What was the surgery core like?

My friends we are half way done with third year of medical school after the completion of our 12 week surgery core rotation. This included 8 weeks on the hospital floor with the residents and 4 weeks of electives. My electives included neurosurgery and plastic surgery.

The 8 weeks on the floors started at 5:00/5:30 am everyday. This included coming in for one weekend day each weekend to round. We also had two full weekend days 6:00 am- 6:00 pm during the 8 weeks on floors. Once-twice a week your team would be on call and stay until 6 pm. The 8 weeks included one full week (6 nights) of night shift from 6:00 pm to 6:00 am.

At 5:00/5:30 am we would come in and review charts for our patient list. At 6:30 am we would round with our residents and present whichever patients we saw that day (usually 1-3 patients). Surgery presentations are done differently than in internal medicine which took some getting used to. During internal we presented more in an H&P format and in surgery it was a SOAP note format.

During the remainder of the day, we would go to resident or student lectures and attend surgeries that we signed up for the day before. There was 4 teams that the residents and students were split into- red, blue, green and gold. I was on blue (general surgery) and gold (trauma surgery). Red was focused on cardiothoracic surgery.

For the 4 weeks I was on blue team I saw many general surgeries including cholecystectomy, appendectomy, and several bowel surgeries. For one week of the four I had the pleasure of working with an attending one-on-one who. That week included attending all of the attendings surgeries and clinic hours.

For the 4 weeks I was on trauma surgery, I was mostly responding to the few traumas our hospital received and learning from the patients on the floor. Most of the traumas our hospital gets are hip fractures, falls and motor vehicle accidents. I had a lot of time to study during these four weeks and also had my week of nights.

My electives were my favorite time during the rotation: I learned a lot and had a lot of interaction with the attendings directly. Neurosurgery exposed me to many spinal surgeries and chronic back pain patients. Plastics was my absolute favorite! I got to see several hand surgeries, skin grafts and some breast surgeries.

Denzel really enjoyed surgery. Since he wants to be an anesthesiologist, being in the OR appeals to him. I enjoyed my plastic surgery elective, but overall surgery wasn’t for me.

How we studied for the internal medicine shelf.

The resources we used for the surgery shelf included UWorld, Online Med Ed and the Emma Holliday YouTube video. We also purchased all 4 surgery NBME shelf exams and took them on timed mode.

The shelf exam was 110 MCQs with 3 hours to complete it and no scheduled breaks. This exam did not have any fill in the blank questions. I found it to be of medium difficulty, it was not as hard as the internal medicine shelf in my opinion. The majority of questions were about imaging modality and next steps. It was pretty repetitive when compared to the UWorld questions and the NBME practice exams.

I would suggest starting the UWorld questions in slow increments since there isn’t many and really focusing on reading each question since they are so repetitive. Then, I would re-do your incorrect surgery questions after you complete the 300+ MCQs available. At first, I was doing both internal medicine and surgery MCQs, but then I started focusing on surgery which paid off for me come test day. I watched both surgery topic videos on Online Med Ed and took notes one time through. The last 4 weeks before the test, I watched Emma Holliday video 2-3 times and rewrote her entire presentation once. This is where the majority of my knowledge came from. I took one practice shelf each week before the exam.

Some topics I recommend mastering before taking the exam include and are certainly not limited to: imaging modality of choice for each body part, when to do an exploratory lap, hip fractures and hip pain in children, and perioperative care and evaluation. Check out the Emma Holliday video I linked, it covered all the major topics I was tested on!

Comment below or reach out to me if you have gone through the surgery core rotation and have anything to add to this post.

Yes, I have always dreamed of being a physician, since I was a little girl. And I worked hard to get to where I am- half way through third year of medical school, preparing for my second shelf exam and currently working the night shift.

But there was a whole other part of my heart that wanted to find a partner in life and one day have a family. So here I am, also working hard to plan my wedding that is a mere 6 weeks away- two weeks after my surgical core rotation ends.

Yes, I can do both!

People often assume when you choose medicine, you forgo the rest of life AKA relationships, friendships, traveling, having a family and attending important events. That’s a fair assumption and it is partly true. And up until I met Denzel, I had accepted that fact that the only roles I would play for the next several years of my life were “medical student” and then “doctor”.

 

“You can’t have a serious relationship in medical school, it would be distracting.”

“How could you plan a wedding right now, you should focus on studying.”

“You should wait til after you graduate to get married and have a family.”

 

I have heard it over and over again. I have heard it worded many different ways. More often than not I hear it from colleagues in medicine. I have even heard it from my clinical advisors who have “advised” me to put off my wedding and definitely never consider having a family during clinical years. For some reason, the belief is that if you choose medicine you cannot choose anything else.

I refuse to be confined to that belief.

I think it is very unhealthy to deny yourself happiness, whatever that may mean to you. It is so important to keep your mind and soul at peace if you want to be there for someone during their time of weakness or illness as you do in the medical field. And to be frank, since I started allowing myself happiness outside of medicine, my performance in medicine improved. I am more focused, more confident in myself, and more decisive.

So I am going to keep doing question blocks and wedding planning in between. I am going to continue being known as “medical student”. And on my way to being known as “doctor” I will step into the role as “wife”.

Don’t limit yourself because of other people’s opinions. Your happiness can be made up of medicine and lots of other things too!

What was the internal medicine core like?

Well everyone, my first core rotation has come and gone. Internal medicine core was a 12 week rotation that included 8 weeks on the hospital floor and 4 weeks of electives. My electives included outpatient clinic and cardiology. A typical day would start at 6:45 am and we would go home around 4 pm, this was Monday-Friday with weekends off. We were “on cover” every 4 days which meant your team stayed until 6 pm that day. We also had one week of night shifts (8 pm- 8 am, Monday night through Saturday morning) during the rotation.

internal medicine rotation

A typical day on the floors started around 7:00 am and usually began with morning rounds which was a lecture led by an attending and usually covered a patient who was admitted overnight. Then at 8:00 each team of residents and students would go to their floor and split up their patient list. A team consisted of one senior resident, two intern residents (PGY-1), two third year medical students, and one fourth year medical student doing a sub-I (internal medicine elective). Usually as a student you got to know 1-3 patients per day- this meant you knew all the details about your patient by reading their chart, meeting and interviewing them, and performing pertinent physical exams. Then, the attending would meet with all the residents and students to round on everyone’s patients. Rounding included presenting your patient, going in as a group to see and examine the patient and then making decisions on their care. At the end of rounds, attendings would typically sit down with the group and teach a topic for 15-45 minutes. Most days, we would have a noon conference with the residents where we ate lunch while listening to a lecture. In the afternoon, we had our own student lectures from 1:30-3:00 where we would do case presentations (a patient we had seen previously) or learn another topic from an attending. We would then help our residents with any new admissions from the ER by going down and doing full interviews and physical exams and then writing a History & Physical.

internal medicine rotation

My outpatient clinic elective was a two-week long elective that was from 8 am to 4 pm Monday- Friday. I shadowed residents and attendings while they saw patients for follow up appointments or physical exams. It was a short, yet good experience in primary care.

The cardiology elective was also a two-week long elective. I worked directly with the cardiology attending during this elective. In the mornings, I would meet up with the attending and we would see her patients who were in the hospital or any new consults that she had for the day. She would review their ECGs or echocardiograms with me and discuss management of their conditions. She also taught me how to best hear and identify murmurs in patients. Mondays, Tuesdays and Thursdays we would then go to her office and see her patients. Wednesdays she would do stress tests, stress echocardiograms and echocardiograms in her office that I was able to observe and then review with her afterwards. On Fridays, I would go to the resident cardiology clinic where I shadowed the IM resident and cardio fellow while they saw patients for follow up appointments. I really enjoyed this experience!

 

What we loved about internal medicine.

Patient care: one of our favorite things about internal medicine was having the chance to form relationships with patients. As students, we had a lot of time during the day to spend with our patients that we were following. Lending a sympathetic ear to patients, I believe, is something special we are able to offer. It is quite rewarding to gain trust with patients and sometimes that trust can lead to discoveries that change the patient’s care plan.

internal medicine rotation

Having to be inquisitive: something Denzel and I found to be enjoyable during our internal medicine rotation was having to search for answers and put together a full story when meeting patients. Patients would present with a chief complaint and it is then your job to dive into the full story of that patient’s presentation. This was not always easy, especially when interviewing patients who were talkers, had dementia, or were too lethargic to give a full history. We found ourselves often researching conditions and treatment options. I really enjoyed this part of internal medicine, I felt like I was constantly learning something new while working through patient’s cases.

internal medicine rotation

Wide variety of presentations: in internal medicine, you see so many different patients of all ages (adults 18 and older). Even though most of the time patients had common illnesses (CHF, A.Fib, COPD, etc.), there was always an interesting case or twist.

internal medicine rotation

Our personalities fit well in the field: we both felt like being “people persons” served us well during this rotation. It felt comfortable and natural to meet patients for the first time and get down to the details we needed from them. I feel like the more extroverted and open we were, the better response we received from patients.

internal medicine rotation

The opportunity to learn from intelligent, well-rounded attendings and residents: Our program has a large internal medicine program with residents and attendings from many different backgrounds which I felt enriched our experience as students. We had residents who had previously practiced abroad, residents who used to be nurses, and several residents who went to RUSM. Every resident I met shared stories with me from their personal experience that I was able to gain insight from. We felt like no matter what question we came up with, our residents and attendings always had a good answer for us.

internal medicine rotation

 

How we studied for the internal medicine shelf.

The resources we used for the internal medicine shelf included UWorld, Online Med Ed and this YouTube video by Emma Holliday. We also learned a lot during the rotation in the various lectures and in rounds. We were always looking things up on Up To Date for our patients conditions and a lot of what was tested we had seen as patients in real life! We also purchased and completed all the NBMEs for medicine shelf on the timed mode.

internal medicine rotation

The shelf exam was 110 questions and we had 3 hours to complete it with no scheduled breaks. Overall, we found the exam to be quite challenging, perhaps because it was our first shelf exam. Also, for the first time in my medical school career I was presented with fill in the blank questions. There was about 2-3 of this style of question.

I would suggest starting UWorld questions and studying early, rather than putting it off until the last half of the rotation. I think starting with Online Med Ed plus some MCQs would outline the “expectations” for internal medicine studying. Like I said above, the information is broad and there is a lot to know. I wish I would have reread First Aid for the USMLE Step 1 before I started rotations since it had been a few months since I had seen all the material, I had to refer to my First Aid book multiple times while studying since a lot of the information is still relevant.

internal medicine rotation

Some topics I would recommend mastering before the exam include and are certainly not limited to this list. These are just topics I remember coming up several times throughout the rotation and on the exam:

  • Chest pain work up and the treatment of common causes of chest pain
  • CHF work up and management
  • UTI management and how to understand the results of a UA
  • Syncope work up
  • A. Fib EKG and treatment
  • Management of common arrhythmias
  • Anemias
  • Liver enzymes and LFTs
  • Management of DKA and treatment of diabetes (medication MOA and side effects)
  • COPD exacerbation management

Comment below or reach out to me if you have gone through the internal medicine core rotation and shelf and have anything to add to this!

Are you going to IMF soon? Check out my blog post about my experience in IMF.

Often I am asked and often I wonder myself how I would’ve prepared for NBME Comp and USMLE Step ahead of time in my last few semesters of basic sciences.

Going into my final semester (5C), I had a plan to split my time between studying for the semester and preparing for the NBME Comp. Unfortunately, some unforeseen circumstances (ahem, hurricane and GNV Excellence) disrupted my plans.

If I could go back, I would have tried to spend some time preparing for the NBME Comp and Step in addition to my basic sciences curriculum. In the end, all the information you study in basic sciences IS preparing you for these exams, but aside from the information you are currently studying, there is much more that has been in the back of your mind for several semesters that needs to be brought forward in order to be prepared.

First and foremost, it is most important to pass and do well in your final semester. That should be the main focus- I would not recommend sacrificing those last few modules, there is a lot of important pathology in them!

If you got this in the bag, these are my suggestions on how I wish I would’ve supplemented my studying to prepare for comp and step.

  1. Get familiar with your First Aid book: it takes time to get used to reading and using the First Aid book for your studies. After reading it a few times, I finally felt like I knew the book in and out. Part of my preparation for these exams including reading through First Aid multiple times. I wish I would have made a schedule and planned to read a couple pages everyday while I was in my final semester. You could approach it in different ways. Maybe read the chapter that corresponds to the module you are learning or read a chapter of something from a different semester to keep old info fresh.
  2. Do some questions: I would still save my UWorld questions for comp and step, but I wish I would have done a few RX questions everyday or every other day. Even if it was just 5-10 questions. I was so unfamiliar with questions and so inefficient when it came to reviewing them! It would have helped to be better at reading and answering MCQs and getting used to how to review them and annotate into first aid BEFORE it was time to get down to business.

Simple steps to prepare can really go a long way! Part of getting into the flow of Comp and Step studying is just figuring out what to do with all the resources available. Being familiar with First Aid and MCQs would have saved me a lot of time and stress when I was just starting out my dedicated study period.

Lastly, do not underestimate the benefit of planning your study schedule out ahead of time. If you are interested in the schedule Denzel and I used, check out the details here. Check out how I studied for semester 4C here. Good luck with your final semesters of basic sciences! Feel free to reach out anytime with questions.

 

Hello fellow Rossies! I am guessing you have come to this post for some more information about the first third year rotation, Internal Medicine Foundations. (Still need help with Comp or Step? Click HERE)

Fortunately, I have recently gone through November IMF 2018 so I have some details to share to help you make a smooth transition to IMF and Miramar, FL. Unfortunately, I am a part of the last IMF class before some big changes are being made to the IMF curriculum starting in January 2019. However, I have collected as much information as I can to help your transition go smoothly and set your expectations straight.

(PS if you are looking for an embroidered white coat for a good price, check out Lydia’s Uniforms)

Complio and Health Documents

First things first. Once you register for an IMF class, you will receive documents regarding your health status. I urge you to start your paperwork ASAP, even if its during the weeks that you are studying for step. The reason I say this is because there is many requirements that are required to be met in order to be “compliant” for your rotations. This includes several documents and vaccines and blood work to be complete.

If your paperwork is not completed and you are found to be non-compliant, discipline DOES happen. It is not an empty threat. Regardless of the reason for your non-compliance, action is taken to label your non-compliance as misconduct. SO start your paperwork as early as possible.

One mistake several of us made was getting our titers done and not getting QUANTITATIVE results. When you go to see your doctor, make sure (I mean double and triple check) that your results will indeed have a number for you to input into Complio. Ask for quantitative results.

The only item you need to pay for online when you register for Complio is the $29.00 fee for your background check. The first part is completed online and the second part is completed during IMF orientation.

Housing

We have lived in Miramar since March and have looked high and low for places to live that are affordable, clean, safe and close enough to the Ross campus. Truly, our favorite place we found was Milano in Miramar, renting via our landlord who has furnished 1, 2 and 3 bedroom apartments. If you are interested let me know and I can get you her contact information.

Transportation

If you have your own car and are able to bring it with you, I would highly recommend this as it allows you the freedom to get too and from Ross and Cleveland Clinic and any leisurely activities. Since the schedule is changing for IMF, having your own transportation is crucial to getting too and from your assignment since they may vary in times. As an IMF student you will be offered a discounted Enterprise rate as well. This is a good option. There was an option to list a carpool partner a few weeks before IMF. I am not sure if this will still be the case, but if so there is another option for transportation with friends.

Curriculum

Although many changes are happening to the IMF curriculum to prepare students better for rotations, I believe many of our experiences will be the same. There is assigned readings, my suggestion would be to print them out or buy the book and read them a little everyday. This way you will not have to cram everything the night before the exam. The readings are not very dense, make sure to pay attention to any criteria, mnemonics or screening guidelines in the readings.

In IMF there is five main parts

  • Clinical rotations
  • OSCE
  • Simulation
  • EPP
  • Random Lectures
  • BLS/ACLS

Clinical Rotations

While those in November 2018 IMF and those before us have done our clinical rotations at many different clinics around Southern Florida, starting in January 2019 all clinical rotations during IMF will be at the Cleveland Clinic. We only did two days a week of rotations, but starting in January, many more days will be spent at the clinic. This also included different shifts (morning, afternoon, night, weekend). Clinic work will include more skill work like writing SOAP notes and presenting! It’ll be a good change.

 

OSCE

During the 6 weeks of IMF we did two standard patient encounters with write up and presentation each week. You are broken up into small groups of 5-6 that you stick with for OSCE and every week, two people choose to do the full patient encounter. Everyone writes up one of the patients afterwards. The OSCE patient usually stems from the assigned readings for the week so it helps to keep up with your assigned readings (if these still exist from now on).

Simulation

One of my favorite activities in IMF is sim lab! There are 12 cases in total. These aren’t the same simulation patients as we had in Dominica. They are extremely advanced and they even have conversation with you so you can take a history! I really loved doing sim. This is not tested, but take notes on the teaching points that the teacher goes over after all 4 cases are complete, because these are tested on the midterm and final (if these still exist).

EPP

Essential patient procedures in IMF include airway, pelvic exam, IV insertion, scrubbing and suturing.  Three of these are tested on the final (pelvic, IV, and airway).

Random Lectures

There is many, many… many hours spent in lecture. Lots of them are given by administration about how to get through the next two years. There is several lectures about what to do and what not to do during rotations.

BLS/ACLS

One of the weekends during IMF you will spend a Saturday and Sunday learning Basic Life Support and Advanced Cardiac Life Support. You will get your certifications later that week and those have to be uploaded into Complio in order to be compliant. I believe they will no longer be doing PALS (Pediatric Advanced Life Support) starting in January, but I am not sure. If for some reason you cannot make it to these trainings, you will have to pay for them yourself and attend them on your own days off (and there is NOT many).

Selecting a Track

The tentative track list below is very much a tentative track list. Sometimes they add tracks and sometimes they take some away. Regardless, at least you can go into IMF with some idea of how you want to rank the track options. The second day after we started IMF (a Tuesday), we got an email about the tracks that would be offered and lots of information about each track and their start dates. You then have about 5-6 days to fill out your track application which includes ranking the sites and personal comments about why your number one pick is important to you. This is also the section where you will tell them if you want to go to the same place as your partner (girlfriend, boyfriend, fiancé, husband, wife, whatever). Make sure that you BOTH put that you want to be together on BOTH applications. Also, if it is more important for you to be together at any site rather than separated at your top two choices, then make sure you BOTH put “we would rather be placed together at any choice than our top choice”. This doesn’t mean you wont get your first choice, most people do get their first choice!

HAVE AN OPEN MIND! Some people do get their second or third choice, so rank places that you would be ok going to in places two and three. If you don’t get your top choice, still try to keep an open mind. All the tracks are great, students who are currently there have good things to say about every track.

Downtime

Although there is and will be very little downtime in IMF, it is important to still enjoy your time in South Florida! BUT do not forget to get some sleep when you can, or else grumpiness will sneak up on you.

Some of our favorite places to visit while in South Florida:

Hope this synopsis of IMF gives some of you some clarity! Good luck with IMF and feel free to reach out to me with any questions!