RETURNING TO CLINICS resources
Coming back to clinics after defending your dissertation is a big transition. This site includes:
- General guidelines about timing
- Recommended reading and study resources
- Clinical activities and refresher options
- Other resources and sources of advice
GENERAL TIMING GUIDELINES
One of the most commonly asked questions is “when do I need to defend if I want to graduate the following year?” The answer to this is different for different students. If you are unsure of what field you want to go into and/or did not have strong clinical grades before you started the PhD and/or are going into an especially competitive field and want time to do an additional research project in that area and/or are choosing an early match field, you may need to defend in August or September of the year before you graduate. (For instance, Aug-Sept of 2012 to graduate in May of 2014). On the other hand, if you know what you’d like to go into and did well in clinics before the PhD, returning in November of the year before you graduate might be optimal. If you do not plan to do a residency, an even later defense is fine. Doing Clinical Connections and seeking out other opportunities to help you refine your career goals can make a huge difference in lessening the stress and time constraints when you return. Maggie meets individually with everyone to discuss their return options/plans.
RECOMMENDED READING / STUDY RESOURCES
Doing occasional clinical reading - or listening to podcasts or attending departmental Grand Rounds, etc - during your thesis can be helpful for keeping in touch with your clinical skills and knowledge. It's definitely wise to make time for clinical reading and study toward the end of your thesis, and, if possible, to build in a week or more of full time study before starting the refresher course. It's helpful to study both core clinical topics and also material that is specifically relevant to your first clerkship back. Suggested resources include:
- Differential Diagnosis lectures (MD 305) via Virtual Curriculum - there are about 8 case study lectures which are helpful for review plus an extensive syllabus - (if the timing in December works with your return schedule, you can also simply attend the course)
- MED 200 didactic session on Oral Presentation via Virtual Curriculum (dated 7/12/10 on VC); this is a lecture on how to present a patient that was specifically added to VC in order to be available to returning MD-PhDs
- Med U – web based tools with bread and butter cases that can teach core knowledge and clinical problem solving in an interactive way - click here for more info and access
- Text books that include clinical vignettes, such as Lange’s Case Files series
- Texts that are symptom based, like Symptom to Diagnosis by Stern, Cifu, Altkorn
- The Returning to Clinics - MD-PhD Student to Student Advice page
- The MSG Advice for the Clinics site , which includes recommended reading for specific clerkships and has general tips of all sorts
- Notes, reading, and on-line lectures from med 200
- Clinical journals, particularly segments like Clinical Problem Solving in the New England Journal
- First Aid for USMLE step 1
- For shelf exam prep, First Aid for USMLE step 2
- Podcasts (search "medicine" on iTunes for a list of options)
- Reviewing your evaluations from your second year clerkships – as a way of reminding yourself of what evaluators are looking for and what your own relative strengths and weaknesses were during the first phase of your clerkships
The above list is evolving. If you have feedback on any of the resources listed or additional ones to suggest, please let Maggie know.
CLINICAL ACTIVITIES AND REFRESHER OPTIONS
The transition back to clinics after the PhD will be smoothest if you spend some time during the thesis years keeping in touch with your clinical skills and if you allow yourself ample time for warming up before you re-enter the clerkships.
In the Clinical Connections program, thesis students are matched with a physician-scientist clinical preceptor in an area of interest to them. The goals of the program are 1) to help the student to stay in touch with his/her clinical skills and knowledge base, 2) to pair the student with someone who can offer insight into physician-scientist career paths in a clinical area of interest to him/her. More info at http://www.med.upenn.edu/mstp/connections.shtml
OTHER WAYS TO SPEND TIME IN A CLINICAL SETTING
- Volunteer for UCC or UCHC. More info in the Student Organizations Directory at http://www.med.upenn.edu/student/student.shtml
- Make informal arrangements to spend time in the clinics with an attending or resident you know
- Attend departmental Grand Rounds in your area(s) of interest
RETURNING TO CLINICS WARM UP OPPORTUNITY WITH STANDARDIZED PATIENTS (RTC-SP)
- GOALS: This experience is designed to give MD-PhD students returning to clinics a chance to dust off their clinical skills and receive guidance and feedback in a low-stress setting. The program provides thoughtful one-on-one clinical teaching prior to the two week clinical warm up course (med 250). We developed this initiative in response to feedback from students who have been through the transition and felt that a more structured experience, even before med 250, would be helpful. The feedback on the course has been very positive, and we highly recommend signing up.
- STRUCTURE: Each student will work up two bread-and-butter cases selected to cover fundamental areas of medicine. Here’s how it works:
- Prior to the program, you’ll get some info and tips on how to prepare. The goal will be to give you some suggestions to feel comfortable going into the experience, without requiring too big a time commitment.
- The program runs at Rittenhouse, and there are two dates available each year. Timing is typically 8:45-11:30.
- You’ll have an orientation to start the day, followed by a 45 minute overview of important physical exam techniques (similar to some of the techniques you learned in your ICM course).
- For each of the two cases you will:
- Have about half an hour to take a history, do a physical exam, and discuss your assessment and plan of care with the patient.
- Then a few minutes to list the tests you would want to order such as labs, imaging, etc.
- You’ll then meet again with the SP to get some feedback from the patient’s perspective.
- Within two days you will turn in a write-up on each of the two patients, and you’ll have a chance to view videos of the encounters.
- Later in the week you will meet with a resident or faculty preceptor and present one of the two patients. Your preceptor will give you some feedback and offer suggestions that will help as you get ramped up to return to clinics.
MED 250 – 2 WEEK WARM UP COURSE
Med 250 is the two week medicine refresher course which re-introduces students to Internal Medicine and the core clinical skills required for patient care. The course is graded pass/fail and the focus is on knowledge and clinical skill acquisition. Students refresh their skills through didactic conferences, case studies, patient care experiences and independent learning. Course components include history taking, physical examination, diagnostic test interpretation (i.e. labs and imaging), clinical reasoning (i.e. differential diagnosis), therapeutics, documentation and presentation skills. During the refresher, students are encouraged to become an active participant of their team. Students may be assigned to a site at HUP, PPMC or Pennsylvania Hospital.
Information about signing up for the course is available through Helene Weinberg
FRIDAYS WITH FAMILY MEDICINE
An alternative warm up option is to spend Friday mornings in a family medicine practice over the course of about two months before returning to clerkships. This can be a good option for students who will not have the time to fit in two full weeks in med 250 before returning. If you are interested in setting this up, contact Helene Weinberg (firstname.lastname@example.org).
OTHER RESOURCES and SOURCES OF ADVICE
ADVICE FROM STUDENTS AND FACULTY
Your peers are a great resource. Talk to students who are already back in clinics for their advice on getting ready. It can also help ease the stress of coming back to talk with others who will be returning at the same time as you. You can also form a study group to help bring each other up to speed on key clinical topics and practice your presentation skills. (You can check with Maggie to get names of other students if you don’t already happen to know them and/or use the combined degree e-mail distribution lists to connect). Also, check out the Student-to-Student Advice page on our website about Returning to Clinics.
Faculty advice will also help. Skip Brass, Jen Kogan and Nadia Bennett (along with Maggie and Helene Weinberg) hold a meeting in April for students who are returning later that fall. You can also meet with Skip and/or the course director of the clerkship to which you’re returning for one-on-one advice. All students are also encouraged to seek guidance along the way from key faculty in your chosen clinical field, once you have decided.
Keep an eye out for e-mails from Suite 100 about relevant issues as you get ready to return to clinics. Helene Weinberg and her staff will send out information about key scheduling deadlines, training sessions, etc. Staying on top of those deadlines and details will help make for a smooth transition into the clinics.