Sunday, June 26, 2011

Things I Wish I Knew - Third Year

And now for one of my favorite posts of the year; taking a look back at everything I have experienced and attempting to come up with a few things that helped me succeed. I would like to invite you to share your input as I may have overlooked a number of useful ideas. As in years past, I am including my weekly intensity chart.

The Year Reviewed

I will be the first to admit that this year's intensity chart has little benefit to anyone but myself. Everyone experiences rotations in different orders and each has a varied feel depending on site, preceptor and specialty. For the most part it was on a steady continuum. The occasional peaks and troughs were likely tests or vacations respectively. The large dip representing my vacation month when I was recovering from surgery and the recent peaks reflecting weeks that I left nothing to chance on elective rotations in emergency medicine. These later markings also show stress that has been mounting in anticipation for board examinations. Without further delay, below are those things which I wish I knew coming into third year.
  1. Maintain an open mind - Every specialty has something to offer, even if you are not enthusiastically interested in the field. You never know when a lesson learned from a particular patient will come in handy on another rotation or even later in your career. There is always something to be learned, even if you are not fascinated by the work before you.
  2. Participate actively - It is easy to observe and nod your head when preceptors carry about their normal activities. Encourage them to teach by asking thoughtful questions or volunteering to participate in procedures. One night during my studies I watched how to place a central line only to be asked the following day if I knew the steps. Because I was familiar with the procedure I was given the opportunity to place the line and have been entrusted numerous times since then. Always be ready to step in to answer questions or use your hands and actively learn.
  3. Avoid easy rotations - Every now and then it is nice to have a rotation that demands less, but too many of these can be detrimental. This is the best time to interact with patients, perform procedures and learn from attendings. We pay good money to be in clinics and hospitals, why read about the diseases when they are in the room next door ready to be seen first hand. Even if you are on an "easy" rotation, push yourself to take advantage of the little time you are there, you can read later when you get home.
  4. Pace yourself - There is more information than you can possibly consume in a few short weeks about any one subject. Start studying the specialty early on in the rotation and regularly review the "bread and butter" topics. By the end of your time there you may become exhausted when shelf exams are just around the corner. Cramming for the end of rotation exams is not going to help you in your career as much as regular study.
  5. Enjoy your time off - It is really easy to get swamped by the books, board exams and stress of preparing for residency. There is a little more time in third year to break away from school and it can be a perfect therapy for all the stress that will inevitably mount. Be sure to have regular time set aside for exercise and breaks. Work hard, play hard.
Question of the Week
A 67 year old male patient presents with mild confusion, diarrhea, and a new skin rash. These symptoms have been present for 1 week according to the patient's wife. What is the most likely nutritional deficiency that this patient is experiencing?

A. Vitamin B1
B. Vitamin B2
C. Vitamin B3
D. Vitamin B5
E. Vitamin B6

Answer & Explanation


  1. Thanks i am really impress for reading your best blog.... keep the good work carry on...thanks.
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  2. Awesome reflections, best of luck with your residency match!


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