Psychiatry Core Rotation

To be completely honest, I was not looking forward to completing this rotation. Mostly due to the uncomfortableness of the subject but I was pleasantly surprised how much I enjoyed. A lot of the patients just want to be listened to and you just have to have compassion.

I completed the rotation at Danbury Hospital in Connecticut and it was a great experience. The hospital is like a hotel and the people are just friendly all around. It was a breath of fresh air after my surgery rotation that wasn't exactly filled with the kindest of people. It just goes to show that the environment in which you surround yourself with really matters! Another great aspect of this program is they allow you to experience many different forms of psychiatry; child psychiatry, inpatient, outpatient, crisis intervention in the ER, consult psychiatry and visiting a drug rehab program.

Danbury Hospital

My first week I spent doing consult psychiatry. These was a good experience and eased me into interviewing patients. These patients were admitted for a medical problem but since being in the hospital have developed a psychiatric condition or always had an underlying psychiatric condition. The doctor you work with is a pleasure to work with. He makes the week fun but also a learning experience.

My second week I spent doing crisis intervention. Danbury hospital has a great behavioral health portion of the ER. It was hit or miss with the business of the day depending on how many people came it. I worked hand in hand with social workers and nurse practitioners and developed my interviewing skills.

My third and fourth weeks I spent inpatient. I really enjoyed being inpatient. This is where you got the exposure to acute conditions. I worked with a fabulous, very knowledgable psychiatrist and really learned what good interviewing technique looked like.

My fifth and sixth weeks, I spent outpatient. Mainly working with patients that were in an Intensive Outpatient Program, attending therapy everyday. I got to sit in on many therapy sessions and truly understand all the different types.

Every monday afternoon all the psychiatry students would met, one would interview a patient while others observed and then we would discuss the case with a physician. The was probably the highlight of the rotation. The physician created a comfortable environment where we could state our opinions even if it meant disagreeing with what he thought was the diagnosis and encouraged us to defend our answers (which usually resulted in him being right but we learned but was wrong with our thinking ;))

We also have to complete three full H&Ps which was an great learning experience. They were critiqued and given back to us. I had written lots of medical H&Ps but the psychiatric H&P includes many different aspects including the mental status exam which we had never learned before. We always learned how to do a mini mental status exam but a full mental status exam involves much more.

We also had many lectures given by physicians.

I highly recommend this rotation even if you don't want to go into psychiatry because this is the last time you'll get trained if you don't go into psychiatry and take advantage of a great program!

CT sunset with students on the lake

Preparing for the Shelf:
I felt super prepared for this shelf, I studied a lot and the material just seemed to make sense to me. I had a hard time determining what the best resources for the shelf would be at first. A lot of the books I had only had DSM IV and I wanted to make sure I was studying DSM V. I used First Aid for Psychiatry and it is GREAT! I also watched DIT videos for a general overview as well as completed all uWorld questions. I had extra time in the end so I chose to look over Pretest questions but it was a DSM IV book so I had to pick and choose which questions to do.

I officially finished my last core and last shelf. The only thing standing between me and graduation is 4 more months of electives and Step 2 CK!

Took my shelf in Philadelphia right next to Independence Hall

Surgery Core Rotation

At the end of March, I completed my surgery core rotation in Waterbury, CT at St. Mary's Hospital. This was by far my most difficult rotation, not because it challenged me mentally but because it challenged me physically. For 3 months I reported to the hospital around 4:30-4:45am and didn't leave the hospital until 6-6:30, sometimes later, 6 days a week. It was very difficult to come home and then study and even the 1 day we had free a week, all I wanted to do was sleep. The fact that it was winter was a good and bad thing. Good because I wasn't envious of others for getting to be outside, because it wasn't nice anyways but bad because there was very little daylight. I went to the hospital when it was dark and returned home when it was dark. Never really got to see what Waterbury looked like but from what I've heard there's not much to look at anyways :)

The rotation consisted of 11 other students from 4 different caribbean schools, 2 being PA students. This was the first rotation I had the opportunity of working directly with students from other schools which I met some great new friends. 12 students sounds like a lot but 2 were always on the night shift which left 10 others to cover the surgery board each day and there were almost always enough surgeries to go around.  

One of my best friends throughout the rotation!

In the mornings, we prepared for morning rounds with the residents then went to surgery or helped with floor work then afternoon rounds. One benefit of this program is you get to see a lot of different surgeries. They primarily do laparoscopic and robotic surgeries with occasional open surgeries. You are working with the General Surgery team so get to see appendectomies, cholecystectomies, hernia repairs, and amputations galore but also colo-rectal surgeries such as hemicolectomies, hemorrhoidectomies and low anterior resections. There is multiple bariatric surgeons so I saw gastric sleeves and gastric bypass surgeries. There are also many breast surgeons so you will see lumpectomies and mastectomies with reconstruction. You are get to sit in on cardiothoracic surgeries such as valve repairs and replacements, coronary bypass surgeries and aortic aneurysm repairs. They also have many vascular surgeries so you will see fem-fem bypasses, angiograms w/ angioplasty, carotid endarterectomies and AVF formations. Some friends even got to see some neuro surgery for subdural hematoma evacuation and urological surgeries. I was very grateful for the exposure I got. While a majority of these surgeries you are scrubbing, you usually don't get to participate much as the residents are helping a majority of the time. They would let you hold retractors, cameras and maybe even throw a few closure sutures. 

I had a few cool experiences in the OR. Having a surgeon (who is not normally too nice) say that he wanted me to be in everyone of his cases because I held the camera better than any other medical student he had, made me happy! Also getting to help close the chest after an open heart surgery (even though we NEVER get to scrub in on heart cases). Those were God's way of telling me to keep pushing onward even though I know you're tired :)

On the floors we would do a lot of wound dressings, wound debridements, placement of NG tubes and I&Ds. Every Wednesday was academic days where we would have lectures, cancer conference and sim labs. We had labs on Central line placement, chest tube placements and suturing. All were very helpful things that we had not gotten in our Maine semester so I enjoyed it. We also got called to all traumas and suture opportunities in the ER.

Our Team!

Studying for the Shelf:

Everyone will say the Surgery shelf is all Internal Medicine, ummm yes it is because surgery is just operating on medical conditions. They aren't going to ask you specific procedure related questions on the exam so they have to ask questions over the pathophysiology etc. It just makes sense. Learn IM but also postoperative complications. 

Books I used: I used surgical recall through the rotation for pimping in the OR. I knew the surgeries I would have the next day, so I just read that chapter quickly the night before to refresh my memory. For the shelf, I used Pestana's surgical notes. The book not the pdf document. The pdf document is a bunch of cases, the book is short descriptions of a bunch of conditions. And as always I did the uWorld questions. 

For the rotation here, we had weekly quizzes over chapters in Essentials of General Surgery. It's a good book to reference if you want a little more information than what Pestana's offers. 

Operative Anatomy is a great resource for the step-by-step of each procedure. NOT necessary for the shelf but I liked to briefly skim it before each surgery to at least have a generalized idea of what was happening. It included a lot of anatomy which the surgeons would pimp on in the OR too. 

Internal Medicine

I'm done with Internal Medicine which means another 12 weeks of rotations completed! I am still in Atlanta at DeKalb Hospital. The first 6 weeks of the rotation was outpatient and myself and 5 other students saw a lot of patients! The second 6 weeks was inpatient and I learned a ton! I wish the entire 12 weeks was inpatient. The attendings challenged us constantly to think outside the box and also make connections. It was a great experience. Every morning we had morning report led by an IM resident in which we would present a case and the group would have to work through it, asking the right questions, coming up with differential diagnosis' and a plan of action. It really made me think about how to approach a patient in an inpatient setting. I have nothing but good things to say about the residents we worked with. I learned sooo much from them! We worked with IM residents as well as podiatry residents that are required to rotate through IM. The attendings would then let us see patients on our own, take a history, do a physical exam and then present the patient to them on rounds. We were required to know up-to-date labs and other information about our patients and it helped us understand management better. We also had weekly lectures over common topics by attendings to solidify our knowledge. Of the 6 weeks inpatient, 1 week of that was spent in the ICU. I really enjoyed my time, learning about end of life care and critical care in general.

I took the shelf, a few days after I finished the rotation. I thought it was challenging. To prepare, I uses Case Files: Internal Medicine and UWorld questions. I tried to read Step Up to Medicine at the beginning because everyone said it is a great resource but I never got through the whole thing due to time but plan to use it more as I prepare for Step 2.

Going forward: I am set to take Step 2 CS in 1 week! I have been crazily studying because I have a few weeks off before I leave for Puerto Rico to start some electives. I always heard that the best time to take CS is right after your Internal Medicine Core or after an ER elective because you have a lot of experience taking full histories and doing physical exams so it's natural at that point. I do feel morning report as I mentioned above helped prepare me for CS. I will post about my experience afterwards in a week!

Pediatrics

I just finished Pediatrics. Can't believe I've finished half of my cores already! Everything is flying by. I arrived in Atlanta in June and I am loving being here. I've made it to The World of Coca-Cola, the Georgia Aquarium, walked around Centennial Park, practiced my golf at TopGolf, watched the laser show and fireworks at Stone Mountain and visited Six Flags over Georgia. I still want to catch a Braves game and maybe even a pre-season game of the Falcons. Atlanta Botanical gardens, the zoo, and the Martin Luther King Jr National Historic Site are also on my list to do.

My schedule for pediatrics has been 4 days a week and only 1/2 days so it has given me a lot of time to study as well as get out and explore ATL. I worked with 5 other students which was kinda a bummer because it just didn't allow me the exposure I wanted and it was all outpatient so the rotation lacked the inpatient experience. While I loved seeing the adorable children, I don't think pediatrics is for me. It's been a fun time though.

Some of the students from UMHS I worked with as well as our preceptor.

As far as studying for the shelf, I read Case Files, started Kaplan videos but I'm just not a video person so never finished and completed uWorld and Pretest questions. I think uWorld was almost a little too easy so I chose to also do Pretest which is another 500 questions. I love the explanations that Pretest offers so I honestly learned a ton just from reading those. Highly suggest it and they are a little more difficult and ask more about those rare conditions that somehow always sneak their way onto the shelves. Oh and I usef\d First Aid for the Wards for all the core rotations because it gives a general review of the high yield info. Test day is July 18th!

Next up is: Internal Medicine, getting into the nitty gritty of medicine!

Family Medicine

I am almost done with this rotation and have yet to post anything about it. This rotation has been busy! I am still in Augusta, GA. I did my family medicine rotation with Dr. Overstreet-Wright and she is fabulous. Very kind and willing to answer any/all of your questions. The clinic she works in also has a physican assistant and nurse practitioner which are also very friendly. The staff are fabulous too. So basically I loved this rotation :) We see around 25 patients a day usually depending on the day. The clinic has a women's health office upstairs, a dental office and a pharmacy. Due to the women's clinic being upstairs we don't deal with any gyn issues as we just send them there. The patient population is older but we did see an occasional child. You become very good at the treatment of hypertension and diabetes!

In my clinic, we would go in prior to the doctor and interview the patient and complete a limited physical exam necessary and then discuss the patient with the dr, then go in together. She would ask additional questions, that I forgot to ask but it was a great learning process because the next time I got a patient I remembered to ask those questions I forgot the first time.

Family medicine is a lot of the same things over and over but you have variety as well. My pharmacology knowledge greatly increased because previously I did an OBGYN rotation and as expected we don't deal with a lot of pharm. It challenges your differential diagnosis skills. 

With each rotation, I think that this is the one that I want to do. I loved OB and I really liked family too. I'm just blessed to be able to soak in all the knowledge from these preceptors. Throughly enjoy each rotation you are given!

Preparing for the shelf:

I read Case Files Family Medicine. I really enjoy this series, it's better than a textbook and easier to get through. Family Medicine is very broad so you have topics from rashes to hypertension to thyroid disorders. 

USMLE uWorld doesn't have a specific set of questions set aside for family medicine so I did AAFP questions. If you go to their website and sign up for a membership, it's $35 dollars for the board style questions. They are helpful. 

My shelf is April 20th. Ekkk nervous, 1 week then I'm 2 rotations down :)
Update on the shelf: It was hard! Kinda felt like Step 1 all over again...

OBGYN Shelf

I finished my OBGYN rotation and took the shelf on Friday! Friday March 13th, pretty unlucky of a date. About a month before your rotation ends, the clinical department will send you an email saying they are registering you for a two week period to take the exam, a few days later you will receive a scheduling permit from prometric and you can then schedule. There were not times offered in Augusta over the weekends so I ended up choosing a Friday. The exam does cost $106. It is 100 questions and you are allotted 2 hours and 30 minutes without breaks (You can always get up and take a break but the time keeps ticking).

Prepping for the exam:

• Throughout the rotation I read Case Files, it's an excellent resource. I read it almost 2 times. 
• I also used Step 2 Uworld which mimicked the questions on the actual exam.
• NBME offers 2, 50 question exams for $20 each, but I didn't take them as I felt prepared with the Uworld questions that I did.
• I'm working on possibly getting UMHS to have a subscription to the Association of Professors of Gynecology and Obstetrics, as they have a killer qbank called uWISE which all of the U.S medical students use to prep for the exam, otherwise an individual subscription is over $200 which isn't worth it. More on that to come.

How the NBME shelf is used:

What you receive on the test has nothing to do with the grade you receive for the rotation in general. Your grade is determined solely on your evaluation from your preceptor. You must pass the NBME in order to pass the rotation. A passing grade is 50%. If you do not receive a passing grade the first time, you will have one more chance to take the exam and if you fail a second time, you must redo the entire rotation.

According to the clinical department, your scores from your NBME shelves will not be released to any schools or residencies programs in the future. So techinically there is no added benefit on scoring extremely high on a shelf in a area in which you want to gain a residency spot. Of course, you always want to score well as you are continually prepping for the USMLE Step 2.

When will you receive your score:

You should receive it 3-5 buisness days after the 2 week testing period ends but you will have to email Isabel at imonarca@umhs-sk.net to receive a copy of your report.

**Update: I passed!