Returning to Clinics - Student Advice
Student to Student Advice from the MuDPhuD Class of 2008
We (members of the MD-PhD class of 2008) surveyed Penn MuDPhuDs who returned to the clinics and survived! We have provided below their answers to the most frequently asked questions (Note: everyone is different, and though there are common themes in this advice, no one strategy works for everyone. Pick and choose as you will, and seek advice liberally!)
1. What general advice do you have for someone returning to the clinics?
- I think the most important thing to note is that the medical class you are rejoining don't know as much as you think they do. I have regularly found that we ALL get lost in the hospital and don't know stuff. So don't feel too anxious. The "getting back to clinics" list that you should have received from Maria Hernandez should be followed religiously, however (and keep a copy of your PPD clearance so you can get a Presby ID if you need one). (Melissa Middleton)
- Don't be afraid. Although you might feel you don't know anything, the medical students don't necessarily know more. I came back during the second half of clinical year and survived. You definitely feel "rusty" and it took me a while to get back into the rhythm of presenting…Let people know you are a returning PhD. It usually impresses them, and, I think, makes them a bit more compassionate. (Mike Buckstein)
- Read a lot. I also thought the intro back to clinics course (which for me was two weeks at Pennsy) was great for helping me get back into things. (Joanne Jang)
- Relax. You know more than you think you do. I'm sure your PhD experience has exploded the myth of authority so apply that to the medical hierarchy. On the other hand, don’t be cocky...you are a bit rusty. :) Most importantly be earnest and diligent. You might have already picked out a specialty...great for you. So if you definitely know you're going to apply and specialize in X then look at all the other clerkships and electives as your first, last and only chance to deliver a baby, be inside the abdomen, try to make sense of a floridly crazy person, etc. Learn as much as you can. At least be open to the idea of trying a new specialty. (John Northrop)
- Don’t stress too much. After the first block, you will be fine. If you can, try to review a bit before coming back, but it is not essential. If I had to do the transition over again, I would have read the First Aid Guide to the Clinics and Bates. Alas, I had no time, and was fine without it. You forget a lot during your absence from the clinics, but just remember that your medical student colleagues are also learning everything for the first time. Besides, occasionally medical students (such as yourself) will know more on a particular topic than interns and residents on the team. (Dasha Babushok)
2. How did you refresh your history/physical exam skills?
- Review the Bates history & physical examination pocketbook. Practice percussing and listening to your own heart for the S2 split and whatnot. Definitely try to do a warm-up, if you can, and practice H&P and presentation skills in real time. (M.M.)
- Did clinical connections - didn't help that much. Used Bates when I had a specific question (not particularly helpful) (M.B.)
- Just by skimming that history and physical book and by doing that 2-week refresher course at Pennsy. (J.J.)
- Clinical connections. Great experience. (J.N.)
- I looked through my medical school notes and looked at a few sections of Bates. It comes back with practice. The good (but also scary and bad!) thing is that nobody really sees or checks your physical exam skills when you are running around in the wards. So you will make mistakes, but it will be ok, if you just know your limitations and keep practicing.(D.B.)
3. Did you carry a PDA? What do you think is essential to go in your white coat?
- I decided to just go with a book, etc for the first block so I could figure out what would eventually work best for me. I ended up getting a Palm TX. If you get a PDA, remember that Penn has a wireless system that you can get into, so it might be worth getting a Palm TX (popular right now) or something else with Wi-fi so you can surf on the net if you need to. I couldn't survive without my Maxwell's. Sadly, I forgot all those little diagrams for CBC and Panel 5 (remember the electrolyte panel?) and how to write a note, etc, so the little front pocket Maxwell's available at Dolbey's was a godsend. Also, a little notebook to write stuff down and multiple pens. (M.M.)
- No PDA - we are still the old-timer generation. I didn't even buy that little blue medicine back (even for my sub-I) and I did just fine. (M.B.)
- I did not have a PDA - there are computers everywhere so I don't think this is at all essential. It can occasionally be helpful, but I honestly think it's rare. Essential - that little orange, white and purple book with normal lab values, H&P, etc. Also the little blue manual that every intern and resident has. And of course your stethoscope. (J.J.)
- Nope. My palm m505 was out of date and couldnt even run the new free Epocrates, let alone the kickass version they give us from the medschool. I carried little to nothing, but get Sabatine's lil book--there's a new edition this past year and it's great. Plus all the residents have it. (J.N)
- I decided against the PDA. I had Maxwell’s, the MGH handbook (small, ring-bound pocketbook, everyone has it now), Pharmacopeia, and, sometimes, a rotation-specific book. For surgery, carry Surgical Recall. (D.B.)
4. What do you wish you'd known/remembered prior to returning?
- The SOM transportation system for HUP, Presby, Pennsy, and the VA, where they will pick up you anywhere between 8th and 48th street and drop you off at your clinical site early in the morning for $2 vouchers. I spent the first 2 weeks with transportation hassles before getting hooked into this system, and recommend it over driving. You can get these vouchers from Suite 100 (Maria Hernandez). Away sites should have ample parking. (M.M.)
- I wish I had studied more before I left for the PhD! (M.B.)
- More about different drugs, and infectious diseases. (J.J.)
- THAT could fill a book. Most of it came back. What i should've worried more about was preparing my presentations. Focus on your presentation skills above all else, that's what you're graded on. (J.N.)
- Oh, many many things! Medical knowledge, presentation skills, physical exam skills, procedure skills! But, in retrospect, none of them proved essential to know prior to returning. In fact, residents are still learning that stuff themselves! (D.B.)
5. What did you worry about too much?
- Not knowing enough. Medicine is kinda like riding a bike and you will quickly catch on again.
- Not knowing the basic information. (M.B.)
- Remembering the H&P - you do need to brush up, but it comes back to you pretty fast in the clinics. (J.J.)
- The hours and the med Sub-I. (J.N.)
- Lack of procedure skills. You learn what you need quickly once you do it, and being super at blood draws and IVs is really not as important as I fretted about. (D.B.)
6. What was the hardest part about returning to the clinics?
- One of the hardest things for me going back was taking "the game" seriously. The lab was the closest thing I had to a real job with real responsibility, and it is hard going backwards. It has helped me in clinics because I am always seeking out a role, but it can be very frustrating not to find that role as a lowly medical student. (M.M.)
- Vaguely remembering things you learned about years before but not being able to recall the terms or speak about them intelligently. That is what being in the clinics is all about! i don't know if there is any remedy for this. (M.B.)
- The schedule. I was used to my PhD schedule - although I worked just as hard (if not harder) during my PhD years, my schedule was much more flexible. (J.J.)
- Being back on the bottom of the heap and the pony show that is the clinics, particularly after being independent for several years in my lab. (J.N.)
- It is a humbling experience to come back to the wards, where you know very little, after having been an expert in your field in your PhD years.(D.B.)
7. Did you do a warm-up course? Did it help?
- I did the Family Medicine on Fridays things for a month. It was a nice transition, no stress, and I re-learned a lot of basic stuff that proved to be useful. I highly recommend it. (M.M.)
- No - I didn't have time. (M.B.)
- yes – [it helped] immensely (J.J.)
- Clinical Connections, not the Pennsy one. It helped for confidence and nerves, but questionable for helping with the skills and stuff. (J.N.)
- I did a two-week Pennsy med refresher course, which helped a little bit. I would still recommend taking it, as it gives you a chance to review physical exam skills, presentation skills, and a bit of medicine. (D.B.)
8. To what degree did you leave the lab after returning to the clinics?
- I kept my old desk, often go by, and am still working on a paper with my PI. Thus far there has been ample time for this. (M.M.)
- Still had papers pending - now, a year later, they are finally getting published. It's doable but I would not recommend it. (M.B.)
- 100%. I think that was good. (J.J.)
- Still trying to get a paper out but haven’t gone back to the bench. (J.N.)
- I had my space at the lab for a few months. When I was on campus, I stopped by to see everyone pretty often. I was still finishing up my manuscripts for about 8 months after my official return to the clinics.(D.B.)
9. How did you end up choosing a specialty?
- I did clinical connections a few times, which helped me eliminate some possibilities. I also used AAMC Careers in Medicine you can get a personal code from Helene Weinberg or Barb Wagner. Most importantly, I went with my gut and thought hard about how to integrate my most favorite clinical activities with my favorite aspects of research. (M.M.)
- I had heard about RadOnc as a great field for bridging research and medicine with a doable lifestyle. Did a rotation early in January (which is one of the luxuries of being md/phd) and loved it. Had lots of extra time to do some research in the department to get really familiar with it. (M.B.)
- Recommendation by my thesis committee advisor to follow an attending in this specialty around for a while during my PhD years. This was part of Clinical Connections and was very helpful for me. (J.J.)
- Picked based on the principle that I wanted to use both degrees and figured which specialty would have the best day to day experiences, best research opportunities and most rewarding clinical work. (J.N.)
- I liked several specialties, but felt that I derived the most satisfaction from longitudinal care of adult patients. I also thought that internal medicine (and, probably, hematology-oncology) would fit best with my research interests. (D.B.)
RECOMMENDED BOOKS
- First Aid Guide to the Clinics: very useful, starts from scratch
- Bates Physical Exam: review the basics!
- Lange Case Files Series: active learning for those not used to memorizing off a textbook.
- Many other recommendations and useful info from Guide to the Clinics, under online resources.
RECOMMENDED ONLINE RESOURCES
AAMC Careers in Medicine: (http://www.aamc.org/students/cim/)
Get help with choosing a specialty
Access Medicine: (http://www.accessmedicine.com/home.aspx)
It has numerous texts and most importantly a Lange question bank for USMLE1/2/3 prep. You can pick by clinical subspecialty and the step 2 questions were invaluable prep for the SHELF exams. Plus it's all FREEEEEEE.
Auscultation Assistant: (http://www.med.ucla.edu/wilkes/intro.html)
Review the pathophysiology and sounds of murmurs, rubs, etc
BioMed Library Website: (http://www.library.upenn.edu/biomed/)
Tons of clinical resources!
Guide to the Clinics: (http://www.med.upenn.edu/penn/student/documents/survivalguidetotheclinics.pdf?websec_token=63d96fd4fce11e61defac3f3ed98fc46)The MSG guide to the clinics, with lots of useful info for each clerkship and in general!
Knot-tying and suturing videos: (http://www.bumc.bu.edu/Dept/Content.aspx?DepartmentID=69&PageID=5914)
Be a whiz in the OR!
MedCalc: (http://medcalc.med-ia.net/)
Well-done medical calculator designed for rapid calculation of common equations used in internal medicine.
Medical Mnemonics: (http://www.medicalmnemonics.com/)
Not used to memorizing? Use a mnemonic!
Microbiology sing-along: (http://www.melissamiddleton.com/microbio/)
Loved the songs in Dr. Helen Davies Microbiology class? Not sure of the words anymore and need a fun way to remember your bugs? Fear not - this website has a compilation of her songs with their intended beats!
Radiology tutorial: (http://www.med-ed.virginia.edu/courses/rad/)
Re-orient yourself to the radiograph!
SkillStat: (http://www.skillstat.com/ECGskills.htm)
Practice reading EKGs, ACLS, etc
UpToDate: (http://www.uptodateonline.com/utd/content/search.do)
The gold standard in medical info online