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2016 – 2017

M3 Clerkship Guide Brought to you by: MSG and Class of 2017

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WelcometoM3 1 HospitalMap 3BeforeyouBegin 2 HowtoInterpretthisGuide 4

FamilyMedicine 5ContactInformation 5 ResourcestostudyforfmCASESexam 5WhatshouldIwear? 5 Studentcomments 6

Neurology 10ContactInformation 10 Resourcestostudyforshelf 10WhatshouldIwear? 10 Studentcomments 11

Psychiatry 14ContactInformation 14 Resourcestostudyforshelf 14WhatshouldIwear? 14 Studentcomments 15

Pediatrics 18ContactInformation 18 Resourcestostudyforshelf 18WhatshouldIwear? 18 Studentcomments 19

Surgery 23ContactInformation 23 Resourcestostudyforshelf 23WhatshouldIwear? 23 Studentcomments 24

InternalMedicine 30ContactInformation 30 Resourcestostudyforshelf 30WhatshouldIwear? 30 Studentcomments 31

ObstetricsandGynecology 36ContactInformation 36 Resourcestostudyforshelf 36WhatshouldIwear? 36 Studentcomments 37

Ambulatory 41ContactInfo&WhatshouldIwear? 41 Studentcomments 41

Step2Preparation 44ResourcestostudyforStep2 44 Studentcomments 44

T a b l e o f C o n t e n t s

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WelcometoM3!YouhavefinallymadeitthroughthatbighumpcalledCrunchMonthandearnedyourbadgeofhonortostrutthewards.Youhaveheardfromalloftheolderstudentsabouthowmuchfunitwillbeonceyoustartyourclinicalrotationsandthatdayisfinallyhere.Congratulations!Firstandforemost,oneofthebestadvicesIreceivedfrommultipleattendingsandresidentsistoenjoyyourtimeasamedicalstudent.Thismightbethelasttimeeverinyourlifethatyougettosee_______thatiscommonin_________rotation.RememberthatYOUaretheonlypersoninthepatientroomthatispayingforyourexperience(Hello,tuition!).Seekoutexperiences.Yourenthusiasmwilltakeyoufarandyourteamwillappreciateyouforthat.Thisguidehasbeencreatedtomakeyourtransitionfrompre-clinicalstothehospitalalittlebiteasier.Itisdauntingtofigureoutwhattodoorwheretostand(neverbreakthebluesterilefieldintheoperatingroom!!!)Rememberthatthisguidewascreatedsolelybasedontheexperiencesofthestudentsbeforeyou.Itcanchangeanytime,buthopefullytheyareallthingsthatwewishedweknewbeforehand.Thethirdyearofmedicalschooliswhatwedreamedofthroughourpre-medandfirsttwoyearsofmedicalschool.Nowyoufinallygettobepartofpatient-care.Weareextremelyluckytobeataninstitutionthatourfacultyandstaffcareaboutourlearning.However,rememberthatintheend,ourpatientscomefirst.Youmaynotbeconsideredapriorityandtheremightbenoonearoundtogiveyou“formalteaching”sessionsduringtheweek.Don’ttakethispersonally.Everypatientyouencounterisa“teachingsession”.OneofthemostfrustratingthingsaboutM3yearisthatyouarenotgivenasetofinstructionsorpowerpointstogoovereveryday.However,beingproactiveaboutyourownlearningandreadingalittlebitaboutallthepatientsinyourteam(notjustyourown!)willbeplenty.Youwillhave12+hourdaysandwillfeelfrustratedbecausetheonlythingyouatewasabananaat5am.Evenatyourworstdays,pleaserememberto–Takecareofyourself(eat,sleep,exercise,study,talktolovedoneswhenyoucan)Getalongwithfellowmedicalstudents(thereisabsolutelynoreasonthatyouandyourpeerinthesameteamcannotbothgethonorsinaclerkship)Respectyourinterns,residentsandattendingsBecourteoustoyournursesandrestofthehospitalstaffIfanything,comefindafourthyearandtalktothemabouttheirexperience!Wewereinyourshoesnottoolongago.Wehopeyouenjoyyourtime.Hopetoseeyouonthewards!Best,YeriPark(C/O2017ClassPresident)MedicalStudentGovernment

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BeforeyouBeginBeforeyoudiveintothisguide,I’dliketoshareafewthoughtsaboutitscreation.Jumpingfromthepreclinicaltotheclinicalyearsisasourceofexcitementandanxietyforallofus.Whileweknowthatmedicalstudentsdoeventuallymakethetransitionandacclimate,itdoesn’tchangetheinsecuritieswefeelinthismoment.Partiallyinrealizationofthis,theM3ClerkshipGuidewascreatedbycoalescingthethoughts,tips,fears,andsuggestionsoftheClassof2017foreachclerkship,inhopesofmakingthingsjustalittlebitgentlerfortheClassof2018.Thus,I’dliketothanktheClassof2017fortheirwonderfulcontributions,andwishthemthebestofluckintheirM4year.Totheclassof2018:thisguideismeanttobemoreofaninformal,yethonest,perspectiveofclerkshipsandtheshelfexams.Assuch,itisnotasetofofficialrecommendationsfromtheSchoolofMedicine,butratherhelpfulthoughtsandinsightsfromourupperclassmen.Inaddition,itisnotwhollycomprehensiveofallthingsM3–itismoreofaquickreference,abriefintroduction.Futureeditionswillbecomemorecomprehensiveasmoredataiscollectedandmoremindscontribute.Ifyouhaveanyquestionsregardingtheguide,orhaveanyideasonhowwecanmakeitbetterforfuturegenerations,pleaseletmeknow.Here’stous.Wecan,andwill,dothis!Sincerely,RajbirChaggar2015-2016MSGVPPublications

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Contactinfo.ClerkshipDirectorandClerkshipCoordinatorinformation.

Whattowear.Givesyouasenseofwhatcombinationsofclothesareoftenworn;mayvarybyservice.

Resourcestostudyforshelfexam.Coloredbarsforeachresourceindicatesfavorabilityofresource;heightofbarindicatesthenumberofrespondents.

Comments.Includesavarietyofstudentcommentsregardingotherresourcesused,locationofdifferentservices,personalexperiences,andtipsforsuccessineachservice.

H o w t o I n t e r p r e t t h i s G u i d e

FamilyMedicine

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ClerkshipDirector:MelissaBradner,M.D.,melissa.bradner@vcuhealth.orgClerkshipCoordinator:ErinVanVleet-Jester,erin.vanvleet@vcuhealth.orgWhatshouldIwear?

ResourcesusedtostudyforfmCASESexam*:*Note:FamilyMedicinedoesn’tadministeranNBMEshelf–thefinalexamisMedU’sfmCASESexam

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FamilyMedicine

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Otherresourcerecommendations:UsetheyellowsheetstheygiveyouonthechecklistsJustdoMedUModulesThecasesaren’talwaysgreatbutknowthediseasesthatarecoveredineachoneaswellasalltheinfofromthecasesummariesTrytocompletetheself-assessmentsinMedUatleasttwiceinadditiontoreadingthesummariesforthecasesseveraltimes.ShelfisbasedonMedUmodules,sousethem.TestisstraightfromthemodulesMedUCasesTherequiredcasesaresufficienttoprepareyouforthe"shelf".IonlyusedtheMedUstudyguidesprovidedbytheclerkship.DonotuseanyotherresourcestostudyotherthanthemedUmodules!Theentireexamisbasedoffthemodules,sothereisnoneedtodoanythingelse.Gothroughthemodulesthoroughlyandyouwilldofine.StepUpToMedicineissolidaswell.StudytheMedUModulesonly.StudythegoldsheetsprovidedatorientationfortheOSCE.Studythecasesummariesfortheshelf.Whichsitewereyouplacedinandhowwasyourexperience?(housing,food,workingintheclinic)MidlothianatStFrancisFamilyPractice.Itwasamazing!NotinterestedinFMbutlovedmyexperiencetodeathSt.Francis-workedmostlywithresidents,8am-5pm,differentresidenteveryday.BerryvilleVA.Goodvarietyandrurallocation.Livedwithmyfamily.Orange,VA.Excellentpreceptor.StayedwithPastorLinwhichwasnice,howevernointernetinthehousemadeitextremelydifficulttostudy.WarsawMedicalArts.Myoverallexperiencewaswonderful.Mypreceptorwasanexcellentteacherandgavemealotofindependencefromday1.ThehousingsituationwasalsogreatatthelocalEssexInn.Ihadmyownroomincludingfullkitchen.CoffeewasavailablefreefromtheInneverymorning!LuraywithDr.Mashaw.Overall,itwasagoodrotation.Iworked8-430ishMonday-Friday.AsheisoneofonlyafewonlydoctorsinLuray,hehasbothclinicdaysandinpatientdays.Ontheinpatientdays,hefunctionsasthehospitalist,admittingandroundingonpatientsatthesmall(25bed)hospitalinLuray.Dr.MashawalsodoescolonoscopiesonTuesdays,onwhichheletmeassist.Dr.MashawrunsthefreeclinicinLuray.Soonenightaweek-usuallyTuesday-westayedlater(7-8ish)toseepatientsatthefreeclinic.VCUputmeupintheGarfieldGuestHouseinLuray.It'sthe2ndfloorofasmallhousewithabedroom,bathroom,andkitchen.Dr.Mashawmentionedthatinthepastthestudentshadactuallystayedwithhimathishouse,soI'mnotsurewhattheplanwillbefuturestudents.Manassas.Dr.P.isprettycoolandiseasytoworkwith.Youwilllearnatonofsportsmedicine.Chatwithhimaboutthefutureoffamilymedicine.Hehasawealthofwisdomandopinionsfromhisyearsofpractice.FairfaxFamilyPractice,myexperiencewasAMAZINGFrontRoyal.Own1bedroomapartmentlovedit.Colonialheights-amazingexperienceAtSt.FrancisFamilyPhysicians-Dr.Campbellisnice,alittledifficulttoreadsometimes,andhastonsofOB/GYNpatients.Theresidentstherearegreatteachers.St.FrancisFamilyMedicine.Residentsandmostattendingsweregreat.Dr.Campbell,themainattending

FamilyMedicine

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youaresupposedtoworkwith,mainlyseesonlyob/gynpatients,buttheotherattendingsseetheusualrangeofpatients.NavyHospitalCampLejeune.Highlyrecommenditforanymilitarymedicalstudents.LynchburgFamilyMedicineprovideshousingandfood.Youneedacarforthisclerkship.Theclinicisawesomeandyouareprovidedagreat1on1teachingwithyourpreceptorandresidents.LynchburgFamilyMedResidency.Freefoodanditsoundsliketheyopenedanewplacetolivethatshouldbereallynice.Iwouldrecommendbringingyourownsheetsthough,mybeddidnothaveafittedsheet.IwouldalsorecommendaweekendtriptohikeSharpTopMountain,verycoolVirginiaexperience.SouthHillFamilyMedicineinSouthHill,VA.Experiencewasawesome.TheyhaveyoustayinthehomeofJoanMedlin,whoworksatthepracticedoingdocumentationtypestuff.Youhaveyourownbedroomandbathroom,andshareakitchen,buthaveprivacytostudy.TheclerkshipasksyougobacktoRVAontheweekendsbutyoucanleaveyourbelongingsthere,shedoesn'tusethespaceforanythingexceptstudents.Youareresponsibleforgroceriesbutshehasafullkitchen.Thepracticewasgreat,yourotatebetween3MDswhileyou'rethere.Theygiveyouindependenceprettyquickly,yougoseethepatientonyourownandthenpresenttothem,andthengoseethepatienttogether.Beontime,polite,eager,andthey'llloveyou.Theyarevery,verynice.Nopimping,andtheyansweranyquestionsyouhaveeasily.Theyletmedowell-womanexamsandpelvics(whiletheywatched)aswellasbiopiesandsuturingonseveralpatients.Dayswere8to5ish.sportsmedicinepracticeunderbonsecoursinrichmondwasgreat!Afterthefirstfewdays,mypreceptorhadmeseeeverypatientandwriteallofthenotes.Itwasagreatexperience!Iwasluckyenoughtostaywithfamilymembers,butheardsomeconcerningstoriesregardinghousing(Winchester,VA)HayesEWillisClinic,varietyofexperiencesincludingtimeinlab,pharmacy,andwithpsychologytema,low-incomepatientpopulationLynchburg.Housingwaspoorbuttheyweregoingtochangeitthisyear.Freefoodforthewholemonth.Greatdiversityofpractitioners.St.Francis-stayed@myownhome,8-5ish,differentresidentalmosteveryday,goodexperienceoverall.Orange,va.Greatexperience!Shenendoahfammed.Goodexperience,heavyutilizationofalternativemedicineandOMT,sobraceyourselfforthat.Theapartmenttheyputyouinisalittlegrossandtheareaisntthegreatestbutthepeoplethereareabsolutelythenicestsoenjoyit.Hrs:8am-5pmconsistently.PSfreelunchtues-thursday(Andmostfri/mon).Learntoadjustbecauseyouwillbeworkingwithanewattending/residenteachafternoon/morningsonotmuchcontinuity.Harrisonburg(Sentara).Excellentexperienceintheclinic.Interesting,diversegroupofpatients.Harrisonburgisacoolcity,Ireallyenjoyedmyexperience.CreweMedicalCenter-30minswestofFarmville,aboutanhourandfifteenminsfromRVA.EXCELLENTexperience,Dr.HallisanalumniofMCVandistrulylovedbyallofhispatients.Daysarelong9a-6/630pmbutyouseeavarietyofthings,chronicmanagement,acuteonchronicmanagement,canfollowNPsformorewell-woman/pedsexams,followoneofthepart-timedocsforproceduresformorehandsonexperience.Dr.Hallwillpickbreadandbutterfamilymedicine/internalmedicinetopicforyoutoreadandpresenttohimthenextday,whichareimportantforlearningdiseaseprocessesandstudyingfortheshelf!YoualsogettostayatanadorableB&Babout15minsawayandgetthemostamazingbreakfasteveryday(paidbytheCreweMedicalCenter!).Berryville,VA-greatexperience!

FamilyMedicine

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Tipsforsuccess:Don'tthinkyou'reabovefamilymedicine.SomeM3sactliketheythinkit'stooeasyorboringorwhatever.Trytofindsomethingtolearneveryday,showyourpreceptoryou'reexcited,andberespectful.Youslowdowntheirdayandmakemoreworkforthembuttheydon'tmindbecausethey'reexcitedtoteachsobeexcitedtolearn.ThekeytodoingwellontheFamilyMedicineshelfistodoalloftheBoardReviewquestionsavailableontheAAFPwebsitewithafreestudentaccount.Thosequestionsarehigheryieldthananyotherresource.PretestwasagreatsourceofquestionsReadStepuptoMedicine,probablyyourbestbetfordoingwellPre-Test.FirstAidFamilyMedicineClerkshipisbestsourceformeTheAAFP'sjournalhasexcellentreviewarticlesthatcanbeusedtoclarifyconcepts.Iusedthisjournalthroughouttheyearforvariousclerkships,anditwasveryhelpful.AAFPquestionbankQ-BankfromtheAAFP,freewithstudentmembershipStepUptoMedicine(AmbulatoryMedicinechapter)JustdothecasesandyoushouldbesetforhonorsBeprofessional,knowyourlimitations,keepstudying.StudytheMedUmodules.Thisisallyouneed,noothertexts,fortheexamStudyMedUStarttheMedUcasesearlyanddevelopagoodstrategytoreviewthecontentbeforethecasesexam.OtherwiseaverylaidbackclerkshipUnlikeothershelves,thefamilymedicineshelfisaMedUexam.Takeyourtimegoingthoughallthecases,andmakesuretoreadallthepartsofeachcase,includingthe"expert"sections.Trytogetthroughallthecasesaboutaweekbeforetheclerkshipendsandthenreviewtheoverviews/quizzes.Thereisnoneedtouseanyotherresources.Pocketprimarycareisagoodresourceifyouareinanofficewithspottywifiandyouneedawaytolookstuffup.DOtheMedUModules!showinterest.Evenifyouarenotinterestedinfamilymedicine,thisrotationisagreatonetopracticeallyourclinicalskillsinaveryfriendlyenvironment(hint:fammeddocsaretheNICESTdoctorsandtheyreallycareaboutstudentswhoshowinterest!)lovedmyrotationbecausetheattendingsactuallycareaboutyouasawholeperson!Trytohaveaconciseassessmentandplanreadyforeveryencounter.Itcanbeoverwhelming,butthisiswhatattendingsandresidentsarelookingfor.Onlydomedumodules.Testisonlyfromthosematerials.Dothecasesearlyon,especiallyifitisoneofyourfirstrotations.Examiseasyandrotationishonorableifyouworkhard!StudyMedUfortheshelf.Bereadytoseeptsandpresentondayone.Focusonagoodassessmentandplan.Getappslikeepocrates,ASCVDcalculator,ePSS,AFPbytopic,andShotswillhelpyouquicklyfigureouttheplanforyourpatient.ToHonortheyarelookingforastudentwhocanquicklysummarizepertinents,giveadiagnosis,andplan(includingwhentof/uinclinic).Workhardandaskalotofquestions.Makesureyougetexposuretoalotofdifferentpractitionersastheyhavedifferentareasofinterest.Startstudyingearly.Timewillflybytooquicklyandthereisalotofmaterialtocover.Makesuretofocusonhighyieldandnotgetboggeddownbyamountofinformation.

FamilyMedicine

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Askthedocslotsofquestions,beeagerforprocedures,buildrapportwithpatients.Thesedocsknowtheirpatientsveryverywellandifthepatientsloveyou,theyprobablywilltoo!stayontopofyourmedumodulesastheyaretime-consuming.donotwaituntiltheendtocompletethem.theywereprettysufficienttodowellontheshelf.Keepupwithyourcases.Reviewthembeforethetest."Shelf"isprettyeasyifyou'refamiliarwiththeinformationfoundinthemodule.Beenthusiastic!Bepreparedforyourpatients.Studyandgetthroughthe40caseswithinthefirst3weeksandusethelastweektoreviewEmbraceworkingwithmanydifferentprovidersandlearnfromtheirexpertiseintheareastheyspecializein.JustMedU,itsallyouneed.Knowitbacktofront,includingthenon-medicalculturalstuff.KnowSpanish,beproactive,askspecificthingsyouwanttolearn.Thecasessuckbutyougottadothem...reallyweirdstudyingforthisonesojustkeepgoingthroughthecases.Theosceisstraightforwardbutthewriteupisonly10minutes,makesureyoupractice.Knowthesheetsprovidedbytheclerkshipandyou'lldogreatontheexam!Workhardtofinishthemodulesearlysoyoucanspendmoretimestudying.Workhardandhavefun.MedUModulesandgoldsheetsareallyouneed!

Neurology

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ClerkshipDirector:ElizabethWaterhouse,M.D.,elizabeth.waterhouse@vcuhealth.orgClerkshipCoordinator:MelissaHoward,mdhoward@vcu.eduWhattowear?

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Otherresourcerecommendations:OnlineMedEdStepuptomedicineneurochapterGreenbergHandbookofNeurosurgery(checkitoutfromthelibraryonyourNeurosurgeryweek)Qbanktwice,andthe2NBMEpracticeselfassessmentexamsarekey.Med-u.orgishelpfulMakesuretoreviewtheneurosectioninFirstAid-itgoesalongwayontheshelffortopicsthatmightnotbecoveredinotherresources.FAforStep1-Neurosectionwasagoodprepbeforedelvingintothestepprepbookslikepre-testandcasefiles.TheFridaylectureswereveryhelpfulMarkTuttleNeurology!QBankNeurologydoesnotcoverallthematerialthatwillbeontheshelf.Besuretostudylysosomal/mitochondrial/glycogenstoragedisorders,pedsneuro,nerve&NMJdz,dermatomes,andinnervations.Whichservices(MCVconsults,in-patient,ChildNeurology,Epilepsy,VA,MovementDisorders,Neuro-Onc,Neuromuscular,NightFloat,NSICU,OutpatientClinic,SleepMedicine,Stroke)wereyouplacedinandhowwasyourexperience?In-patient,EpilepsyandStroke.Myoverallexperiencewasgreat.Oninpatientteams,gooutofyourwaytoreadaboutyourpatientsandgotheextramiletohelpwiththingsforthem(phonecalls,placinglaborders).EpilepsyandStrokewerebothveryenjoyableexperienceswithlotsofone-on-onetimewithattendingswhowereexcellentteachers.IworkedatMCVconsults,outpatientclinicattheVA,andNSICU.IdonotrecommendoutpatientattheVA.Eachdayisadifferentclinic(stroke,epilepsy,etc.)soitisdifficultforwhichtoprepareandyouworkwithdifferentresidentsandattendingeachday.NSICUwasgreat,butveryattendingdependent.Myattendingdidn'tteachandignoredthemedicalstudents.However,itwasstillagoodexperiencetolearnhowanICUrunsandtoseeverysickneuropatients.IstronglyrecommendMCVconsults.Thedoctorsletthestudentsseepatientsindependently,andthereisawiderangeofcomplaintstoevaluate.Iwasonconsults.Myexperiencewasthatconsultssawmorevariety(andwasmorerelaxed),butinpatientgotmorecontinuityandmanagementexperience.Iwouldhighlyrecommendneuro-oncasaoneweekelective.Theattendingsaregreataboutteachingandletyouseepatientsonyourownwhichisn'tagivenonotherpartsofthisrotation.Child(Amixofclinicandinpatient,overallgood,probablylowyieldwhenpreparingfortheshelf)In-Patient(verybusy,tonsofinterestingpatientstofollowandmanyinterestingdiscussionsarehadduringrounds)Neuro-Onc(clinicbasedelective)MCVConsults-fantasticexperience.Youseeabroadvarietyofshelf-relevantpathologies.Formyrotation,wealsohadmoredowntimetostudythanInpatientfolks,butwestillgotmuchoftheteachingthatcamefromInpatientresidents(ConsultsandInpatientshareateamroom).NightFloat-greatexperience,lotsofdowntimetostudy.Outpatient1week,Neurosurgery1week,andInpatient2weeksConsultteam-justbusyenoughtolearnbutnotoverwhelming.Hoursaregood.VA-excellent,goodhours;NightFloat-greatexperience,gettoseeanddoalot;Epilepsy-prettyslowservicebutattendingsandfellowswanttoteachIn-patient:dependsontheattending,ifyougetagoodonethenthiscanbethebestpartofneuro;theresidentscanbeiffybutmostarereallyniceNeuro-onc:theattendingisawesome,youwillseesome

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extremelyinterestedcasesinclinic,itwasagreatweekNSICU:likein-patient,itdependsonhowgoodofanattendingyouget.Theresidentsaremostlyfromanesthesia,sotheyareverysmartandgoodtoworkwith;thepatientsyouwillcoveraresomeofthemostcritically-illwiththemajoritysedatedandonvents,makingthisagreatintroductiontocriticalcaremeidcineNSICU-goodrotation,mostlyindependentlearning.ChildNeuro-goodlearning,smallerteam=moreinteraction.MCVConsults-lesstimeonrounds,decentlearning.VAInpatient/consult:slowbutveryinformative.Attendingphysiciansweregoodteachers.NSICU-onlyopportunitytoseewhatcriticalcareislike,nootherserviceallowsyoutoworkintheICU.Byfarthebestoneweekelective.Manycriticalpatientsandgreatopportunitytolearnventilationsettings.Moreopportunitiestodosmallproceduresdependingontheattending.MCVconsults,MovementDisorders,EpilepsyInpatientNeuro-intense.Iwassurprisedathowmanypatientsarecoveredbyoneservice.Expecttotable-roundforseveralhoursinthemorningandthenphysicallyroundonallthepatients.Dependingontheattending,thiscangointotheafternoon.VANeuroClinics-experiencewasokay,theyhadnoideaIwascomingandtheschedulewaskindofthrowntogether.Ishadowedfortheentireweek,didn'tspeaktoasinglepatientonmyown.ChildNeurology-goodexperience,verysmalllistofpatientsandonly1otherstudentsoyouworkcloselywiththeresidents.Notmuchwasexpectedfromme-nodailynotes,andonlyinformalpresentationsMCVin-patientwasgreat(consultserviceissuperbusy).Movementdisorderclinicwasreallycoolandyougettoseealotofinterestingpresentations.EpilepsywasVERYhelpfulinlearninghowtolocalizelesions,whichisveryusefulfortheshelf!!Ididinpatient,movementdisordersandnightfloat.Themovementdisordersclinicwasfine,mostlyshadowing.Inpatientwassimilartointernalmedicinebutthepatientvolumeislowerandthereislessforstudentstodo.Ididnothaveagoodnightfloatexperience.Thesystemisorganizedpoorlyandthereisonejuniorandoneseniorresidenttocoverthefloors/ICU,allstrokealertsandallconsults.Makesforalotofactivitybutisverybusyandcanbestressful,especiallyfortheresidents.Wards(VA)-good,laidback,lotsofteachingPedsneuro-notverystructuredSleep-verynicepeoplebutrepetitiveInpatient-greathoursforaninpatientserviceNightFloat-Hitormissonlevelofactivity.Attendingwasnotpresent.Goodopportunityforproceduresthough.MCVConsults:Strokealertsarecool!Otherwiseyoudon'tgetahugevarietyofneurologicissues.NSICU:AWESOME.YougettoseetheacuityofneurologicissuesandgetanintrotoICUcare.NSICU-dependsALOTonyourattending(likeanyotherserviceinthehospital),myhourswereexcellent,roundswereshort,andIlearnedalot.YouworkwiththeAnesthesiaresidents,NOTNeurologyresidentsinNSICU.ChildNeuro-goodvarietyofpatients,7-4pm,didbothconsults&inptcareessentially.MCVConsults-busierthaninptteamduringmy2weeks,notterriblydifficult.responsiblefor1pt@roundsinthemorning,plus1-2consultsduringtheday.Ididn'twritenotesandnobodyseemedtonotice/care.Willbedependentonyourresident.Duringmyclerkship,MCVconsultshadbetterhoursandpatientloadthanthein-patientservice.Ifyouwouldlikemoretimetostudy,chooseMCVconsults.mcvconsults-hoursvary.givenapatienttofollowforadayortwountiltheyareofftheconsultservice.willdoafternoonroundsbasedontheattending.willgetalotofafternoontimetostudy,takeadvantageofthistimeandstudywhileyoucan.sleepmedicine:9a-5pmhours,interestingandgoodoneweekexperience.Nightfloat-greatrotationandsuperchill.ICU-nicehoursandyougettodosomeproceduresifyouareproactive.Inpatient-youseeagoodvarietyofdisorders

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Tipsforsuccess:FirstaidforCK-neurosectionQBankwasveryhelpfulTheClerkshipgoesbyfast,sostartyourstudystrategyfortheshelfearly.Thisisafairlylightservice,sospendyourtimewiselytopreparefortheshelf(it'soneofthetougherones).Startstudyingearly,practicetheneuroexamasearlyandasoftenasyoucanStudyoninpatientservice,youhaveplentyoftime.Startpreppingfortheshelfonday1,andstudyeveryday(duringdowntimeonthefloorandwhenyougethome).Theshelfisverytoughandyoumustknowallthedetailsofpresentationformanyneurocasesthatseeminglyoverlapinpresentation.Studyhard!Onthefloor,thisisagoodfirstexperiencetoinpatientcareandpresentations,sodon'tbetoostressedabouthavingaperfectpresentation,theattendingsarejustlookingforyoutoputinsomeeffort.Clinicalevaluationsdeterminemostofyourgrade,sospendextratimepreparingforwards/clinic.StudyearlyforthisShelf.Trytogettopretesttwice.Showasmuchinterestasyoucan,evenifitgetsboring,whichitwill.IfIcoulddoitagain,Iwould'veusedPre-TesttogetmorequestionsinalongwithCaseFilesandQBank.Also,trytodoEpilepsy,it'salaidbackatmosphereandyougettolearnaboutanareaofmedicineyouwouldprobablyneverhavegottentoexperienceotherwise.Youdon'tneedtorelearneverysingledetailonneuroanatomy.Butitisimportanttoknowthedistinctionbetweendifferentlevelsofpathology,fridaylectureswereveryhelpfulforthatTableroundsinthemorning=computers!Constantlyrefreshthescreenstomakesureyouhavetheabsolutemostup-to-dateinformationonyourpatientbythetimeit'stimetopresent.Whoknows?Maybesomeimportantlabsjustcamebackandyoucanbethefirsttonotifytheteam.Knowyouranatomywellsothatyouknowhowtolocalizelesions!Beproactiveinaskingtheresidentstodothings,becausemoresothanotherrotations,theresidents(atleasttheonesIworkedwith),reallydidnotdelegatethingsforstudentstodo.WewerekindofanafterthoughtStartstudyingearly.Tricktogettinghonorshereistodowellontheshelf.GothroughtheFirstAidStep1Neurosectiononceortwicethefirstweekoftherotationthendotheqbank.KnowMarkTuttleNeurology,itsgoteverything.Pretendtobeinterested,eventhoughyouprobablywon'tbeaneurologist-theseguysactuallyreallyliketoteach.Learnhowtodoagoodneuroexam,andaskthemtoexplainwhyyoudocertainthingsifyoudon'tunderstandit.IlovedneuromuscularDr.WongandDr.Votaarereallyniceandtheyteachalot.IalsolearnedalotinNSICU.Dr.Dorriz,PGY2wasanexcellentteacher!Helpedagreatdeal.Pre-testandQbankweremosthighyield.TheweeklylecturesfromDr.Waterhousewerealsohelpful.NeurologyandNeurosurgeryIllustratedbyKennethLindsayFirstAidNeurologyClerkshipisbestsourceformeTheshelfisprettyhard,butIdidwellusingjustqbankandpretest.

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ClerkshipDirector:CherylAl-Mateen,M.D.,cheryl.al-mateen@vcuhealth.orgClerkshipCoordinator:KimBertram,kim.bertram@vcuhealth.orgWhattowear?

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Otherresourcerecommendations:FAPsychandLangeQ&Aarethewaytogoforshelfprep.GothroughbothtwiceFirstAidforUSMLEStep1-greatresourcefordrugs.Whichservicewereyouplacedin(VA,Consultteam,CrisisStabilizationUnit,Geriatric,InpatientMedPsych,MoodDisorders,Schizophrenia,VTCC)andhowwasyourexperience?inpatient(inova)Mooddisorders.Goodexperience,lotsofvariety.Prepareforlongrounding,MedPsych-greatexperienceaslongasyou'rewillingtoworkandlearnTheconsultserviceattheMCVhadalotofdowntimeandtherewerealotofteachingsessions.You'regoingtoneedtodoFULLH&Psoneverysinglepatientifyouseeonebutnotenoughtimetoformulateyourthoughtsandthings...WhenIwason,therewasmaybe1or2consultsthatwesaweachdayandIwasboredoutofmymindsinceIdidabsolutelynothingformostofthedayseventhoughIwasn'tinterestedinpsychtobeginwith.VTCC:IfyouareinterestedinpediatricsIwouldrecommendthisrotation.VTCCallowsyoutobeveryinvolvedinpatientcareandyougetlotsoftimewithattendings.Itcanhoweverbeemotionallyexhausting,andyouprobablyworkharderonthisservicethanmostoftheotherpsychservices.VTCC(greatexperience,workedwithDr.SoodwhichwasamazingbutIthinktheotherattendingsgotgoodreviewsallaroundtoo,nopre-rounding,youroundtogetherasateamintheAM,presentafewlinesveryinformallyattheinterdisciplinarymeetingwhichisheldeachmorningwithPT/OT,education,nursingstaff)VTCC-predictablehours(8-5PM),forsomeonewhoisinterestedinworkingwithchildren,youareapartofaninter-professionalteam,youmakealotofphonecallstofamily/docs/friendstotrytofigureoutthe'real'storyaboutwhatisgoingoninyourpatientslifeConsult:Excellent,bestattendingsIvehadthisyear.Alwayswillingtoteach.MoodDisorders-astheonlystudentonMood,Igotalotofexperiencedoingthepsychiatricinterviewfornewpatientsinfrontofmyattending/therestoftheteam.NotonlydidIgetlotsofpointers,butitreallymademefeellikeausefulpartoftheteam.OnMood,thepathologiesyouseearemainlyMajorDepression,BipolarDisorder,SchizoaffectiveDisorder.Howeveryouaremorethanlikelytogetoverlapfromotherservices(mainlyschizophrenia).OnlycomplaintisthatIdidnotasmuchteachingasIwouldhaveliked.NexttimeI'dbemoreproactiveaboutaskingforteachingfromresidents/theattending.4thfloorinpatientservice,Isawlotsofpathologyandhadafantasticattending.Thequizzesareapainandaterriblelearningtool,butyougottadothemandtheyareaneasywaytogetpoints.CSUGeriatrics.Itwasawesome.VA-best4weeksofyourlifeSchizophrenia:Dr.Moranisareallygreatattendingandtheresidentsarealwaysverynice.Youwillcarrybetween1-2ptsandpresentthemaresit-downroundsinthemorning,beforewalkingroundswiththeteam.TalkwiththeNPandSW,theyaregreatresources.Schizo-goodteam,mostofyourpatientshavealotgoingon.GeriatricConsults-awesomeexperienceyougettoworkwiththe3amazingfaculty:Dr.Levenson,Dr.Meguid,andDr.Kogut.Youspendtheentiremonthwiththemwhichgivesyouagreatchancetoshineandgetgoodtraining.Alsoyoudon'troundtilllaterintheday,sowhenyoudon'thavealotofconsultthereisalotoftimetostudysinceyoumustbeinthebuilding.Youlearnalotaboutassessingcapacityandwhetherapatientshouldbeadmittedtothepsychiatricunit.

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Consults.Aboutaveragehours,slowmornings,bestattendings.InpatientMedPsych.Havingjustfinishedinternalmedicine,itwasinterestingtoseehowmedicinecouldalsorelatetopsychiatry.ItalsohelpedgetmehonorsasIwasabletoimpresstheattendingwithmymedicineknowledgeandapplyittopsychiatry.Schizophrenia-greatexperience;veryeye-openingbutalsoterrifyinginmanyways.Thereisoftenalotofdown-timeintheafternoon,somepeoplechosetousethistimetostudybutIoftenreturnedtopatientsrooms,especiallyiftheywereanxious.Thisbuiltalotofrapportwiththepatientsandmanyofthemsharedthingswithmetheyhadnotyetsharedwiththeteam.VA-easiestrotationyou'lleverhave.VTCC-probablythelongesthours(745-5ish)butveryrewardingexperience.ItisveryattendingdependentbutminewasgreatInpatientMedPsych-greatopportunitytoreviewmedicineaswell,attendingthatlikestoteachonrounds,varietyofpatientsseenConsultservicehasthebestattendings.Schizophrenia:DrMoranisthebest.Youlearnalotoftheservice,especiallythedrugs.Youwillseealotofthedrugsused,soyougetusedtotheirsideeffectprofile.Schizow/Dr.Moran.He'sverydifficulttoreadasaperson,butactuallydoescareaboutyouasaperson(justwon'tshowit).Lotsofextremepsychiatriccasesontheschizoteam-agoodchancetohearsomecrazystoriesfrompatients.Consult/LiaisonC&L,Attendingsareamazing.VTCC-ifyou'reinterestedinpeds,greatexperiencetorotatethroughtheVTCC.childpsychiatryisachallenginganddemandingfield.It'snotemotionallychallenging,butyouwillgettoappreciatewhatchildpsychiatryhastooffer.Attendingsaregreat.Youwillmakealotofcollateralcallsforthepatients.Wasatlinicfrom8am-5pm.spendtimewiththekidsifyoucan!Mooddisorders-theyhaveyoupracticeyourH&Pinfrontofyourteam.Tipsforsuccess:Lange2X,FirstAid2X=95%onshelfNoresourceisparticularlystellarforPsychiatry,sousingacombinationof2or3isprobablythemostvaluableapproach.Don'tbeajerkBeengagedevenifyou'renotinterested,theyareunderstandingthatnoteverybodywantstodopsychandwillhelpyoulearnthingsthatarepertinenttowhatyouactuallywanttodo.Bepolite,beinterested,beontime,respecttheentireteamReaduponyourpatientsandknowthepharmacologycold.AvoidCSUifpossibleunlessyouhavearealinterestinthissortofthing.Dayswerespentinroomthesizeofarefrigeratorandpatientfloorsarelockedwithheavysecurity.Studyhard-theshelfisoneoftheeasiest.Comereadytopresentyourpatientsandwriteanoteonthemeachday.Helptheresidentsiftheyneedanyhelp.Makesuretobringyourlaptopbecausetherearenotenoughcomputersintheresidentworkroom.Tryandgetoutofyourcomfortzoneandpickupptsthataremore"challenging."Anddon'tstresstoomuchabouttheweeklylearningsessionsandnightcall,justworkhardandyouwillbefine.HighshelfscoreisneededformeanT-score.Goonasmanyconsultsasyoucanandstudyuponkeyconceptsearly.Beavailabletohelpwheneveryoucan.Don'twaitforotherstoformaplanforyourpatients,ortolook

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upnewimagingorlabwork.Beproactiveandgolookatimagingandlabvalues.Alsobeproactiveinusinguptodatetoformulateaplan.Evenifwrong,itstillshowsinitiativeandthatyouarelearning.Shortclerkship,startstudyingearlyAskquestions,checkonyourpatientsalot!KnowyourdrugsBeateamplayer.Thesocialworkerandresidentsneedyourhelpconstantly!Don'tasktoleaveearly.WehadonestudentwhogotBURNEDbecausetheresidentsthoughthewasaskingtoleaveearly,eventhoughhewasn't.Theteamroomisinsanelysmall,sogowritenotes/work/studyinoneoftheconferenceroomsafterrounds-theresidentsactuallypreferit.Knowthedrugs/sideeffects/usesandyou'lldowell.knowpharm!beinterestedinyourpatients.

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ClerkshipCo-Director:CliftonLee,M.D.,clifton.lee@vcuhealth.orgClerkshipCo-Director:MariekaHelou,M.D.,marieka.helou@vcuhealth.orgClerkshipCoordinator:DawnM.Landschoot,dawn.landschoot@vcuhealth.orgWhattowear?

Recommendedresourcestostudyforshelfexam:

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Otherresourcerecommendations:OnlineMedEDIalsousedthisthedaybeforetheshelf.IgotseveralquestionsrightthatIotherwisewouldhavehadnoidea.http://som.uthscsa.edu/StudentAffairs/thirdyear.aspOnlineMedEdvideosQbankwasagreatresource,runthroughitatleasttwiceandtheshelfshouldn'tbethatmuchofasurprise.Don'tskimponpretest,IdidQbanktwicethrough,andfeltlikethereweremorezebrasontheshelfthanIwasexpecting.PretestgenerallytestsmorezebrasthanthebreadandbuttertypestuffyoufindonQbankFirstAidforUSMLEStep1forinbornerrorsofmetabolism/geneticdisorders.Whichserviceswereyouplacedin(Inpatientteams,PedsED,PedsHeme/Onc,NewbornNursery)andhowwasyourexperience?InpatientTeamA,nightfloat,newbornnursery,outpatientwithDr.IqbalScheduleinpatientfirst(it'sthemosttime-consuming).PedsEDis32hrtotalduringtheweek,andyoumayormaynotgettoseeinterestingthings(justdependsonwhatcomesin).PedsED.Itwasgreat!NewbornNursery,PedsEDandChippenham.Nurserywasmyfavorite,goodtimetolearnlotsofnormalnewbornexamfindings.PedsEDcanbeallovertheplacebasedonhowbusyitis.IworehospitalscrubsforNurseryandPedsED.InpatientatChippenhamyouareexpectedtowearbusinesscasualandwhitecoat.Myunderstandingisthatourpatientloadwaslowerandlessacademiclearningonthejob(smallerteams),butbetterhoursandnoweekends.Chippenhaminpatient,PedsHeme/Onc,NNChippenhaminpatientisawesomeinmanyways.You'llgetalotof1-on-1timewiththeattending,shorthoursandfoodofcourse.Moreforpeoplewhoaren'tinterestedinpedsthoughsinceit'snotatMCV.PedsEDisfunexceptsomepeoplehavetopulltwoovernighters.Newbornnurseryisagoodexperiencetohave.Ihadneverdealtwithbabiesbeforeandwasaneyeopeningexperience.MygradedphysicalexamonthisserviceactuallycountedmorethanIhadexpectedittosodon'tblowitoff.InpatientTeam2(coveredgeneralpatientsandalsopulm,GI,andendocrine):aLOTlikeinternalmedicineintermsofhoursandrounding;expectedtopickupgeneralpatientsandpresentthemonrounds;teamroomisverysmallandnotthemostconducivetogettingworkdoneduetolackofcomputers,soyouMUSTbringyourownlaptoptogetontoCernerPedsED:FANTASTIC;reallyuptoyoutogetoutofitwhatyouwant,buttheresidentsareverywillingtoletyousuture,etcifyoushowinterest;work4shiftsin1weekandknowthatexactlywhenyou'reexpectedtocomeandleave.NewbornNursery:reallycooltolearnhowtoexamineanewbornandtakecareofthemduringtheirfirstfewdaysoflife;don'texpectthebabiestobeintheactualnurserythough-theyusuallyspendalmostalloftheirtimewiththeirmoms,soyouwillseetheminthemorningwiththeirmoms.Inpatient:Team1-Greatexperience,similartoIM,youpresentyourpatientsandfollowthemthroughouttheirhospitalexperienceED-Superrelaxed,youhavetobeproactivetobeabletosee/doanythingNewbornnursery-Busy,makesureyouarecomfortablespeakingwithparents,beconfidentHeme/OncwasawesomeHeme/OncED.VerylaidbackInpatientteamsarethelongesthours.Inpt:ifyougetagoodattendingthenisshouldbefun,andhopefullyyougetaPGY3thatactuallywantsto

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teachyouguys.Patient-centeredroundssoundscarythantheyactuallyare.Don'tstressabouthavingtohaveaperfectpresentation,itreallydoesn'tmatterexactlywhatyousaycausetheresidentorattendingwillcorrectyou.Justpresenttotheparentslikeyouarejusthavingaconversationwiththeminlayman'stermsandroundswillbelessstressful.PedsED:ifyouaresuperintoEMthenthisisanawesomeopportunity,justmakesureyoutryandworkwiththeEMresidentswhoarerotatinginthepedsED(causetheyactuallywanttobethereandarewillingtoteachandworkwithyou,unlikethepedsresidentswhomostlydonotwanttobeinthePedsEDandarenotveryinterestedinworkingwithyou).Volunteerforprocedures,ifplasticsiscomingdowntosewupafaciallac,thenasktoscrubinandhelp--Igotto!Volunteertoseepatientsthatinterestyouandbeabitpushy,especiallywiththepedsresidents,orelseyoucouldverywellgothroughawholeshiftwhereyoudon'tseeanyptsyourselforarejustfollowingtheresidentaround,bothofwhichisnotagoodlearningopportunity.NN:babies!Dependingonhowbusyobisdownstairs,thisservicecanbecomeverybusyandyoumayverywellbecarrying4ptsfromday1,sojustbeready:)ThisistheonlyservicewheretheattendinghasactuallytakendowninhernoteexactlywhatIpresentduringrounds,whichreallymakesyoufeellikeapartoftheteamforonce.Outpt:Nomatterwhichpracticeyouareat,itwillbebusy(likelyaround30ptsaday).Makesureyoudon'tgetinthewaytoomuchifyourattendingseemsbusyandrushedtoseepts.TryandfocusonA&Pforeachpatientpresentationyoudo,that'sthemostimportantpart.PedsED-notagreatlearningexperiencebutlotsoftimetostudyNN-excellentplacetointeractwithkiddos,myfavoritepartInpatientChippenham-excellentexperience,lesserptloadbutmorelearningopportunitiesdependingonattendingInpatientteams-experiencewasokay.Theteamroomsarenotbigenoughandmakeituncomfortable.Attendingsaregreat.LookupAAPguidelinesforwhateveryourpatientcomesinwith-they'llappreciatethat.Newbornnurseryisfunandrelaxing.PedED-ifinterestedinwhatemergencymedicinethisservicesgivesgreatglimpseofwhatitslike.Opportunityforprocedures.LearntotakeafocusedH&P.Youdon'twritenotessoyoucanfocusonashortpresentation.Inpatientteam1-lotsofgreatteachingfromcardiologyandnephrology.Learnalotregardlessofwhichteamyouareon.Youwillwork1weekendifonVCUteamsandhoursarelongerthanChippenham.YoushoulddoVCUteamsifinterestedinpediatricsothatyoucangetaletter.NewbornNursery-lotsoffunspendingtimewithhealthybabies,veryeasyweek.PedsED.Showupandhavefun,youcandoasmuchoraslittleasyouwant.Chippenhamisthebest!YougetmoreindividualizedattentionfromtheAttendings,alotofindependence,andyougettoexperiencehowacommunityhospitalfunctions.Plus,freefood!Pedsheme/onc,newbornnursery.Pedsheme/oncisverylaidbackandyoulearnALOT.Iwouldhighlyrecommend,especiallyifgiventheopportunitytoworkwithDr.Sisler.Sheisamazingandwillreallyletyouparticipateindifferentproceduresinheme/oncifyoushowaninterest.In-patient(lovedit,butveryteamdependent),Heme/onc(reallycomplexandspecialized),NB(LOVEDNB!)Inpatient,newborn.Ilikedtheinpatientservice.Somepeoplecomplainaboutpeds,butIhadagreatexperience.TheresidentsIhadwerefriendlyandwillingtoteach.Plusbeingaroundthekidsisgreat.Ifyou'reeverhavingadowndayjustgopickuponeofthebabiesontheserviceanditwillturnyourightaround.Chippenhaminpatient-highlyrecommend.Goodteaching,freefood!PedsED-verylaidbackInpatientTeamsPedsEDyoudoasmuchoraslittleasyouwant.PedsED:YougetverygoodatthequickassessmentofH&PtoformulateagoodDDx.Manyshelfquestionsare"PatientcomestotheED.....,"sothePedsEDisagoodwaytolearnthesequestionsonthejob.JamesRiverPediatrics-goodplace,8-5ish,prettylowkey.Nursing/officestaffreallynice,herpartner

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canbedifficultforsomepersonalities.NewbornNursery-everybodyrotatesthroughhere,butitjustdependsonyourresident/attending.Howbusyyouwillbealsodependsonwhatwashappening~9monthsago...Team2-theteamroomsareREALLYsmall.Bringyourowncomputer.PEDSED:kindaawkwardbutmakethemostofit,learntopresentpatientsquickly.Studyduringthisrotationbecuaselotsoftimeoff.Chippenham:Greatrotation,freefood,goodwaytolearntopresentappropriately.everyoneisnice.InpatientTeam2,PedsED,NN.Tipsforsuccess:WhatCaseFileslacksindetails,BRSmorethanmakesupfor.StartwithUWorldquestions,thendoBRSwithPre-Testifyouhavealotoftime,orCaseFileswithPre-Testifyouareshortontime.IreadalotofreviewarticlesintheAAPjournal,whichwashelpfulonthefloorandfortheshelf.IgotanHonorsintherotationandit'snotdifficulttodoso.PretestPedsistheisverygoodforthisspecificrotationandisthebestPreTestbookout.Doittwice(firsttimewithquestionsandsecondtimereadtheanswersonly).UWorldisgoodandyoushouldtrytodoittwice.OnlineMedEdisgoodifyouwantalecturetohelpreinforcestuffyoureadinUworldandpretest.BRSwastoodenseforme-youcanpasstheshelfbyjustdoingQBankandCaseFiles.Washyourhandseverysecond,andyoumaystillspendalloftheclerkshipsick.Manyofusfoundthepedsshelftobeverywide-rangingandrandom--IthinkBRSisthemostcomprehensivetextanditincludesalotofquestions,thoughitisaslogtogetthrough.Studyonyouroutpatientrotationandnewbornnursery,asyou'llhaveatonoftimevsinpatient.Hangoutwiththekids--it'sthebestpartoftherotation!Citearticlesinyourplanforinpatient.Thisismoreimportantthanevenwhenyouareoninternalmedicine.DoQbank2xthrough,gotothereviewsessiontheMondaybeforetheShelf,andmakesureyouknowhowtodoeverythingonthePractical.TheytellyoualmostexactlywhatisonthePractical,soaslongasyouunderstandhowtodothoseproblems,itisaneasywaytopickuppointsforyouroverallgrade.Ingeneral,justbepresentandwillingandeagertolearn,evenifyouaren'tinterestedinpediatrics.Attitudegoesalongway,andifyouareateamplayer,youwillhelptheresidentstremendouslyandtheywillappreciateyoumore.AlwayshavestickersinyourpocketGettoknowyourpatientsStudybroadly.Mostquestionsareeasytogetrightifyou'veseenitafewtimesbefore,soreadasmanyresourcesaspossible.Shelfisdeceivinglydifficult.Startwithpretest(whichisoverratedbutyoumustdoforquestions)thenuworldAddingresourcestonotesoninpatientservicesanddoingmini-presentationsafterroungs(1or2duringtherotationisprobablyadequate)makegoodimpressionsandareencouraged.Examineasmanyearsaspossiblebecauseittakespractice.Knowwhatshowsarepopularamongyoungkids(e.g.PawPatrolandDr.McStuffins).Studyfromdayonefortheshelf,thereareatonofdiseases/syndromesyouhavetolearn(it'skindofamini-IMrotation).Workhardbyhelpingouttheresidents/NPs,practicewritingnotes,andtrytospendsometimeplayingwiththekidswhoseparentsaren'tthere--that'sthebestwaytolearntoidentifydevelopmentalmilestones.Enjoyyourself,thisisoneofthemorefunrotations.Theresidents/attendingsrespondwelltopeoplethatarehavingfunratherthanjustworkinghard.BRSwasagoodtextbookforthisStayengaged,followuponlabsforyourpatients-gospendtimewiththemintheafternoonifpossible.Startstudyingearly,thepediatricshelfisnotaninternalmedicineshelfforlittlepeople.Themedicineis

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completelydifferentandtherearealotmoreopportunitiesforzebrasandweirdcongenitaldiseases.Workhardandasbestyoucan,incorporatearticleevidenceforyourtreatmentplans.Theattendingsloveit,agreatwaytostandoutasinterestedinwhatyou'redoing.Interactingwellwithfamiliesisveryimportant,makesuretotakethetimetoconnectwithyourpatientsandtheirfamilies,it'sbothfulfillingandreflectswellinyourevaluations.Behappyandwillingtowatchothersperformthephysicalexam.Thenbeproactiveandaskifyoucangoseethenextpatientonyourown.Bewillingtostaylateiftheresidentsareswampedduringin-patient.Besuretobefriendlytothenurses,NP,andallmembersoftheteam.Theyhaveasayinyourfinalgrade.GivethetinyhumansandtheircaretakersyourtimeChooseonebookandfinishtheQbank.Dothesethingsatleasttwice.Thatshouldbeenoughtodowell(read:notjustpass)ontheshelf.Offertohelpinanywaypossible.Remindtheresidentsyou'retheretohelpthemandshowthatyouareinterested/active.Getyourpresentationsdown,andtryandgetusedtopresentinginfrontoffamiliesassoonasyoucanbecauseitcanbeadifferentexperienceatfirst.Beproactiveandtakeownershipofyourpatients.Taketimetohelpfamiliesthroughtheirsituations.DotheqBankquestionsearly,asit'sagoodrefresherforinfoduringrounds.Studyearlyandoften,easyrotationtogetanHifyoudowellonshelf.Peopleallreallynice.Makegooduseofyourtimeonoutpatientandnewbornnursery,becauseyouwon'thavetimetostudyduringinpatient.

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ClerkshipDirector:RahulAnand,M.D.,rahul.anand@vcuhealth.orgClerkshipCoordinator:SalemGlenn,salem.glenn@vcuhealth.orgWhattowear:

Recommendedresourcestostudyfortheshelfexam:

(NOTE:Pestana’sreallyshouldbeonthislist.PESTANAISGOLD.Readcommentsbelow).

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Otherrecommendations:PestanaPestanasPestana!!!!x3-readthisthedaybeforeormorningofyourshelf.Pestana'sandOnlineMedEDPESTANA'S!!!Pestana'sSurgeryNotesPestanaSurgeryistheBESTbookforthisrotation.Pestana!Pestanaisgold,knoweveryword.IwatchedasmanyWiseMD/MedUsurgeryvideosaspossible.IreadPestana'scasesandnotestwiceeach.DoNBMEsurgerypracticeselfassessments.ReadPestanafirst.DoQbankforsomemedicinesections,especiallyGI.Pestana'sisaMUST-itwillnotgetyouatopshelfscorebutisagreatandessentialfoundationplusitwillfitinyourpocketandyoucanreaditwhilewaitingforcasestostart.***Pestana'sSurgeryNotesPestanaandQbank'ssurgerysectiontwicethroughisthebestprepforthisbusyrotation.ReadPestanawhenintheORwaitingforyourpatientorattendingtoarrive,doafewqbankquestionseverynightbeforebedandyouwillbereadyfortheshelf.Pestana>>>>>>Pestana'spestanaw/accompaniedvideos.Pestanaisagoodandsuperquickhigh-yieldread.Pestana's.However,ifyoureallywant/needtoHonorthisclerkship,takemedicinefirst.TheshelfissuchasubstantialpartoftheHonorscriteriathatit'salmostimpossibletogetHonorswithoutrockingit.PestanasDoGIaswellonuworld,veryhighyield.Pestana's-excellentresource.PestanaisagoodoverviewPESTANA'S,medicineQbank,onlinemededPestana'sisallyoureallyneed.Makesuretodosomeinternalmedicineqbankquestions!There'salotofinternalontheshelf.Whichservicewereyouplacedin(VA,differentVCUdepartments,generalmonthanddifferent2weekspecialties)andhowwasyourexperience?PedsSurgery,Ophtho,plasticsTrauma,Plastics,Ortho.Plasticswasmoretime-intensive,buthadalotofORtimeanditwasinteresting-learnedgoodsuturingskills.OrthowasalsoOR-intensive;coolprocedures,nicepeople,0545start-time,norounding.Traumanightswasmyfavoriteweekofmedicalschoolhands-down.VA-hearditwasagoodexperience,hadapoorexperience.ENT-hearditwasapoorexperience,hadagreatexperience.Choosewhatyoulikebecauseyourexperiencewilldependontheattending/residents/studentsyouworkwithmorethananythingelse.VCUNeurosurgery-greatservice,buthadahardtimefiguringoutmyroleontheteamasastudent.Overall,IthinktheymostlywantyougoingtotheORcasesyouwanttogoto.VCUCTSurgery-awesomeservice,goodhours,goodclinictime.TraumaSurgery(akaAcuteCareSurgicalServices)-verybusy,long

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hours,butlotsoflearningonthejob.VAvascular:goodteaching,IfoundtheVA=morehands-onexperienceVAneuro:lotsofspinalsurgeries,butthey'vesinceopenedmoreORssothereisnowmorevarietyMCVPeds:shortersurgeries,yougettoparticipatelessintheORbutthekidsarealotoffuntoworkwithVAVascularwasoneofmyfavoriteservices.Dr.Amendolawillletyoudostuffthatotherswon'tletyoudo.Youlearnalotandvascularsurgeryisprettycoolsoit'sfun.VAneurosurgeryischillb/cyouprettymuchhaveaverysmallteamsoyougettotalktoyourresident/attendingalot.TheydoalotofspinestuffsoifyouwanttoseeacraniotomygotoMCV.KnowthatMCVneurosurgeryisalotmoreintensethantheVAone.Justasidenote:you'regoingtohavetodoanartprojectattheendofyourrotationattheVA.Didn'treallyknowthatuntiltwodaysbeforeitwasdue.Bariatric/GI:thebesthoursofallthegeneralsurgeryoptions;only4attendings,soyougettoknowthemprettywellandoncetheygetmorecomfortablewithyou,mostarewillingtoletyouparticipatemoreinsurgeryanddomorethanjustretract(bovie,cut,andsuture);alotoflaparoscopicandroboticsurgeriesCTatMCV:fantasticsubspecialty;youdon'troundormakelists,youjustworkdirectlywiththeattendingsandgettochosewhatsurgeriesyouwanttosee;youcanreallygetoutofitwhateveryouwant;attendingsmainlypimponanatomyandpatienthistoryVAVascularisadecentservice,butunderstandthateveryonegetsthesamegrade.Ifyouwantanopportunitytostandoutchoosesomethingelse.INOVACardiacsubspecialtynotworthit.INOVAENTwasagreatexperiencewithanicebalanceofsurgeriesandclinicdays.Generalsurgerywaslonghours,butagreatexperience.Traumacallwasfunandagoodtimetogetthingscheckedoffofpassport.Surgicaloncology,neurosurgery,plastics-workedveryhardonallthreeandhadagreattime;thesearetheserviceswithprobablythelongesthours.VAopthovascularVA-probablynotgoodifyouwanttodosurgerybutgreatifyouwanttospendmoretimeinclinicthantheOR.Hoursaregoodandtheattendingsarenotveryintense.Plasticsisaveryinterestingspecialtywithgreatresidents.Trauma/AGS-fantasticexperienceespforsomeonewhoisnotinterestedinsurgerybutyouseealotanddoalotespeicallyonnights;CTSurgery@MCV-veryinteresting,lowcaseloadbutcasesareinterestingandsurgeonsaregreattoworkwith;CommunityI2CRP-ifyoucandothistakeadvantageofit.Surg-onc(VCU):veryverybusyservice,itwilltellyouifyouarereallyinterested/readytogointosurgery.ReadthegoogledocthatiscirculatingamongthecurrentM3'sCT(VCU):mainlyscrubbingintocases,andcanleavewhenyouwant.Ipersonallywenttoamorningcase,scrubbedin,andwasdonebyaroundlunchtime,atwhichpointIwenthomeforthedayandstudied(thisisagreatopportunitytogetsomestudytimein)Vascular(VCU):youhavetomakethelistinthemorningasifyouwereonyourgeneralmonth,whichstinks,andyouarenormallytheonlymedstudentsoyouhavetomakeitallyourself.Casescanbeverylong,especiallythefem-femorfem-popbypasses,somakesureyoueatandgotothebathroombefore,6ormorehoursisalot.VAurology-greatteamoverthere,6-5VCUVascular-goodexperience,highyieldforshelfVCUTrauma-veryhitormissdependingonwhoyourcheifisandwhoyougetforAGS.Somelovedit.Runningtraumasisfun.TraumaSurgery-greatrotation,lotsofhandson,intense.Neuro-intense,alotofautonomy.ENT-goodrotation,attendingsareallgreatPedsSurgery-greatexperience.Veryniceattendingswholiketoteachandwillletyoucloseifyouasknicely.It'sagoodgeneralmonthforthosewhodon'tnecessarilywanttodosurgery,orwhoareinterestedinpedssurgery.Thereisnoteamroomforpedssurgery-sohangoutonMain4.Surg-onc,neurosurgandVAurology

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VA.TheVAhasareputationforbeingmorelaidbackbutthat'snotnecessarilythecase.Lotsoflecturesfromseniorstaff,onlysomeofwhicharereallyuseful.trauma,ortho.neurosurgeryVCUtransplanthasbrutalhoursandlimitedteaching.VCUCTsurgeryissuperinterestingandyougettoseealotofreallyinterestingcases(andtheyletyouassistalot,whichisawesome).Ophthowasreallyfunandtheresidentsareverynice,plussurgeriesareveryshort.VAgeneral(lotsofgoodclinictime,teachingsessionswithattendings),Plastics(excellentandchillresidents,reallymakeyoufeellikepartoftheteam),I2CRPFrontRoyal(HIGHLYrecommendforI2CRPstudents,fantastichours,exposuretoprimarycarewithinsurgery,yougettobefirstassistoneverysurgeryforwhichyouscrub!!!)TraumaSurgery-AWESOME.Plastics-longhours,coolsurgeries,residentsmostlynice.Ortho-awesomesurgeries,oneovernightcall,1presentationrequired.Trauma-REALLYtoughtostartonthisone,makesureitsnotyourfirstrotationbecausetheydonthavetimetoteachyouthebasics.otherwisegreatrotation,trytoworkwithanandorwhelentheyaregreat.SurgOnc,UrologyVCU,NeurosurgeryVCUVACT:greatexperience.Therearenoresidentsonthisservice,justtheattendingandPAs.Sostudentsgettodoalot(openingthechest,closing,holdingtheheart,etc).Ifyouwanttogetinvolved,choosethis.VANeurosurgery:verylaidbackandnoweekendcall.Don'tgettoseemuchduringsurgerybecausethefieldofviewissolimited.MCVGIandBariatrics:greatifyoulikebothsurgeryandclinictime.YougettoseesomeofthesurgeriesthatAGSdoes(lapchole,colectomies)buttheseareelectiveandscheduled(notashectic).IfelttheattendingsonthisservicewerethemostrelaxedandfriendlyofalltheservicesIworkedon.Traumasurgery-amazingexperience.youwillrotatethroughoneweekofnighttrauma,twoweeksofdaytraumaandoneweekofacutegeneralsurgery.willseealotof"breadandbutter"surgeryandtraumamanagement.attendingsaregreatandinvestedinstudentslearning.CTsurgatVA-awesomesurgeriesbutyouwillworkweekends.NeurosurgatVA-awesomerotation!!Sochill.Trauma-Ilovedit!Tipsforsuccess:MustdoPESTANA!Pestana+Pretest+Casefiles=93PestanaiskeySurgicalRecallisgreatforwardsandpimpingsessions,butnotsomuchfortheShelf.DotheUWorldquestionstwice,readPestananotes,andthenuseCaseFilesifyouhaveextratime(whichyoumightnot,sincesurgeryisabeast).PestanaisGOLDPastanonotesPestananotesareREALLYhighyield.youwillseeessentiallyALLofpestanaonyourexam.SurgicalrecallisgoodforpimpquestionsinOR,notsomuchforshelf.Pestanaisexcellent!!!!ThatanduworldisallyouneedUseStepUptoMedicine,especiallytheGIchapter.TrytoreadPestanabeforetheclerkshipstarts.Itisaquickreadandwillhelpyouanswerlotsofcommonpimpingquestions!PestanaReviewTheshelfisthekeytosuccess(DJKhaledreference).Studyhardforit.EvaluationsmatterbutnotasmuchasotherrotationsfromwhatI'veseen.Thatbeingsaiddon'tslackoffandputyourbestfootforwardonthisrotation.Therotationisnotasbadaspeoplemakeitouttobe,it'sactuallyveryfunandif

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youtakeitforwhatitis,you'llenjoyyourselfandexcelintherotation.Thiswasmyfirstshelfandit'sdefprettydifficultbutPestanas,UWorld,andPretestarethebestthingsyoucanusetostudyforit.Surgicalrecallisgoodtolookupafewthingsbeforeyouthinkyou'regonnagetpimpedbutitshouldNOTbereadforshelfpurposes-completelynotworthitandnotrelevantSTUDYFORTHESHELF.Yourgradewillbedeterminedbytheshelfscore,NOTbyyourevaluations.Bepreparedforrounds.Knowyourpatients.ReaduponcasespriortogoingtotheOR.Askquestionsthatshowyou'reengagedandinterested.Beflexibleandattentive.Prioritizestudyingfortheshelf,eventhoughit'shardtofindtime.Somepeople'selectivemonthsarebusierthantheirgeneralmonthandviceversa.Doyoubesttomotivatedtostudyearlyintheclerkshipbecauseyouneverknowhowbusyyou'llbeleadinguptotheshelf.Therearen'tthatmanysurgeryQbankquestions,soifyouhaven'thadmedicinefirstIwouldrecommendeddoingsomeMedicineQbankQuestionsaswell.Pestana'sx3.PESTANA'S.Readitasmanytimesaspossible.Alsotakeinternalmedfirstifyoureallywanttorockyourshelf.IhadsurgeryfirstandknewIabsolutelydidnotwanttogointoit,butstillwasabletogethighpassusingjustPestana's+Qbank.AlsoDr.Anandisamazing--youwillhearhisvoiceinyourheadduringtheshelf.Eventhoughthehourscanbemiserable,trytopayattentionduringthedidactics(manyofthemaregold)andkeepapositiveattitude.Packyourpocketsfullofsnacksandeatwheneveryoucan.Ifyouhaveafreehour,powernapinthecallroom.IntheOR,trytopayattentiontothesmalldetailsofwhichsurgicaltoolsareusedafterxstitchorcut,howresidentspreppatientsforspecificprocedures,etc.soyoucanhelp(orattheveryleast,notgetintheway).OhandyourbiggestjobintheOR:don'tgetintheway.Ifyoufeelhotandsweaty,sitdown.Noshame.Finally,eventhoughsurgeryhasoneofthemorestrictgradecutoffs,yourevaluationsreallydomatter.Glowingreviewsfromevenoneofyourspecialtieswillhelpyououtaton.PedssurgerywastheBESTrotation.yougettodoalotandtheattendingsaregreatteachers.highlyrecommendforgeneralsurgerymonthforthosewholovekidsandsurgery!:)Taketimetogettoknowyourpatientsandexplainwhatisgoingon-roundsaresuperfastsoit'snicewhenyoucanexplaineverythinginawaythattheyunderstandStudyeverychanceyouget-IfoundNMSsurgerytobeexcellentforshelfpreparation,alongwithPestana.Definitelylookatthepublished,"adviceforgettinghonors"--it'sallprettybasicstuff:showupreadytowork,alwaysbepresent,prepareforcasesanddoyourbest.Don'tfreakoutwhenyoudon'tknowtheanswerstothings,butmakesureyoucanprovethatyoustudiedforthecasethatyou'rescrubbinginon.Intermsofshelfstudying,doqbanksurgery,qbankIMGI,andpretestsurgery.IalsodidPestanasacoupleoftimes,butpestana'saloneisnotgoingtogetyouanhonorlevelsgrade.Stepupanddon'tbeafraidtohelporasktodothings.Doarotationwithabreakbuiltinforstudytimeifyouareseriousaboutdoingsurgery.Thereislittletimeduringtheactualrotation.Domedicineqbank.Renalandpulmonaryessentialfortheshelf.Theymaytellyouonethingbutexcellinginthisrotationpurelyhastodowiththeshelf.Youneedtocrossthethresholdontheshelf(atalltaskifyouhaven'thadmedicine)orelseyouwillnotgethonors.SpendmosttimeonthatmorethananythingelseDon'tdwellontheobscureanddetailedinformationfoundinPreTest.Mostoftheshelfconsistsofmedicine-focusedquestionsandthesurgeryquestionsarelargelyemergencysituationrelated.Tues/Thursafternoonlecturesareactuallyverygoodso,foronce,payattentiontoanM3lecture.Pestanaisgreatforquickstudyingwhenyouafewminutesthroughouttheday(gothroughittwice).Qbankshouldalsobegonethroughtwice,it'squestionsaremoreliketheshelf,comparedtothequestionsattheendofPestana.Evenifyouarenotinterestedinsurgery,tryandgetyourhandsinonthecases(literally),thiswillbethelasttimemanyofusewillbeabletotouchapt'sliver/heart/brain,so

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takeadvantageoftheopportunity!Dontforgettostudy...justfamiliarizeyourselfwithasurgerybeforehandbecausethey'llneveraskyousomethingyouvestudied.focusmoreontheshelf.Getyourbreakswhenyoucan.Makethelistright.Trytoknowwhat'sgoingonwithyour/allpatients,oratleastwhytheyarehere.Pre-readaboutsurgeriesthenightbeforeifpossible,andaskgoodquestionsthatcanleadtoadiscussion.Ifyouaskadumbquestion,you'remorelikelytogetpimpedonlittlethingsthatdon'tmatterthatyou'llhappentoforgetduringthesurgery.Alwaysaskwhatcanyoudotohelptheteam.ReadPestana'smultipletimes!!Studywhenyoucan,sleepwhenyoucan,bepreparedforlectures,alwayshavefoodavailablesoyoudon'tgetcaughthungryandtired.Arriveearlyandmakesureyouknowwhatyouaredoinginregardstothelist.Youmighthavetocomeinearlierthefirstfewdaysasyoubecomeaccustomedtowhatisandisn'timportanttosurgeons.Alwaysstaypositive.Therearegoingtobedayswhereyoufeellikeyoudidn'tlearnanythingthefirst2yearswhenyougetpimped.Staypositiveandshowthatyouarewillingtolearnandbepreparedforthenextday.Therewillalsobedaysyougetallthepimpingquestionsright.Beoutgoingandconfident.Evenifwrong,surgeonswanttoseeyouhaveconfidenceorareasontobackupwhyyouthoughtacertainanswerwasright.Makesuretoworktogetherasateamasthatismostimportant.Don'ttryandthrowanyoneunderthebus.It'simmatureandwillbenoticed.Setsmallstudygoalsforeachdayoftheclerkship.Theamountoftimeyouareatthehospitalcanfeeloverwhelmingandmakestudytimefeelimpossible.Takeanydowntimetoreviewatopicordoafewquestions.STUDYMEDICINEFORTHESHELF,notSURGERY!Thesurgeryshelfisdeceptivelymostlymedicine(i.e.,everythingyoushoulddoforthepatientbeforeyouwheelthemintotheOR).VAGenSurg-balancingyourtimecanbedifficultbecauseyouareconstantlybeingpulledindifferentdirectionsandyourattendingteachingsessionstakepriorityoverORcasesandclinic,haveopencommunication,takeownershipofyourpatients/cases,bepreparedforyourcases-youwillalwaysgetaskedquestionsyoudon'tknowtheanswerto,butyouwillbefineifyoushowinterestandenthusiasm;Plastics-bepreparedforyourcases!comeupwithauniquepresentationtopicfortheresidents;I2CRPFrontRoyal-youcan'taccesstheirrecords,sofigureoutwaystobeproactivetoknowthepatientsandthecases,gettoknowthestaff.Ingeneralinsurgery,tryyourbesttobeofservicetotheteam,whetherthescrubtechortheattendingsurgeon.Knowwhenit'sappropriatetospeak/askquestions.Study!Don'tputitoffforthelast4weeks.Bequick,beontime,beawareofwhat'shappening.Readtheroom/situationbeforeaskingquestions/doingsomethingstupid.studyearlyanddogiuworld.beenthusiastic.readPestana'safewtimesduringtheclerkship.TheshelfismostlymedicinesoreadsomeStepUp(atleasttheGIsection)anddosomeGImedicinequestions.Listeninlecture-someofthemareuselessbutmostofthemareprettygoodresourcesfortheshelf.BringpestanasorQbankonyourphonewhenyouaresittinginthepre-opareawaitingforpatientstogototheircases.Don'tbotherlearningthedetailsoftheprocedures-itwon'thelpyourshelfandtheywillveryrarelypimpyouonthis.Spendyourtimelearningtheanatomy,reviewthepatient'schart,andthenreadaboutthepathophysoftheirdisease-it'llbehelpfulfortheshelfandyou'remorelikelytogetpimpedanatomyandpathophysduringcases.Thisisalongclerkshipwithlonghours.Takeadvantageoffreeweekendstostudyifyou'reonaservicethatdoesn'thaveweekendcall.ReadPestanamultipletimes,whichIfeltwasmosthighyield.Studyingfortheshelfandstudyingforday-to-daysurgeriesaredifferent:theshelfisbasicallyamedicineshelf,soyouwillneedtobecomfortablewithgeneralmedicinetopicslikehowtodiagnosepancreatitis,etc.Howeverday-to-dayyouwillneedtobepreparedforyourspecificsurgeries,likeknowingtherelevantanatomyandknowingyourpatient'shistory,etc.Coffee

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beenthusiasticaboutallthecases,nomatterifyouwanttogotosurgeryornot.readaboutyourpatientsandwhatsurgeryyouwillseethenextday.surgeryrecallisgreatforpimpingquestionsintheOR.neverbreakthesterilefield,befriendlytoscrubtechs,circulatorsandnurses.takeinitiativeandaskresidentsifyoucanhelpclose.readNMScasebookstoprepforlectures,readpestana's,dosurgeryqbankandGI/cards/pulm/renalsectionsfrommedicineQbank.sleepandeatwhenyoucan.neversacrificeeatingforORtime(hypoglycemicepisodeandpassingoutintheOR=notgood)

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ClerkshipCo-Director:JeffreyKushinka,M.D.,jeffrey.kushinka@vcuhealth.orgClerkshipCo-Director:StevenBishop,M.D.,steven.bishop@vcuhealth.orgClerkshipCoordinators:BrieDubinsky,brieanne.dubinsky@vcuhealth.org;GildaHarris-Howard,gilda.harrishoward@vcuhealth.orgWhattowear:

Recommendedresourcestostudyfortheshelfexam:

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WhiteCoat

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I n t e r n a l M e d i c i n e

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Otherresourcerecommendations:onlinemededwasreallyhelpfulforoverviewsBelabortheOSCE.Theygradetoughandthat15minuteswillkeepyoufromhonors.Step-upandQbankarethegoldstandardshere.Ifyousomehowhavetimeforbothandareanexceptionallyfastreaderdothatbecausetheyreallyreflecttheexamwell.EmmaHolidaypowerpoints(universityofTexas)areexcellent!OnlyuseuWorldandStepup.onlinemededHowwasyouronemonthofgeneralin-patientexperience?IwasonTeam1atMCVandIsawawesomestuffIneverexpectedtoseeoutsideofatextbook-everythingfromundiagnosedGuillianbarretodisseminatedKarposi's!Wegotallthestepdownpatients.Goodvariety,notjustCHForasthma.ReallypleasedwithitItwasgreatGood,notasdauntingasexpected,everyoneisveryniceandhelpful(Inova)GoodIwasattheVAGreat!Hadtwomonthsofgeneralinpatient.Alotofhoursroundingandtalkingabouteachpatient.YouprettymuchneedtoknowEVERYTHINGaboutyourpatient.Yougetpimpedalottoo(well,dependingontheattending).IactuallythinkIgotpimpedmoreonmedicinethansurgery.TrytoseealotofEDconsultsthoughtheytakeforeverandwilltakealotofthinkingb/cit'lldefinitelyhelpyouhowtow/uapatientbasedontheirsymptoms.Ihadmedicineasmyfirstrotationanditreallysetmeupnicelyfortherestofmyyearsinceit'sreallythebasicforeverything.Wouldnotsuggestdelayingmedicinetilneartheendofyour3rdyear.IwasplacedoninpatientwardsatVCU.Iworkedfrom6AM-7PM6daysperweek.Normally,thestudentswillbeabletorotatewhostayslate,howeverIhadanM4onmyteamwhowasveryapatheticandleftearlymostdays.Ididn'tmindstayinglatebecauseIwantedtodowell,andIhadagreatteam.Ienjoyedmytimeonwards.Ididn'tenjoymedicine-it'sjustnotforme.Ididn'tlikeroundingonpatientsfor4hoursandthenspendingmoretimeafterthatwritinglongnotesoneachpatient.Imuchpreferamorehands-onapproachtomedicine,asopposedtotreatingwithmedicationandconsultingotherservicestodoprocedures.Itjustwasn'ttheserviceforme,butIknowtherearemanypeoplewholoveit.Thehourscanbelong,andoftenyouwillbesittingaroundwithoutmuchtodo,soalwayshavestudystuffwithyou(Qbankmainly).Youreallyfeellikeyouareapartoftheteam,youarerequiredtoreallythinkanditisfuntoapplyeverythingyoulearnedinthefirsttwoyearsofmedicalschoolIdidonemonthattheVAandonemonthatMCVandlovedbothinpatientexperiences.HighlightsincludeddailyMorningReportsandChiefResidentteachingsessions.Itwasprettygood-sawadecentvarietyofclassicinternalmedicinecases.IwasattheVAsothepaceisalittleslowerthanMCV,butitwasenjoyable.Steeplearningcurve.LearntopresentusingSOAPformat.Readuponallyourpatients.Knowthemedicinesyourpatientisonandwhy.Anticipatehelpingyourteam(gettingoutsiderecords,doingmedrecs,etc.).Lookupanythingyoudonotknow.Understandtheplan,thinkaboutwhatitwilltaketogetyourpatientdischarged.Itwasgruelingandmonotonousness.Intense.Hourswere6amto6:30/7pm,occasionally9pmiftherewasalateadmissionbeforethenight

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teamcameonanditwasyourturntopickupapatient.Roundsoftenlastedintotheafternoon.MyexperienceandmoodvariedDRAMATICALLYdependingontheteamIwaswith,especiallytheresidentsandattendings.Itreallyalljustdepends.MygeneralmonthwasattheVA,butIhadagreattime.Thepatientpopulationisgreat,butsometimesnursescanbeachallenge.Theresidentsareextremelyintelligentandarewillingtoteach.WehadsomeattendingsthatwerefabulousteachersaswellBusy!CCHgivesalotofopportunitiesforstudentstobeactivelyinvolvedinpatientcare.DonotexpecttohavemuchtimetostudyduringthedayonTeam3orTeam4.Asktheresidentstodevelopalistoftopicsyouwanttocoverduringthemonth/week.CoverissueslikeCHF,COPDcare.Getyourbread-and-butterdownearly.Ifyou'refree,gototheproceduresandconsultsforyourpatients.Suchagoodexperience,makesureyou'reenthusiasticandallthehardworkwillbeworthit.Generallythehoursare6am-5atMCV(7ifyouarelatethatday)andlike6-4atVAMC.Again,enthusiasmgoesalongway,trytoownyourpatients,presentaplan.Ifyoupresent1relevantarticleaweek(meaninga30secondsynopsisoftheresults)youwillbearockstar.Ihad2monthsofgeneralinpatient:no"electives".Wardmanagerteamsaregreat,fastpaced,andyougettodo/learnalot.MyVAexperiencewaslessfastpaced,andbecauseIwasonateamwith3medstudentsand2interns,therewaslessworkthatthemedstudentsgottodo.Team1-great(tough)learningexperience.Ifyou'reonawardmanagerteam(2ndyearresidents,nointerns),yougettoactmorelikeanintern-callingconsults,helpingplaceorders,etc.It'sagreatexperiencebutdoesn'tgiveyoualotoftimetostudy.IworkedbothattheVAandMCVformyin-patientexperience.Ilearnedalotfrombothsitesbutyoucantellthedifferencesbetweenthetwo.Forexample,nursingatMCVisfarsuperiorthanattheVA.GenerallytheillnessesyouseeattheVAarelessdiversethanatMCV.Bothhadgreatattendingsthatenjoyteaching.MCV-excellentWhichservicewereyouplacedinforyouronemonth"elective"month(VAED,Consults,DigestiveHealth,Heme,Onc)andhowwasyourexperience?DigestiveHealth.Theywillworkyouhardbuttheteachingisreallygoodbecauseyouhavefellowsthatjusthangaroundandhelpyoulearn.Hourswerelongbutthat'sIMingeneral.Gotthechancetodotonsofproceduresincludingmyownparacentesis.Sadpatientpopulationthough-lotsofalcoholiccirrhosis.Medconsults.Ienjoyedit.Itgaveyoutimetostudyandyougotalotoftimetoworkonyourpresentations.Consults:verygoodhours,youwillwriteatonmorefullH&Psthananyinpatientservice,canbeverybusyorslowdependingontheday,attendingshavealotoftimetoteach,andyouwillfocusonspecificproblems--manyofthemcommon(i.e.diabetes,sepsisworkup,HTN)Therewasn'tan"electivemonth"forme.HadonemonthofVAgeneralmedicineandoneatMCV.IwasplacedattheVAED.Iworked35hoursperweekeither8AM-3PMor3PM-10PMontheweekdaysplus8AM-2PMor2PM-8PMonSaturday.Therefore,Ihadatonoftimetostudy.So,Iwouldrecommenditbecausethehoursaresogood.Thatsaid,IendeduphatingtheED.TheEDattheVAisnotliketheEDatVCU.AlotofveteranstreatitlikeaPatientFirst,soyouhavetodealwithnon-emergentcomplaintsontopofthebreadandbutterIMstufflikeCOPDorCHF.Inmymonththere,Ionlysawahandfuloftrueemergencies.Also,becausethereadozendifferentattendingsthatworkthere,Ididn'tgetaconsistentexperienceasfarasexpectationsforme,theM3,andmanyoftheattendingsignorethestudents,soIreallyhadtotaketheinitiativetoseepatients.Oncology:eventhoughIdidn'tlikemedicineasawhole,Iwashappytodooncologyforamonth.The

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patientsarefantastic-theyaremuchmoreappreciativeandgratefulforyourhelp,comparedtopatientsonthegeneralwards.Imetsomeincrediblepeople,andIwashonoredtohavetheprivilegetohelptakecareofthem.Theattendingsareallfantastic,andtheyreallyappreciateenthusiasmandwillingnesstolearn.Consults(very,verychill.Mucheasierhours,roundmuchlatersoyoudon'thavetobeinuntil7-8:00AM,thenleaveearlierthanweeverleftongeneralinpatientmonth)Hematology-awesomepatientsandprofessorswithlotsofstudytime.Heme-wasawonderfulservice.Greatopportunityforlongtermcareofpatients-Ihadthesamepatientforamonthundergoingchemotherapy,whichleadtoherremissionandsheleftonmylastday.Itwasanincredibleexperience.Notasmuchtypicalinternalmedicine,butanawesomeglimpseintoHeme-OncandmanagementofLeukemias.Ihighlyrecommendit.Oncologywasagreatexperiencebecauseoftherelationshipsyoubuildwithyourpatients.Iwasoninpatientwardsforbothmonths.Iwasplacedonthehemeservice,andwhileIlovedtheservice(youreallygettoknowyourpatients,Istillkeepincontactwithone)youloseoutonamonthofgeneralmedicinethatIreallycouldhaveused.However,thehourswerelessintensesoIwasabletostudymorethanthoseIgeneralIthink.Heme-awesomeattendingsandfellowsOnc-goodexperience,fairlychillrotationcomparedtootherIMservices.Youdon'talwaysgetthebreadandbuttercasesthatareimportanttotheshelf.Trytopickuppatientsthatareinforcomplicationsrelatedtotheirdiseaseratherthanjustcominginforchemo.VAED-hoursaregreat(8a-3por3p-10p),IwaspartofthefirstgrouptodoVAEDandatthetime,nooneknewwhattheexpectationswereforthemedicalstudentssoitwasdifficulttogetmybearingattheVAED(notsureifithaschangedmuchsincethen).Theattendingschangeeverydaysoit'sdifficulttofindsomeonethatcanevaluateyou.Trytostayproactiveandaskattendingswhoyoucanseebeforepickingupapatient.Iwasfriendlywiththenursesandtowardstheend,theywouldcomepullmetoseeinterestingcases.Sincethehoursaregreat,studyasmuchasyoucanduringVAEDmonth.Tipsforsuccess:BuyPocketmedicine(littlepurplebook)andbringiteverywherewithyou.Onrounds,youcan'tlookatyourphone(wellyoucanbutit'srude)butnoonecomplainsifyoureaduponsomething.Anythingyoudon'tunderstand,readaboutaftersomeonefinishestheirpresentationandyouabsorbaton.BesidesthatIdidQbank2Xandonlinemededandscoredinhonorsrangefortheshelf.Don'tletthemfoolyou:Symptomstodiagnosisisacompletewasteoftime!!!MakeyoutimecountwithactualshelfandUSMLEpreparation,i.e.StepUptoMedicineandUSMLEWorld.DoALLoftheUworldquestionsandreallyreadthroughtheanswersorlookupthattopicinStepUp.ThendotheMKSAPquestionsandreadthroughStepUpifyouhavetime.Also,readinguponyourpatientsdiagnosesandtreatmentisaVERYvaluablewaytolearnandpreparefortheShelf.EveryonetoldmetogoallthewaythroughStepUpandUWorldbeforetheshelf.Ididabout600UWorldq'sandgot2/3ofthewaythroughStepUp,andIgota96ontheshelf.However,Ialsoreada3"binderfullofqualityreviewarticlesonvariousmedicinetopicsIneededhelpwith.Figuringoutwhatyoudon'tknowandthenlearningitismoreimportantthatgettingthroughanyparticularbookorquestionset.StepupandQbankisallthisaveragestudentneededtogetanhonorsexamscore.Workveryhardinallaspectsandshowenthusiasm.Itishardtogetanhonorsinthisrotationbecausethestarshavetoalignessentially(needtogetTscore>55inallpartsoftherotation).Cray.MakesuretogetthroughallofQbankandthenstartgoingovertheonesyou'vemissed.ThemosthighyieldsectionsinStepupareCardio,Pulm,andGIsomakesuretoreadthosetoo.Onwards,getthereat6AMforsignoutsoyouknowifanythinghappenedtoyourpatientsovernight.

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Knowthepathophysiologyofyourpatient'sdiseasestate,andknowthetreatment.Beenthusiastic,asmostoftheIMresidentsreallyliketoteach.Overall,workhard.Thestudentwhodoesn'tknowalotbutshowsupearlyanddemonstratesthattheyaretryingtolearnwilldobetteronevaluationsthanthesmartstudentwhoischeckedout.Fortheshelf,ifyoucangetthoughStep-upandUworld,youwilldofine.Studyalittlebiteveryday,thereistoomuchto'cram'attheendTaketimetoknowyourpatients-everyonecanlistfacts,butitreallystandsoutwhenyouknowdetailsaboutyourpatientslifeandcanmaketheirexperienceinthehospitalbetterTodowellontheshelf,thekeyistostudyalittlebiteveryday,anddoasmuchstudyingasyoucanwithyourfreetimeonweekends.ByreadingthroughStep-UponceandgoingthroughQbank1-2times,Iwasabletodowellontheshelf(rawscore90,t-score64).Howevertheshelfscoreisnoteverything!Todowellontheperformanceportionofthegrade,youcanreallyshinebypreparingfortheOSCE.Practice*efficient*interviewsandphysicalexamsonnewpatients,grabapartnerandrunscenariosbyeachotherfromFirstAid:Step2CS.Starttheveryfirstdaydoing44UWquestionsaday.Thiswillgiveyoutimetofinishanddowrong/marked(1400Qs).ThiswasmyprimaryresourcefortheshelfandIalsofoundtheOnlineMedEdvideostobeextremelyhelpful.Theseresourcesplusafewothers-->95onshelf.Knowyourpatientsinsideandout.Doagoodphysicalexameverydayanddon'ttakeabenignexamonedayforgranted.Helptheotherstudentsonyourteam-trytomakethemlookgoodandtheyshoulddothesameforyou.Asktositdownandtalkwiththeattendingforexpectationsforpresentationsandnotesduringthefirstweekoftheservice,andforfeedbackbeforetheygooffservice.GotoMorningReportwhenyoucan-it'sagreatlearningopportunity,anddon'tbeafraidtoparticipateandbewrong.Donottrytousetoomanyresources.FinishQbank1xandthenstartworkingontheincorrectquestions.Trytodoasmanyquestionsasyoucanwiththeverylittletimeyouhave.Beefficientwithyourdowntimeanddoquestionsifthereisnothinglefttodoonthefloor,butdon'tgettoowrappedupinstudyingduringworkhours,itwillseemlikeyou'renotasinterestedinwhat'sgoingonaroundyou.Internalmedicineislongbothinthehourseachdayandhavingitovertwomonths.Alwaysarriveearly(especiallybeforethechief)andpre-roundonyourpatients.Trytohaveatleast2-3patients,evenifit'syourfirstrotation.Theattendingsdon'tsympathizewithusifwecan'tcomeinearlyenoughtopre-roundonatleast2patientsaswewillhavemuchmuchmoreduringourfirstyearofresidency.Makesuretoalwaysbelookingupinformationonuptodateandsiteyoursourcesonyourprogressnotes.Alwaysbewillingtoaskifthereisanythingyoucanhelpwith.Listeninwhentheresidentsare"runningthelist."Thisisthebestwaytojotdownthingsthatneedtobeaccomplishedduringthedayandagreatwaytojustgogetitdonewithouthavingtobeasked,oraskingwhatneedstobedone.Ithelpsouttheresidentsandmakesforagoodevaluation.Evenifyoudon'tknowhowtodosomething,therearemanypeoplewhodo(nurses,NP,thepatientthemselves),askthem.Makesuretostudyeverydayanddon'tputitoffuntilacoupleweeksbeforetheshelf.Takeadvantageofanydowntimetostudyandreview.TheresidentslovetoteachsobesuretoaskforatopicrevieworifyouhaveanyquestionsKnowmedicationsyourpatientisonandwhytheychosethosemedications,knowantibioticregimens.OffertofaxrecordrequeststoOSH,beeagerforprocedures.Beengagedduringrounds,evenifitisnotyourpatient.Anticipatehowyoucanhelpresidents(callingconsults,gettingoldrecords,makingpatientappointments).Don'taskifyoucanhelpthemwithanythingaskifyoucandospecificthings.CanIcallMr.X'sprimarycaredocforyou?Itshowsyouwerelisteningduringroundsandthatyouareagoodteammember.Duringyourdowntime,studyallyoucan,becauseinternalisabusyserviceandwhilethematerialismostlythingsyouarefamiliarwiththevolumecanbedaunting.Qbanksisthewaytogohere.Trytogothroughthemtwiceifyoucan

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Trytobreakdownthe#questions/daysoyouhaveascheduleandalsotrytoreadCPR+GIinStepupandyoullkilltheshelf.Beorganized,takechargeofyourpatients,knowafewresourcestothrowoutonpresentationsifyoureallywanttowowyourattendings.AggressivelyQBankearlyintherotation.IusedonlinemededforreviewandtheUniversityofTexasreviewsessionthenightbeforetheshelf.UseStepUptoreadabouttheproblemsyourpatienthas-itputsthingsincontextandhelpsyoulearn.Thisisalongclerkshipwithlonghours(maybeevenworsethansurgery).Youwillroundforalongtime(3-4hours).Nomatterifyouaretired/bored,lookinterestedandtrytolearnaboutotherpatientsthatarenotyourown.Thiswayyouwillbeabletomaximizeyourlearningtime.Useyour1dayoff/weekwisely!Keepupwithqbankquestionsandanyothersourcesyou'reusingthestudy.IfoundStepUptoMedicineveryhelpfulandusedthisinconjunctionwithqbank.Trytobehelpfultoyourresidents/internsbutnottothepointwhereyouaregettingintheirway.Offertohelpmakecalls,obtainrecords,follow-upwithpatients,updatesign-out,etc.Doinglittlethingslikethatmayseemdumbandnotagooduseofyourtime,buttheresidentswillnoticeandtheywillappreciateyourhelp.Onlinemeded,Qbank,readstepupwhenyoucan.readaboutyourpatientsandtheirdiseaseprocesses.Askresidentswhatyoucanhelpwith(suchasdischargesummaries).ProvideevidencebasedmedicineorguidelinesfromUpToDateduringrounds.

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ClerkshipDirector:FidelmaRigby,M.D.,fidelma.rigby@vcuhealth.orgClerkshipCoordinator:MartaVicente,marta.vicente@vcuhealth.orgWhattowear:

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Otherresourcerecommendations:NBMEpracticeexamTrytodobothNBMEpracticeselfassessments,uwisequestionstwice,andQbankatleastonce.INOVAsimulationsarewonderfulandreallyhelpful.WatchOnlineMedEd.comvideos.Ididthose3x,uWorld2x,andUWise1.5x-didverywellontheshelf.Ididn'treadtheOB@aGlikeothersandwasjustfinewithoutit.onlinemededIfyouwenttoRiversideorINOVA,howwasyourexperienceatthesesites?DoALLoftheUWisequestions,readCaseFiles,andthendotheUworldquestionsifyouhavetime.ThequizzesandteachingsessionsatMCVarealsosupervaluableandcoverhighyieldtopics.CheckouttheACOGpracticebulletins.Thesearehelpfulonthewardsandontheshelf.IreallydislikedUwiseanddidn'tfindithelpful.Stickwithpretestandcasefiles!Riverside-AMAZING.Highlyhighlyrecommend.IwasatINOVA.Therewasadichotomybetweentheattitudesoftheattendingsandthoseoftheresidents.EveryattendingIworkedwithwassmart,enthusiastic,andexcitedtoteach.MostoftheresidentsIworkedwithwereburnt-outandignoredthestudents.Ifyoucandealwithbadresidents,thenINOVAisprobablyworthitbecauseyougettobemoreinvolvedinpatient'scare(deliverababy,scrubintoalotofsurgeries).Also,theINOVAOBGYNcurriculumisveryheavywithdidactics.Ientiredayperweekisdedicatedtolectures.Ifyoulearnbydoing,andnotbylisteningtosomeoneteach,thisisamajordownsidetodoingOBGYNatINOVA.INOVA(veryveryvaluableexperiencetogotoaprivatehospitalandseethatenvironmentduringthisstageintraining,thefacultyisveryenthusiasticandreadyandwillingtoteach,theinternsarealsowillingtoteach,thespacewaskindofcrowdedbuthopefullythatwillbesolvedwiththeirmovetothenewbuildingintheJanuary2016.)INOVAisincrediblybusy.IwenttoINOVAanditwasawesome.MuchmorehandsonfromwhatitsoundslikefromVCUstudents,greatbeforesurgeryfortechnicalskills.INOVA-GREATROTATION,highlyrecommendittoanyonethinkingaboutit.givesexperienceofadifferenthospital/differentcomputersystem.Attendingsareallveryapproachableandwillingtoteach.INOVA:Bestexperienceever.Thefacultyandresidentsarefantastic.Justbeproactiveandyou'llgettodolostofdeliveriesandprocedures.INOVA-amazing!suchwellrancourseinInova.Willdo2weeksofOB,2weeksofgyn(urogyn,benigngynorgynonc),1weekatInovaCaresClinic(lowincomeclinic)and1weekinantepartum/highriskpregnancies.excellentrotation,busyhospital,highlyrecommend!Housingprovidedatanextendedstaythatis10minwalkingdistancefromthehospital.Whichserviceswereyouplacedin(antepartum,FamilyPlanning,Gyn,NightFloat,Onc,REI,PlannedParenthood)andhowwasyourexperience?Riverside.BenignGynwasgreat.Antepartumseemedlessorganized.Gyn/oncwascoolbutnotmanysurgeries.Ihad2or3perweek.Thesurgeonsdon'treallyexpectmuchfromyouandwon'taskyoumanyquestions.AlotofthemareroboticssinceDr.Carterusesit.L&Dnightfloatishardb/cyouobviouslyhavetochangeyoursleepingschedulefortwoweeksandyouworkmorehoursthandayshift.Apparentlyit'smorechillthanthedayshiftbuteventhenitwasprettystressful.I

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didn'tlikeL&Dthatmuch.Theatmosphereisprettystressfulandyouhavetobeonanalertallthetimeevenifnotmuchisgoingon.AntepartumatINOVAisawasteoftime.Youtableroundfor2hoursinthemorning,thenyousitaroundfortherestoftheday.GYNatINOVAwasagoodexperience;howevertheresidentsdon'tletthestudentsseepatientsontheirown,whichwasstrangetome.Eveniftheyhadahandfulofconsultstosee,theyinsistedthatwegoseepatientstogether.Therefore,weendedupshadowingmostofthetime.Iunderstandwantingtoexaminethepatientjustonce,butIcouldhavetakenahistoryortwo.STRONGLYrecommendPlannedParenthood,ifyouarecomfortablegoingthere.Ihadanamazingexperiencethere-thestaffwereallsofriendlyandwillingtoteachmewhateverIwascuriousabout.Iwastheonlymedicalstudentthere,whichallowedmetogainsomuchhands-onexperience-muchmorethananyonewhowasonantepartumatMCV.NightFloatwasalsoafantasticexperience.Wedidn'thaveanOBinternontheteamwithus,sowegottodoalotmorethanthedayL&Dstudentsdid.Iwasabletodeliverababyonmyown(withtheresidentrightbesidemeofcourse).TheresidentswereverywillingtoteachandletmedoasmuchasIwanted,especiallybecauseIexpressedinterestingoingintoOB.GynOnc:weonlyhadacouplepatientsthewhole2weeksIwasthere,soIdidn'tgetasmuchhands-onIexperienceasIwashoping.Buttheresidentswerefantasticaboutteachingusandtakingtimetogooverimportanttopicswithus.L&D2weeks,Antepartum1week,UroGyn2weeks,Ambulatory1weekGyn-servicethatvariesquiteabit,maybeverybusyormaybequiteslowbutcasesareinterestingandtypicallyontheshorterside.Muchmorelikeageneralsurgeryserviceintermsofyourresponsibilities.PlannedParenthood-goodexperience,startsoffslowasprovidersgettoknowyoubutyouseealotandgetgoodatdoingpelvicexams.L&D-whodoesn'tlovebabiesbeingborn:)OverallIfoundthatmyexperiencelargelydependedontheresidentteamIwaswithsokeepthatinmindwhenaskingfriendsaboutwhichservicestheyenjoyed;thepeoplemaketheexperience.Antepartum-dependsonresidentyourworkingwith,mostareverynice!REI-greatlearningexperience,prettysuredr.lucidigiveseveryonethesamegradethoughsokeepthatinmindNightfloat-morechillthandaytime,butagoodexperiencenonetheless,ithinkyougettoknowtheresidentsbetterthiswayAntepartumistoocrowded-theyarelookingtohopefullyexpandmoresitessothisislessofaproblem.It'shardtofindyourplaceinclinicthere.NightFloatwasamazingforL&D.Icaught5babiesandgottohelpwithmanymoredeliveries.Hoursarerough,butwastotallyworthitintheend.BenignGynwasagoodservice-therewerenotenoughcasestohaveafullschedule-somultiplestudentswentto1case.Surgeriesrarelygobeyond4hours,whicharenice.Only1-2patientsperstudentgenerallyontheservice.Antepartumdidn'thavealotofpatients.Ifyouwantmoresurgery,pickbenignGYNoverGYNOnc.REIisgreat.Antepartumwasgoodbecauseyougottoseeavarietyofthings,butitwasaverychaoticandsometimesfrustratingschedule.Gynwasagoodservicebecauseyoucouldreallygetinvolvedandbehelpful.Gyn,laboranddeliveryREIwithLucidiisawesome.Antepartum-chill,variety;L+D-busy,greatlearningenvironment,activeinpatientcare;GynOnc-fantasticattendings,lotsofclinictimebutbepreparedtoshadowalot...REIisthebest,highlyrecommended.Antepartum:GreattoseetheintersectionofmedicineandOB/GYN.Greatplacetositandtalktoyourpatients,astheyareoftenstressedabouttheirhigh-riskpregnancy.Gyn:Getgoodatknowingyourbread-and-butterpelvicanatomy.Onc:Thecasescanbelong.NightFloat-IdidthisspecificallysoIcoulddelivermorebabies.Duringmy2weeksIsaw2vaginalbirthsand1emergentC-Section.Thereissimplynowaytopredictwhenwomenaregoingtogivebirth...

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it'skindoftheluckofthedraw.NightfloatL&Dwasgreat.Therearen'tmanypeoplearoundatnight,espintheteamroomsothereismoreroomforstudentstowork.BenignGynwasahitormissforsomestudents.WhenIwasonservice,wehadmax6surgeriesovertwoweeksfor4studentstosplitup...needlesstosayitwasaslowservice.2weeksatplannedparenthoodisanamazingexperience,evenifyouareagainstwhatPPoffersintermsoftheirservices.IgotanexcellentoutpatientexperienceatPP,IwasfullycomfortablewithdoingpelvicexamsduetomytimeatPP.L&Dnightsisawesome!Youworksslightlylongerhoursbutyou'remorelikelytodeliverababy.ItcanbehardertoseeC-sectionsunlessthey'restat.Tipsforsuccess:ThekeytosuccessistoshowenthusiasmandgotoRiversideifyoucan.TakesurgeryfirstifyouwanttofeelcomfortableintheOB-GYNOR.L&Dcanbeoneofthemostexcitinganddrainingpartsofthirdyear.Trytostaybusy,keepcheckingonyourpatientsandtheboard,triageefficiently,andhelpoutwithpaperworkandrecordrequests.Thisshelfwasoneofthemorestraightforwardones,andIfounduWISEveryhelpful.GothroughCasefiles,Uwise,andQbankmultipletimes.Ifyougothroughallthoseatleasttwiceyouwilldowell.Usebeckmantocompletetheweeklyassignmentsbutfornothingelse.DouWise2xthrough,andreadbothCaseFilesandOBataGlance.CaseFilesisgoodtostartwithtogetagoodbase,andthenOBataGlancecanhelpfillinthegapsandprovidealittlemoredetail.Bepresentandenthusiastic,evenifyoudon'twanttodoOB--thismightbetheonlytimeyouhavetheopportunitytohelpdeliverababy,soenjoyitandappreciateit!nightfloat;getsincrediblytiringbutyougettodothemost!iliterallydelivered8babies(6bymyself)andpracticedvaginallacrepairsaswell.Sincethereisnonightinterninthefallyouareessentiallytheinternandyougetalotoffirsthandexperience.worththehardwork!gynonc:lovedmyexperience.ifyouloveminimallyinvasivesurgerythisistheplacetobe.antepartum:worthittodoattheendoftherotation.youhaveaLOTofdowntimetostudyfortheshelf!StudyUwiseandfindtheCBCanswerkeys.Studybroadly.TheOBshelfhasalimitednumberoftopicsthatwillbehitineveryreviewresource,buttherewillbe5-10zebrasaswell.Greaterbreadthwillgiveyoubetterchancesofhearingofsomething.beyourpatient'sadvocate,theshelfismorestraightforwardbuthardtodoreallywellonsomoreimportantisgettingbetterevalsItseemedlikealotdependedonhowyougotalongwiththeresidents.Trytobeengaged,helpful,andfriendly,butbecarefulnottoannoythemorgetontheirbadsides.Basically,ifyouworkhardandtrytomaketheirliveseasierinsteadofharder,youwillhaveabettertimeandprobablygetbetterevaluations.Payattentiontothisadvice.DONOTuseanythingbesidesUWiseandcasefiles.Itisallyouneed.Gothrougheachoneatleast2xandyouwillbesetfortheshelf.Passeditwithflyingcolorsandthat'sallIdid.Dr.Rigbywilltryandforceataglanceonyou,butitiscompletelyuseless.Also,ifyouhavetime,douworldjusttokeepupwithitduringtheyear,butitalsoisnotindicativeoftheshelf.OB/GYNisaverytoughrotationasthepersonalitiesaredifferentthananyotherrotation.Trytokeepalevelheadandgoineachdaywithasmile.Yourevalsareveryteamdependentandwilljustbeluckofthedraw.carefulwithuWISE.notasuptodateasotherresources.Sameasforotherrotations,offertodospecificthingstobehelpful,don'tjustaskthegeneric"isthereanythingIcandotohelp?"Ithelpstohavespecifictasksinmind.Also,thepresentationsinOBGYNaresimilartothoseinsurgery.Theydon'twantallthefluffyou'dexpectoutofanIMpresentation,sobesuccinctandhitthehighpoints.Ifyoucandevelopagoodwaytodothatandmoveefficiently,you'llbegolden.MakesureyouarefamiliarwiththeUwisequestionssincetheyarethemosthelpfulfortheshelf.

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HierarchyisveryobviousintheOb/Gyndepartmenthere.Don'ttakethingspersonally.Beinvolvedinpatientcare-showthatyouwanttolearnandyouwillcreateopportunitiesforyourselfasthe6weeksgoby.SpendtimeonyourpresentationforDr.Rigby.Definitelydotheextracreditassignmentandbecreativewithit.Don'tgossipwith(orabout)theresidents.IreadAtAGlancemultipletimesanddidtheuwisequestionsandscoredverywellontheshelfexam.AtAGlancehastoomuchdetail(intermsofstagingofcancers,specificprocedures)butgenerallyisverythoroughandabetterchoicethanbeckmann(thesuggestedtext).GotoDr.Ribgy'sreviewsessionthedaybeforetheexam:itissuperhighyieldandmyshelfhadatleast3-4questionsthatcamedirectlyfromthatexamreview.

Ambulatory

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ClerkshipDirector:BennettLee,M.D.,bennett.lee@vcuhealth.orgClerkshipCoordinator:N/Aasof04/14/2016INOVAClerkshipDirector:CarolynF.Davis,M.D.,carolyn.davis@inova.orgINOVAClerkshipCoordinator:MollyHobbs,molly.hobbs@inova.orgWhattowear?

*NoshelfexamfortheAmbulatoryrotation*Didyouneedtouseanyparticularresourcetodowellinthisclerkship?NoNope.EnjoyyourfreetimeNoNo,justshowupandworkhardIwasplacedinthevascularclinic.Iboughtandread"InterventionalRadiology:ASurvivalGuide"sothatIwouldhaveanideaofwhattheyweredoing,butthiswasnotnecessary.nope.justshowinterestDependingonwhereyourrotationisandhowearlyitisintheyear,it'shelpfultodosomereviewingofbasicoutpatientmedicinebywatchingmed-u.orgvideos(e.g.HTN,DMmanagement,COPD,etc.).NodidtheENTambulatoryclerkshipShowup,enjoy.Notreally,thereisnoshelfexamanditispass/fail.Thereareafewassignments/groupmeetingsbutDr.Leedoesagreatjobmakingitfunandengaging.Ienjoyedthisclerkshiptremendously.No.

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Creativityandexcitement.NADANOWhatamIexpectedtodo?PACEClinic-seepatients,readextramaterials.Usethistocatchuponsomeofyourothereducationalrequirements(i.e.PPSpapers,etc)Patientinterviewsandworking/learningaboutamultidisciplinaryteam.Bepunctualandwantingtolearn.Showup,workhardandbeeagertolearnShowup.outpatientclinicsIshadowedalot,butI'msureifIhadasked,attendingswouldhavebeenmorewillingtoletmeseepatientsonmyown.Justaskyourpreceptortheirexpectations.DependsnotawholelotVerydependentonyoursite.DependsontheserviceyouareonShowupandcompleteassignmentsForENTambulatoryclerkship,showupandbeenthusiastic.Readthebookthattheygiveyouandlearnasmuchaspossible.Whateverisaskedofyou.Itdependsonyoursite.ForGeneralMedicineACC2clinics,hourswere7:30AMto5ishPM.Yourotatethroughseveraldifferentclinics,butallintheACC.Formostclinics,youareexpectedtoseethepatientaloneandthenpresenttotheresidentand/ortheattending.Youneedtopresentwithaclearassessmentandplanaswellasdifferentialdiagnoses.Youareexpectedtowritenotesonthepatientsandsendthemtotheresident/attendingforfeedback.Forsomeclinics(diabeteseducationandclinicalpsychology),youjustshadow.Theteamsareveryinterdisciplinary,solearntoworkwellwiththemandlearnhowtousetheirskills.Showup,learnaboutwhateverclinicyouarerotatingin,behelpfulShowupanddowhatevertheytellyou.Takeadvantageofthesparetimetogettherestofyourlifeinorder.Getexperienceinwhateveryouwanttodo.Mostlyobserving/shadowing,someH&PsJustshowupeverydayandbeinterested.Seeasmanypatientsasyoucan,learnhowtopresentandwritenotes.Goodout-patientexperience.Similartofamilymedicine.LotsofHPIs.Tipsforsuccess:HavetopicsyouwanttogooverBeproactiveaboutdoingthings.BeveryrespectfultotheotherhealthcareprofessionalsontheteamEnjoythismonth,butreadandlearnasmuchasyoucanwhileyou'reonit.Ambulatoryisbasicallyanelectivemonth.Picksomethinginwhichyoumightbeinterestedinacareer.Smile

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AlthoughyoucanpasswithminimaleffortinAmbulatory,thisrotationisdefinitelyonewhereyougetbackwhatyouputin.Itisagreatopportunityfor:learningaboutthemanywayshealthcareisbeingprovided,buildingagoodrelationshipwithyourpreceptor(sincemorethanlikelyyou'llbetheonlystudentatasite),refiningyournote-writingskills,andusingtheWeeklyReflectionsandFinalProjectasgreatcreativeoutlet.Enjoythisrelaxedrotation,buttrytotaketherotationseriously.Justenjoythe4weeks-lowstressBepresent,read,haveanopenmind.Easiestrotation.Minimaleffortrequired.OutpatientENTwasfun,easy,andyougettoplaywiththecooltoys.Short20questionquizattheend.Expectalotofself-reflectionandfeedbackduringthisrotation.Don'tblowitoff,itiswhatyoumakeofit.Showupanduseyourbrain.It'sasimpleservice.Turnyourassignmentsinontime.Don'tjustcheckout.Itmaybepass/fail,butyoustillneedthatpass.There'snoshelforanythingbutthereareafewprojectsyoudoingroupsalongtheway.Getyourstuffdoneontime.Walkintheparkhere.Considerputtingthisblocktowardstheendofyouryearwhenyouhavealotof4thyearplanningtodo.Justgetexcitedeachday!You'vegotnothingtostudy,andit'sjustforgreatexperiencereallyjustshowuptoyourserviceandyou'llpasstheclerkship.

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RecommendedresourcestostudyforStep2*:

*Note:thenumberofrespondentsforthissectionismuchlowerthanforothersections.Therefore,taketheaboverecommendationswithagrainofsalt,andmakesuretoconsultothersourcesforthebestStep2resourcesforyou.Otherresourcerecommendations:MastertheBoards(KaplanserieswithConradFisher)-discoveredthisbooknearlyhalfwaythroughmystudyperiodandwishIhadditchedFAStep2CKmuchearlierandjustfocusedonthisbook.Itisamucheasierreadwithgreattest-takingtipsandstrategiesforworkingthroughdifferentials.ThisbookincombinationwithUWorldquestions+/-Secretswouldbeastrongcombination--definitelyputmoreemphasisonUWthananytextthough!!Asadisclaimerforthistext,youmayneedtosupplementweakersectionswithamoredetailedresourceasthisonecanbebare-bones/asimpleoutlinethat'smuchmoreusefulifyoualreadyhaveasolidfoundation.Comments:Haven'tstudiedforthisyet!Iusedstepuptostep2andIregretit.Didnotlikethisbook,IglancedatCrushinthelastdaysbeforemyexamandIfeelitwouldhavebeenaresourcehadIstarteditearlier.Doasmanyquestionsasyoucan,allthestep2uworldATLEASTonce.Stepuptomedicineisaprettygoodresourceaswellasmostofstep2isinternalmed.UsingStepUptoMedicineasmymainsourceandsupplementedwithspecificclerkshipbooksparticularlyforPedsandNeurosinceIhadthoseatthebeginningofM3andtheyweren'tasfreshinmymind

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HowmuchstudytimedidyouallowyourselftoprepareforStep2CK?3weeks2weeks14fulldaysof4hoursreadingthen7hoursquestions(withabreakfordinner)14days,8-10hoursaday16days13days10days2and1/2weeks2.5weeks3-4weeksAnythingyouwishyoustudiedmore?WishIhaddonemoreUSMLEworldQbankquestions.Itsalotofinternalmedicine.Focusoninternalmedicine.MedicineOB/GYNIgotasurprisingamountofroutememorizationquestionsthatIthoughtweremorestep1style.NopeSpentmoretimeonQBank,lesstimewithreviewbooks.OB/GYN,Peds(croupvs.epiglottitisvs.thoseothercommonrespiratorypresentations)NoAnythingyouwishyoustudiedless?Surgery,Neuro,NothingFirstAidwasn'tawesomeNopeNeurologyAnythingaboutyourapproachthatwasprofitable?Getthroughuworldtwice.Oncethroughtheyear,onemoretimebeforetheexam.USMLEworldQbankDolotsofquestions.Halfofmytimewasquestions~200aday.QuestionseverydayNopeThelast4-5days,Iforcedmyselftoclosethebooksandcampedoutwithmylaptopdoingsetsof44.Igraduallyworkedupfromanunimpressive3-4setsof44inadayto6-8setsof44,whichhelpedbuildmystaminaonthedayoftherealexam.You'llfindthattheknowledgecomponentbecomeslessimportantthanTEST-TAKINGSTAMINAandMENTALFORTITUDEthatwillpullyouthroughtheactualtestdaywhenyoutrudgethroughall352ofthosequestions.Ialsosuggesttestdaypacingwithfront-

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loadinginpreparationfortheexhaustionthatinevitablysetsinafterthat5thor6thset.IstartedoffenergeticintheAManddid4setstraight,hadaquicklunch/snack,then3,thenfinishedoffwith1lastset.Alternatively,4-2-2workswellalso.FocusingwhilestudyingandtakingbreakswhenIneededthem.Anythingaboutyourapproachthatwasamistake?IwishihadgonethroughStepUptomedicineagainbecausetherewassomuchmedicineonit.Ihopenotbut,possiblytryingtodotoomanyquestionseachday.ItmayhaverushedmewhenIwasreadingtheanswers.YouknowwhatyouknowandintheendIfeltwhatIstudiedhelpedmebutdidnothelpmytesting.IletbookslikeFA,Secretsandalltheotheronesouttheredistractmefromwhatshouldhavebeenmymainfocus:UWorldQBank!!However,makesureyou'renotansweringquestionsoutofmemory,asopposedtocomprehension/understanding,whenyoustartgettingrepeatquestions.WatchoutforthoseQsthatyouimmediatelyrecognizeafterreadingthefirstfewwordsorfromtheimagingprovided.Notonlyareyouwastingtime,butthiscanbuildafalsesenseofsecurity/confidenceinthematerialandyourtimemanagement.Becomfortableinyourpreparationunveilingyourweaknessesandworkingtocorrectthesedeficits.IallowedtoomuchtimetostudyHowdidyouprepareforStep2CS?FirstAidisallyouneed.Justreadthesamplecase/notesinthebackofthebookonceortwiceandyou'llbefine.UworldandstepuptomedicineReviewedquickcasesduringthe2dayspriortotakingthetest,takingtheIMclinicalskillsexam.FASkimmedFirstaidforCSthedaybeforeKnowthedifferentialsforchiefcomplaints.Everythingelsewillcomenaturally.Theyprepareuswellforthiswiththeosces.ReadFirstAidStep2CSskimmedfirstaidthedaybeforeGlancedatFirstAid...Ibarelyprepped.NonchalantlyflippedthroughFAforStep2CSthedayprior.Inretrospect,wishIhadtalkedmorewithmyfriendswhohadalreadytakenittogetafirst-handaccountofthegeneralsetupandmechanicsoftheday.Iprobablywillgetawaywithmyminimalprep(sinceIamanativeEnglishspeaker--fingerscrossed)butIwouldprobablytrytogiveFAamoredecentglance-throughfor1-2daysbeforeattheminimum.DefinitelydidntworryaboutthisonemuchasitwasimmediatelyaftermyCKexam(inthesameweek,notagoodidea)andIwassufficientlyburntout.ReadFirstaidwithStepuptoMedicineasareferencewhenIneededit.DidallofQbankoveragainandgotthroughmanyofthequestionsIgotwrongasecondtime.BrowsedFirstAidforCStheweekbeforeandtheOSCEsthroughoutM3.ReallynotmuchpreparationneededexceptthefirstpartofFirstAid,whichtellsyouthenutsandboltsoftheexamfromalogisticalperspective.Firstaid

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HowmuchtimedidyouallowyourselftoprepareforUSMLEStep2CS?2days1weekOneweek,IusedtheFirstAidStep2CSanditwasabreeze!2days.Itwastwiceasmuchasneeded.3weeksWorkshopweek2hoursDiditduringarotation.Gavemyselfacoupleeveningsorreview.<24hours4hoursReadforabout1hour.<1dayafewdays3days

(Your)Notes