By: Jyoti Bhatia, OMS IV
What draws most potential medical students to NYCOM is the range of clinical sites our school has to offer. With rotations ranging in setting from inner city hospitals in the Bronx and Brooklyn, to posh suburban hospitals in Manhasset and Southampton, to rural settings in Upstate New York, the NYCOM student truly has the opportunity to “try on” medicine in different settings. The downside of this myriad of hospitals is that structured learning is piecemeal and often lost in the midst of learning different computer systems, hospital layouts, and medical teams. Further complicating matters, some hospitals offer more structured didactics than others, so obtaining a consistently beneficial learning experience can be difficult. In my four years at NYCOM, I have seen what works for my peers and what does not. Below are seven tips I have either observed or been frankly told by attendings, residents, and other successful students. There is no panacea, but I have seen these tips not only help a students get good grades on evaluations, but also help students leave a rotation satisfied they have become a better future doctor.
You must want to learn.
Nobody on the medical team wants to teach a student who has a bad attitude. Each core rotation has a set of skills—Pediatrics, patient education, clinical acumen for rare syndromes; surgery, anatomy and structured problem-solving; medicine, physiology and algorithmic problem solving; psychiatry, abstract thinking and pharmacology; family medicine, empathy and algorithmic problem solving; OB/GYN, all of the above. If you have no desire to watch a colon resection that’s fine; but at least know why the attending decided to do a diverting colostomy, as opposed to an end-to-end anastomosis. Pick a skill and refine it over the 5-10 week rotation.
How to impress attendings quickly à know the answers to pimpable questions.
Students have a very limited role on the medical team. Our only true responsibility is to be the supplier of mnemonics, rhymes, and other methods of making dry, rote memorization more enjoyable. Have a patient in acute renal failure? Prepare for pimping on FeNA and the AEIOU indications for dialysis. You have very little time to impress an attending. Being able to regurgitate this stuff on the spot impresses the attending, the residents, and fellow students, and helps confirm that you want to learn.
Don’t feel bad pimping fellow students.
Fellow students can get defensive when “cross-pimping” occurs. Keep it behind closed doors, away from any other team members. NYCOM students come from a variety of backgrounds; some have worked in healthcare before and can be a resource. I had a classmate on my surgery rotation who had been an EMT for 5 years before coming to NYCOM. Who better to have pimp me on the ACLS protocol? If you are embarrassed by a fellow student’s depth of knowledge of aortic stenosis, consider yourself lucky. Now you know what you DON’T know.
Latch onto the senior resident of your team.
To put it frankly, the senior resident is the most powerful member of the team. He/She knows the system. During my surgery rotation, my PGY-5 gave me a heads up of good cases to scrub with strong teaching attendings. The senior resident also knows all the pimp-able questions. During my medicine Sub-I, the senior resident pimped me on rate vs. rhythm control of atrial fibrillation; the next morning, the attending pimped me verbatim on the same topic. Finally, the lower-rank residents all have to answer to the senior resident. So what I’m trying to say is, if you’re in good with the senior residents, you’re less likely to be scutted out.
Stay away from the interns.
The way the system is set up, the intern is like the Tasmanian Devil. He’s a work machine, devouring all and any tasks that get in his way. If you’re in his path, either move or be devoured. An intern’s idea of teaching is offloading scutwork. Note that you must endure this torture as a Sub-I. And sometimes, you can barter with the interns. During my pediatrics rotation, I bartered a newborn exam out of an intern in exchange for filling out the discharge paperwork. But as a general rule, stay away from the intern!
Go back to First Aid and Goljan.
First Aid and Goljan are the source material for 60% of pimp-able questions; the other 40% comes from whatever the appropriate review book is for the given rotation (Step Up for medicine; Surgical Recall for Surgery, etc). During my Peds Heme-Onc elective, I was asked to read and interpret the oxygen-hemoglobin dissociation curve; during my medicine Sub-I, I was pimped on the mechanism of N-acetylcysteine; on Surgery, I was told to draw out the lung volume and capacity curves (pages 460, 359 and 459 in my version of First Aid, respectively). These are two books to hang onto, arguably for the rest of your training.
Ask attendings and preceptors for negative feedback.
It’s the bad stuff you really want to hear. Ask for specifics. “Needs to speak up more on rounds, because she needs to show she knows the answers,” or “Her presentations during didactic sessions are thorough, but casual; should be more rigorous and academic.” Attendings and preceptors know what you’re doing wrong but may be embarrassed to tell you, unless you ask.