vs secondary survey

* Basic composition of acute abdomen

* Diverticulitis

* When to operate on a cholecystitis vs. non operative management

* Understand post op complications

* Dehiscence

* Leaking

* 5 Ws of fever

* anastomotic leak

* infection at the site of surgery

* medication implications

* mastectomy and lymphedema in the arm

* 2-3 antibiotic questions, anaerobic coverage for acute abdomen

* biliary tract understanding and pathologic differentiation

* cholelithiasis, vs ascending cholangitis, vs choledocolithiasis, vs pancreatitis

* charcots triad

* raynauds pentad

* becks triad

* any combination of a mans name and a number eponyms are HUGE in surgery.

* Sister mary joseph’s nodule.

* DVTs

* PE vs cardiac chest pain.

* Virchows triad for thromboembolism-coagulopathy, stasis, vascular damage

* Breast nodal distribution

Routine

  • Usually get to work at 5:00 a.m. And work until about 5:00 p.m.
  • One day off a week (on weekends)
  • Grand rounds and M&M on Thursday mornings (have lectures after this)

  • Attendance is mandatory for grand rounds, m&m, and all lectures Call

  • Look for call rooms are the same as medicine

  • If you are bored, wander down to the trauma bay; there’s always something for students to do down there (suturing, casting, etc); or hang out with the anesthesiologists—they might teach you how to intubate/start lines

  • Work on one of several teams – purple, gold or silver

  • Get a lot of or time, very hands on (some months more than others)

  • See thoracic, vascular and pediatric surgery in addition to extensive general surgery

  • Always have supplies in your pocket (4x4s, tape, suture removal kits…can obtain from supply room)

  • Good for working with influential faculty

  • Work long days and call is hard but you get great experience

  • clinic is very exhausting!!

  • Usually free lunch especially on clinic days

Trauma

  • Very hands-on, fast-paced, and get to do a lot of procedures in the er/or
  • Students are crucial to the service (the floor is yours!)
  • Work very long hours, work most weekend days
  • Good for test because you learn management of surgical patients
  • Get to see amazing surgeries, lots of or time
  • Learn to follow ICU patients!!!
  • Lots of OR time
  • Learn to manage critically ill people
  • Mostly work with residents and fellow

Resources

  • Pestana’s Surgery
  • Surgical Recall – good for pimp questions. Find out what surgery you’re going to and read the corresponding section right before. (This will save you!)
  • NMS Surgery Casebook
  • Online Med Ed videos for Surgery
  • Step Up to Medicine – renal, GI and fluids sections
  • UWorld Surgery questions
  • UTHSC San Antonio HY Surgery Review video and pdf
  • Case Files Surgery
  • Appleton and Lange question book

  • Pretest Surgery – difficult questions, but good review for shelf

  • Pestana Notes - notes as published by Kaplan, definitely read at least twice -it includes sections on all the surgical subspecialties that are all given 2-3 questions on the Shelf.

  • Up To Date-For your patients-the more you read on your patients the better your overall preparation.

  • USMLE World Internal Medicine Subsection GI-The surgery exam is basically for an internal medicine resident to know what is a surgical patient and what they would need to ask surgery to do, there are no actual details of surgery or anatomy on the actual shelf.

  • Oral Exam Study Guide-prepare the cases and this will serve double of prepping you for the oral cases and your exam!

  • MKSAP questions on GI. -extremely high yield since this is a medicine exam effectively.

  • NMS Surgery Casebook-while the NMS surgery book companion is great as a reference, this book is more useful as a combination prep for your oral cases preparation, hospital work, the shelf and step 2. It is still dense but with the time commitment is has a very high yield. One of the best big prep books out there.

  • Surgical Recall-This has tremendous utility as a surgical medical student but none for the actual exam. Always reference before entering the OR but this will not help for the SHELF which tests medical management, the exam is very similar to Internal Medicine. Very useful for surgical nomenclature and “pimping”

  • Abernathy’s Surgical Secrets-Very similar conceptually to surgery recall, available for free via shiffman year 3 resources online

  • NBME exam: very helpful, some questions seemed to appear on the shelf however no explanations. Typically people perform much better on this than the actual surgery shelf.

  • Case files Surgery– gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. Not recommended for surgery.

  • Blueprints Surgery: great for a firm basis of pathology and knowledge for reference, not a quick read.

  • Pretest Surgery-will provide questions on all the areas of surgery but not in SHELF format.

  • Pathoma: worth reading over for the GI sections at leaste since every shelf exam will build on basic pathology knowledge. If you used this during step 1 preparation, reading over it should be more of a review process.

  • Kaplan Notes Surgery-found online or in the shared dropbox, this is the same thing as Pestana notes, the most high yield little book.

  • Goljan Rapid Review Pathology: very useful for quick reference of pathology. Just because it is year 3 does not make this useless! Many of your attendings will ask you basic physiology found in this book.

  • First Aid for Step 1-often reviewing your basic pathophysiology will pay dividends on clinical medicine exams.

  • Step Up to Medicine-emergence-you need to know how to manage a patient emergently as a first year surgery resident handles medical management and ICU work.

  • Schwartz Surgery-If struggling with a topic, access major texts via accessmedicine via shiffman

  • Essentials of Surgery-Not useful for the shelf. The Wayne exam is drawn from this books clinical pearls, a document floats around that has these compiled. This book is also available via shiffman for free.

Tips

Anatomy for the course and the steffes exam. Very minimal on the actual shelf exam.
Before an operation look up the landmarks, know any eponynmous anatomical structures.
Know the blood flow, lymphatic drainage, and nervous system relation for pimping.
Steffes exam: at least review the clinical pearls from OR and rounding in essentials of surgery. Document floating around.
Oral exam study guide is very helpful for the rotation, better than casefiles for the rotation.
Always prepare for your surgeries!!! Know you anatomy – bust out your Netter !!
Always know what surgeries you are going into the next day so you will be prepared! (not always able to know especially at LBJ)
Scrub into as many surgeries as you can; take advantage of call nights.
Be in the OR if your patient is in surgery; don’t scrub into other student’s cases unless you have their permission.
Be nice to the scrub nurses/techs; they are capable of making your month miserable if you make them mad.
Practice, practice, practice—nobody becomes a surgeon over-night.
Surgical recall is a good resource to read up before cases. A lot of pimp questions come from that
Wheel your patient to PACU with the anesthesiologist when the case is over—they notice
Always show initiative (ask to suture and tie knots, volunteer to assist in surgeries)
Have supplies in your pockets (tape, 4x4s, suture removal kit, etc); rounds go faster
Test is hard (mostly a medicine and trauma test – have to diagnose diseases and decide medical vs. Surgical management)
DON’T DO ANYTHING STUPID!!!
The unfortunate mistakes made by those who went before you. . .
Don’t lie!—If you don’t know, or didn’t do something say so!
Don’t pimp your attendings, don’t pimp your residents, and don’t pimp your fellow students; they will not like you.
Don’t answer your fellow students’ pimp questions unless the attending “opens” the floor. It is their time to shine, not yours!!! This does not go unnoticed by attendings or your colleagues
Don’t make your intern or residents look bad; if you know something about a patient, tell them; they will make your life miserable if you surprise them during rounds.
Stay off your phone during rounds unless someone specifically asked you to look something up, otherwise it looks like you are texting your BFF, even if you are reading up-to-date. The people who are grading you take note.
Don’t be that person that snoozes 10 times in the call room. If your alarm/pager goes off, get up!
Don’t return pages in the call room while other people are sleeping. This is rude.
Don’t be known as “stinky;” please remember your toothbrush/deodorant.
Don’t pass out in the operating room—tell your attending/resident you’re light-headed and sit down; if you’re going to pass out, fall backwards, not forward.
Please don’t ask patients where they are going after hospice (yes, this has happened.)
Don’t offer a placenta to a resident, they are yours to deliver so enjoy!
Don’t ask for a letter of rec the first day of a rotation; you do not know your attending and your attending does not know you.
Don’t cry on rounds or in the operating room, everybody makes mistakes and we’ve all been yelled at; just learn and move on.
Don’t argue with your attendings/residents/nurses/patients.
Please don’t look things up to prove your attending wrong, this will not make them happy.
Don’t ask questions if you already know the answer—i.e. “so is that beating structure above the diaphragm the heart?”—this will only make you look stupid, and will invite a royal pimping session.
Don’t be a surgery/delivery hog; your team will not like you.
Please don’t be that person who wears their surgical cap in the LRC or scrubs out to dinner; we’ve all done surgery, nobody will be impressed.
Don’t call in sick unless you are actually sick; remember your attendings are doctors.
Don’t let patients out at HCPC, even if they offer you a good bribe (seriously, the patients are good at pretending they’re employees).
Don’t be rude to any nurses/scrub techs/ secretaries/course coordinators, it will get back to your attending and will show up in your grade.
Don’t argue your eval after the test; do it before or it will not change.
Really important: please don’t drive home if you’re tired; stay and take a nap, especially if you’re at LBJsleepy students and 610/59 do not mix well. If you really have to go home, get a coffee or an energy drink before you head out, and figure something out to make sure you don’t fall asleep while driving.
If you have a problem with someone, esp a faculty member or resident, don’t start sending e-mails. Go talk to the course director in person. Make sure your emails never even hint bad vibes about anybody, because, trust us, they can get sent to the whole department.
Be enthusiastic about every rotation. You never know what you may find you love

Overview

Three weeks of adult inpatient psych (HCPC)  Three weeks of specialty service (hospital consult service, child & adolescent psych, addiction, psychopharmacology, etc.)
 Only one call shift on a weekend, otherwise usually 8:00 a.m. To 4:00p.m. Monday-Friday  3 calls over two months – one 12-hour shift on a weekend 8 to 8 – and for two weekday calls go to HCPC at 4:30 pm and ask the receptionist to page the on-call resident  Video exam: you watch a short videotaped patient interview. After watching you write a soap note and differential diagnosis for the patient.
 Standardized patient encounter for evaluation at end of rotation.
 Lectures are once a week from 1-5pm on Wednesdays and are required. Grand rounds wed at noon is required.

Hot Topics: Pay attention to the required lectures, they are excellent. The topics you are told are high yield are in fact high yield.

Paying attention to neurotransmitters and pharmacy MOA are huge, as are illicit drug intoxications, normal bereavement vs. adjustment disorder, schizoaffective vs schizotypal vs the other schizos,.

Psychopharmacology: what neurotransmitter are you impact

Schizotypal vs schizoaffective vs schizoid vs schizophrenic

Personality disorders very high yield to know in depth

Dementia sub types and pharmacological treatment for Alzheimers, alcohol abuse, diabetes, thyroid causes, vitamin deficiencies.

Time course of medication onset and clinical utility, antidepressants can take weeks!

Neurotransmitters of toxicological substances as well as medications.

Normal Grief vs depression vs adjustment disorder

Pediatrics-know what is normal and what is actually a problem, don’t be afraid to prescribe kids on this exam

Thirty percent neurology questions

General knowledge of the applicability of Alcohol, Smoking, and Diabetes (the big three of medical school) to the exam in question. Always good for 5-10 questions on the shelves.

Regarding Step 2: A minority of Step 2 questions, Reviewing First Aid for Psychiatry in a day may be the most useful way to prepare come exam review time.

Inpatient Month

 at HCPC in a specific unit (requires a key to get in and out of the unit)  work every day in the morning  have to get a key ($25 fee for lost key) in order to access anything in the building – even the bathrooms are locked.

Specialty Month
 work with patients in a hospital consult service, or at hcpc child or specialty unit.  work hours vary by location

Resources

 For TBL, required readings in Andreason and Black (some modules have alternative readings in Kaplan and Sadock’s pocket book)  Appleton and Lange question book  Case Files Psychiatry  Pretest Psychiatry  First Aid Psychiatry or High Yield Psychiatry or BRS Psychiatry (not Psychology!!!)
 Psychiatry Pocket Book and the Psychiatry Drugs pocket book can be very helpful  Kaplan and Sadock’s pocket handbooks

First Aid for Psychiatry -the best book out there. Read it at least once, twice is very doable. Combined with the course pack is normally enough to honor if you pay attention to your patients.

WSU Psychiatry Course Packet -well written with useful questions, extremely high yield.

Lange Psychiatry Question book Lange psychiatry. I did two chapters, chap 3 adult psychopathology and chapter 4 somatic treatment and psychopharmacology. Both very high yield topics.

Up To Date -for your patients-the more you read on your patients the better your overall preparation.

NBME exam: very helpful, some questions seemed to appear on the shelf however no explanations.

Case files Psychiatry– gives clear cut pictures on basic presentations, no nuance or depth that shelf questions will often probe at. Case files-most normal presentations of the biggest disease, the breadth of coverage is insufficient, also clunky if you wish to reference a specific illness. For psychiatry this is not a good idea.

Blueprints Psychiatry: great for a firm basis of pathology and knowledge for reference, not a quick read. Not recommended given the utility of the top resources.

Pretest Psychiatry: will provide questions on all the areas of psych but not in SHELF format.

USMLE World Psychiatry -not all encompassing but reading the explanations as always is to your benefit.

Tips

 HCPC is a unique experience as a large (200+ bed) free standing psychiatric hospital affiliated with a medical school; take advantage of this opportunity to learn psychiatry--you will probably never encounter patients like this again.
 Always be aware of your surroundings - these patients are at this hospital for a reason and you always want to protect yourself because some patients can get violent. Do not leave objects on the unit with which patients can hurt themselves  During your rotation your attendings will ask you for dosages of drugs – you don’t need to know them for your written tests  Know your drugs, know your drugs, know your drugs; and know delerium/dementia vs true psychosis (remember these tests always relate back to internal medicine)  Written test is challenging – it is not easy – so please study.

Overview

 Two weeks each at two different sites: MHH Stroke Service, MHH Adult Inpatient, MHH Adult Consult/ER, MHH Pedi Neuro Inpatient, MHH Pedi Neuro Outpatient, MHH Epilepsy Monitoring Unit, LBJ Consult o hours vary by site. Stroke can be very long, but normally if you’re assigned to it, the coordinator will give you a lighter other half of the rotation o most services do work weekends so you will work 6 days a week  Some sites will go to morning report daily, others won’t. Everyone except lbj goes to noon conference daily. All sites go to Pedi Neuro Grand Rounds on Fridays 8-9am and Adult Neuro Grand Rounds Fridays 12-1pm.
 Lectures on Wednesday mornings.

Call
 2 call days (1 weekday 5pm-10pm, 1 weekend 8am-8pm)  Schedule generated by Chief Medical Resident, but can switch with other students (with coordinator approval).
 Work with on call resident to see all consults and admit for all services (Adult, Pedi, Stroke).
 Neuro doesn’t have its own interns (they rotate as Medicine or Pedi prelims), so you effectively get to function as the intern! You may see all consults before the resident and will write up preliminary H&Ps in Care4, help with writing orders, etc.
 Templates for all notes should get emailed to you by the resident on call your first night (or you can get them from classmates). These make H&Ps much less of chore than in Medicine.
 Will round with and present new patients admitted to your service the next morning at morning report.
No post-call days.
 Even if you’re not on stroke, you should have the opportunity to see possible stroke patients in the ER
on these nights and learn about TPA eligibility.  May also get to see LPs.

Sites
 Very busy service. Can be long hours (6.30-5), but you learn a lot.
 Basically function like the intern—see your patients first thing in morning, write notes, present and write orders for co-signing on rounds, follow up labs, etc. Most attendings try to give you study time in the afternoon, but will often end up following up on things and seeing new patients much of the time.
Get to work with some national big-wigs

Get great practice on your neuro exam.
Learn a lot about reading CT and MRI’s for differentiating types of stroke and other injuries.
Stroke manual ( ~ 200 pocket-sized pages) available for purchase from coordinator—read it before you start on the service. It covers all the protocols for evaluation, diagnosis, treatment, and managementbasically everything you’ll need to do with any patient. If you know it well, you can shine on the rotation.
Teams generally round together, but varies by attending. Hours can vary widely based on patient load. Generally arrive by 7am to see patients, then round with attending in morning (and afternoon, if necessary). For new consults, depending on attending, entire team may see them together, or part of team may split off to see them separately. Can stay as late as 5-6 pm. MHH Pedi Inpatient
Depending on attending, arrive around 7-8am, see patients, round in the morning (and sometimes into the afternoon). See consults in the afternoon. Hours generally not as long as adult inpatient, though, with fair amount of down time.

You will have to present a topic at grand rounds; good for your CV.

MHH Pedi Outpatient
 Pretty much 8-5.
 Get to work directly with Drs. Mancias and Butler. You’ll see patients, present to your attending, and then go back to see them together.
 Have collaborate with other student to present a case a Pedi Neuro Grand Rounds  Can see lots of rare pathology and disorders.

MHH Epilepsy Monitoring Unit
 You have the opportunity to evaluate patients for possible seizure focus resection of a seizure focus  You will be exposed to EEGs and various diagnostic tests done to assess appropriate surgical candidates  LBJ Consult  Business depends on case load, so hours can vary greatly.
 Lots of kids from Mexico and Central America with rare diseases—potential for a zebra party!

Quentin Mease/UTPB Clinics
 Will work with a variety of neurology faculty in an outpatient capacity both at our Quentin Mease location and also at our UTPB location. You will see the different subspecialties in neurology at these clinics.
 Busy clinic on T/Th afternoons.

Resources

 Finseth Neurology Review – amazing! Very high yield and succinct (notes written by a neuro resident)  Stroke Manual—must have if you’re on Stroke service!
 Case Files Neurology—moderately-sized presentations of major diseases. Average for the series.
 Blueprints Neurology—relatively quick overview, but not much depth. Questions in back are pretty good.
 In-A-Page Neurology—as advertised. Useful for a brief overview of common pathology
 Step 2 Secrets Neuro Section—short and sweet with key signs/lab values/presentations of bread-and- butter cases.
 Pre-test Neurology—pretty hard questions. Possibly one of the least useful in the series.  USMLE World—geared more for Step 2 CK, but good explanations, as always.
 penlight, reflex hammer, Q-tips—first two are essential tools of the trade!

Tips

 Start studying day one—this is a very short rotation with lots of information. Unlike the longer rotations, you can’t slack on studying and be sure that you can still cover a lot of material!
 Probably the hardest shelf exam for the majority of people. The cases are tough because you have to sif through a lot of layers: Is it a medical, psychiatric, or neurological problem? What does parts of the neuro exam are most pertinent? If there’s a lesion, where could it be? etc.
 If you’re on stroke and you think your patient is having a major change in exam findings (i.e., is developing a new fixed and dilated pupil), contact your resident immediately!
 Try to examine imaging yourself and figure out what’s going on before talking with the resident or reading the radiologist’s report (this is often a necessity, as MRI’s may not get read for hours).
 And did you hear that if you’re on Stroke, you should READ THE MANUAL BEFORE STARTING!

Overview

Department of Obstetrics and Gynecology Student Handbook

 6 weeks at either Hermann, St. Josephs, or LBJ (you will be assigned to a hospital by the coordinator no student preferences – no switching sites)  Usual day is 5 a.m. To 5:30-6:00p.m. (long days)  Do not work on weekends unless you are on call.  Always wear scrubs to work and always bring an extra pair just in case you get covered with baby goo!

Call

 You get to make your own call schedule with the students on the first day of your rotation o Herman and LBJ has a night float system so one week you work Mon-Fri night, take call on 1 or 2 weekends o 5 calls over the six weeks at St. Joes  Usually no sleep on call for OB (if you sleep you will miss stuff – interns will not page you for deliveries)  Always get off post call after board check out ( ~ 7:00 a.m.)  Stick with your intern because they always know what is going on. The last thing you want to do is miss a delivery.  Carry a pair of sterile gloves in your pocket so you’re ready when they call for a delivery (babies come fast)  When you hear “delivery doc” paged overhead, RUN, cuz that’s you!

Hermann Hospital OB/GYN
 2 weeks of OB and 2 weeks of GYN  1 week of “nights” during your OB weeks, weekend call covered by all Hermann students  1 week of clinic  Good rotation to take if you are interested in OB/GYN – a lot of influential faculty at Hermann  GYN month is mainly seeing GYN surgeries and following post-op patients  Wednesdays are very busy on GYN month – expect to be there late  Required to attend Tuesday afternoon conferences on 3rd floor MSB

St. Joseph
 3 weeks of OB and 3 weeks of GYN  Take OB call for all 6 weeks – do not sleep on call  Dr. Harms has extra teaching sessions – very helpful, great teacher!  Faculty, residents and nurses are very nice and helpful. Very positive environment  Clinic only a few half-days per month

LBJ = Baby Factory!
 The 6 weeks are divided into 2 weeks of OB, 2 weeks of GYN, 1 week of subspecialty (MFM or GYN Onc) and 1 week of nights. Lots of labor and delivery  Good rotation if you want to see and help with a lot of deliveries  Do not sleep on call  Don’t be afraid to try your Spanish; you will be fluent in OB Spanish by the end. Three most important words: “Empuje!” (Push); “Mas!” (More); “Fuerte!” (Hard)

Resources

 Case Files OB/GYN – must have – read through it at least twice!!!
 UWise questions on APGO website. The information to access them will be on the blackboard website for the rotation.
 Download an app for calculating gestation
o “Cuando fue su termina regla”? (Roughly, when was your last period?)  First Aid for OB/GYN clear and concise.
 Pretest OB/GYN – practice questions; many answers are controversial so be careful  BRS for OB/GYN – good for resource and to read while you have down time  Step 2 Secrets—just the OB/GYN section

Tips

 OB/GYN uses a lot of abbreviations (I mean a lot) – if you don’t know what the abbreviations stands for don’t be afraid to ask one of the residents.
 Being interested always takes you a long way. They like to see that you taking initiative and being proactive. (applies to any rotation!)
 Always keep track of what’s going on the patient delivery board.
 Always stay by your patients that are in labor – you never know how fast they are going to progress.  Go to Dr. Harm’s review at the end of the rotation – you will actually be surprised when you take the test to find that a lot of what he tells you is on the test.
 Always prepare for your surgeries for gyn. Know your anatomy.
 Have your residents teach you how to tie sutures during down time – very useful.
 Get experience during clinic doing speculum/vaginal exams – you need to know how to do this in most specialties (FM, Medicine, etc.)
 Ask to do things during surgery and deliveries if you are interested.
 If you have OB/GYN before surgery, use it as a month to practice your surgical skills—this will carry you a long way during surgery.
 You are very well prepared for this test by the end of the rotation – concentrate on case files and go to Dr. Harm’s review.

Overview

 Four weeks inpatient (Hermann or LBJ)  Four weeks outpatient (pediatric clinics) certain days in specialty clinics at UTPB so pay attention to your schedule. (note: you are able to rank your choice for inpatient and outpatient)  Three days off during you inpatient month  Noon conferences daily; don’t touch the food unless explicitly invited to do so  Weekend off between four week blocks  No call, and no weekends on outpatient  Inpatient day usually starts around 6:30 a.m. And you get off by 3:00 (resident and hospital dependent)  Clinic days are 8 a.m.-5 p.m.
 Some required assignments during the month including typed H&Ps  Stickers: should be in your pocket at all times (esp. Dora, Spongebob, Sesame Street)  Required to do eight online cases (CLIPP)

Call

 Call only during your inpatient month.
 Have to take 4 calls in one month  Make call schedule with the members of your team – usually one to two med student on call for your team per call night  Your team is on call every 2 nights – you have to make the schedule where you are on call the night your team is on call.
 Pick up 2 patients as your own on call, continue to see new patients with team
Children’s memorial hermann
 Teams composed of 4 medical students, 2 interns and 1 upper level  Sometimes able to sleep on call
o call rooms are the same as medicine (5th floor robinson see im above for codes)  Patients are sick with interesting, rare childhood illnesses – heavy patient load  Three days specifically in the nursery  No clinic included in rotation  Free food occasionally at noon conference – have to be there – do not be late; you are not required to go to noon conference when you are post call!
 Usually get off by 2:00 p.m. (resident dependent)
LBJ
 Teams composed of now one team with 1 senior and 2-3 interns  Smaller patient load  Usually get to sleep on call
o call rooms are hard to find and describe. Need key from nurses station, they can direct you!  Children present with “bread and butter” pediatric cases  Lots of nursery time – you perform the newborn exams  Clinic every other day during the week – only in the afternoon (crazy busy, but you learn so much!!)
Don’t get off until 5:00 p.m. Or later on clinic days.  Students present patients on rounds  A lot of patients speak Spanish especially in clinic

Resources

 BRS Pediatrics – very comprehensive and excellent  UWorld Pediatrics questions  UTHSC San Antonio – HY Pediatrics review  First Aid Pediatrics and NMS are long and detailed  Case Files Pediatrics**  Pretest Pediatrics** and Appleton and Lange – excellent for practice questions o **Case Files and Pretest Pediatrics were written by our faculty at UTHealth. Your attendings are the authors, so your pimp questions often come from these books.  do not buy the Harriet Lane Handbook – mainly for residents – if you are going into pediatrics you will be given one as an intern.  Pediatric Advisor: http://www.med.umich.edu/1libr/pa/pa_index.htm (good for parent handouts in English and Spanish)

Tips

 Wash your hands before and after every patient!!!!! And clean your stethoscope with alcohol swabs.
You will get sick during pediatrics – kids are germy!!
 Always ask the parent to leave the room at some point when you are getting a history from an adolescent patient so you have complete privacy with the patient. You must assure confidentiality and then ask the adolescent patients about home life, drugs, and sex, safety, etc.
 It is amazing how much kids will yell and scream when you walk into the room. It is always good to have stickers or toys in your pocket that can distract them so you can do your physical exam.
 You can get cheap stickers for you team from smilemakers.com; the kids will love you!
 Learn how to do proper pedi-exams; you will not get good at looking in ears if you never try. Ask the residents/attendings to show you their tricks for getting the kids to cooperate.
 If you’re bored on call, wander down to the newborn nursery—they always need help with the newborn exams.
 Brush up on current cartoon affairs—the kids love it when you can discuss with them some of the more important issues in life like Sponge Bob Square Pants and Dora the Explorer.
 Have fun but don’t forget to always be professional.
 If you decorate your stethoscope/badge with stickers or other items (which is highly encouraged to build rapport with the kiddos) don’t forget to remove them before starting other rotations-- .medicine attendings and surgeons are not as amused.
 The previous point is more important than you may realize right now, so get those stickers off your badge.
 The test is hard so make sure you study!!! A lot of the test is knowing how to manage and diagnose acutely ill patients—lots of 17/18 year olds with adult medicine problems and 2 year olds who took grandma’s pills.
 Pedi H&P’s are different than adults. Report all I’s and O’s, med doses, etc in mg/kg  Do not buy a pediatric stethoscope!!! Your adult one will work just as well.

Most learning opportunities this year will happen when you are on-call; so if you snooze, you lose.

  • Nudge your interns/residents to teach you something. **all the quizes except Ob/Gyn and psych are basically tests on medicine — so know your drugs (side effects/interactions) and acute management of critcally ill patients (fluids/lytes/acid-base/endocrine).
  1. How honoring works -you can honor a clerkship and also honor the year. -honor a clerkship by honoring the shelf and outstanding evaluations -To honor Year 3 either honor six of the required 11 months -or if you add up the points from the eleven months, 35 and greater means you honored, 2 points per month of satisfactory, 3 for clinical/academic commendation, 4 per month of honoring. This allows someone to honor only a month or two and still earn comprehensive honors for the year. Eg. Clinical commendation in surgery is 3x2 months=six points. -Your elective is not computed but is on your transcript for programs to see The honoring rates for each rotation for 2013-2014 are in the graph below for reference.
  2. Presenting information discrepancies-you will find the history you get will be contradicted by information the attending or senior resident gets from the same question. You did nothing wrong, this is because patients have more time to think over the question and may remember new or different information.
  3. Do you have to stay late? -if you’re senior resident or attending says you can leave, you should listen, it proves nothing by staying, its because they have work to do that you cannot contribute to. -but staying late and helping with tasks related to patient care are always appreciated, calling in social calls, picking up labs, etc.
  4. You never have to pick up food/coffee for anyone-this is harassment.
  5. Basics of Presenting: Different attending’s have different interpretations methods, but a general outline for presenting in the SOAP style will not fail. You should consult Maxwell’s pocketbook always, Wayne should provide a copy
  6. Pre-round on your patients, look on uptodate for anything you don’t know
  7. Never report a value you do not understand because you WILL be called out on it.
  8. S-subjective, anything the patient said, how things went overnight, etc.
  9. O-objective, always start with VITALS! Then physical exam, head to toe is preferable.
  10. A-can be said in one sentence
  11. P-usually safest by organ system: CV plan, Lung plan, Renal plan, etc.
  12. The plan ALWAYS includes if they can be discharged or when on inpatient and when to be seen again for follow with outpatient visits.
  13. It is always easier to be successful on a rotation if you pretend you want to go into the field and care about your patients, you will learn more which leads to knowing more and looking better to your team.
  14. -The goal of third year is to learn to take an excellent history and present it well. You will learn how to manage patients on your own in residency. Try to learn as much as you can regardless of what field you choose.
  15. -Regarding choosing a field, whether you like your rotation or not, keep in mind that a specialty may be very different at another institution or with different personnel or organization structure so please don’t write anything off too quickly!
  16. Useful planning tips for Year 4 Scheduling -there are “light” rotations useful during interview season when you cannot afford to take a month off. These include: independent study research with a mentor or personal doctor friend, mentor, family friend; anesthesia at harper, radiology dmc (not ford), interventional radiology.
  17. -DO NOT do a required rotation during heavy interview season.
  18. -Try to take any required work BEFORE match, it is much harder to work afterwards.