The third out of eight weeks of OBGYN is coming to a close. Don’t get me wrong, I really enjoy deliveries (yay to babies) but my mind is on what follows this rotation. Make sure to follow along with my day-to-day life on Instagram and Twitter. Just a heads up: I have a really neat giveaway planned for next week. I have a feeling you guys are going to love it! 😻
Okay so before I jump into my recommendations for each rotation, here are some other spots with pretty amazing clerkship advice.
- Bloggers: Ben White, Jenny W, and Bhuvani.
- Reddit: tigecycline, FawnLeibowitz, and hiaips.
Pediatrics at TUSOM: Pediatrics is a 8 week rotation split into two weeks on sub-specialty, two weeks in general outpatient clinics, one week in NICU, one week on well-baby, and two weeks on wards or PICU. Placements are at Tulane Lakeside Hospital, Our Lady of the Lake (in Baton Rogue), Oschner Children’s (in New Orleans), or Lafayette’s Women’s and Children’s (in Lafayette). Outside of the shelf examination and evaluations, responsibilities include: submitting H&Ps and active participation in small group didactics (aka precept).
On the Wards: Expectations from your attending will depend on the service. It’s probably good to know (but unnecessary to present) how many wets/dirties the patient has when you’re on a subspecialty service. NICU presentations are fairly systematic (ins and outs are important, and the assessment and plan are organized by organ system). Well-baby physical examinations are extremely comprehensive. Outpatient pediatric visits are very comprehensive.
- Presentations: I recommend asking your resident / intern if there is a specific format for your presentation. It’s likely that for NICU or well baby that there is a way your team goes about presenting. Below is how I structured my presentations for my other services.
- One-liner: Jane Doe is a XX year old female with past medical history significant for XX who presents with a chief complaint of XX.
- History of Present Illness: The story (given chronologically). Pertinent ROS. Any recent and important illnesses. Course in the ED. Make sure to state if there are sick contacts.
- Review of Systems: All ROS otherwise negative aside from what was mentioned in the HPI.
- Birth History: Jane Doe was born at XX weeks to a GXPX female at XX hospital. Indicate if there were concerns at time of birth and state if there was or was not a NICU stay. If so, for how long?
- Past Medical History: Other medical history since birth.
- Past Surgical History
- Home Medications
- Developmental Milestones: Specify if patient is or is not meeting developmental milestones. Flesh picture of what patient is able to do and is unable to do.
- Vaccinations: Up to date, yes or no?
- Social History: Home environment (location / apartment or house or mobile home / who lives at home / pets). Alcohol intake. Tobacco use. Illicit drug use. Suicidal ideations. Homicidal ideations.
- Sexual History: Sex with men, women, or both (can ask to quantify: would you say you have sex 80% of the time with men?). Ask about contraception and risk factors for sexually transmitted infections.
- Family History: Pertinent family history.
- Vitals: Tmax, HR, RR, BP, O2 sat (on room air or otherwise specified)
- Physical Exam: General, HEENT, Throat, Respiratory, Cardiovascular, Abdomen, Genital, Extremities / MSK, Skin, Neuro, Psych.
- Labs / Studies
- Assessment & Plan
- Patient Tracking: My best friend during my pediatrics rotation was the Perfect H&P notebook. I also used this template to track the patients I followed in the nursery as well as patients on the wards.
- Resources: If you have time between when you pick up a patient and when you have to present, UptoDate is a great place to do some reading and to find some pearls to throw into your assessment & plan and to prepare for pimp questions.
- In the Whitecoat: Maxwell Quick Medical Reference, Reflex Hammer, Ophthalmoscope, Otoscope, Penlight, Sketchy Medicine Cards, and Stethoscope.
In the Library : One thing about the pediatrics rotation is that there is minimal exposure to pediatric pathologies and patient management prior to the start of MS3. So unfortunately, a lot of this material is brand new. Luckily there are quite a few solid resources for the clerkship!
- Textbook: I have come to realize there are two types of medical students. Students who like the Blueprints series and those are abhor those books. I’m the latter but I had no idea until I knee-deep in the book. I tried Blueprints Pediatrics but found it to be a nightmare to slog through. I found BRS Pediatrics to be a more comprehensive and enjoyable read.
- Cases: I found the University of Hawaii cases to be extremely informative. If you have time to work through them, I totally recommend it. The website is a bit annoying to click through, you’ve been warned. I recommend the University of Hawaii cases over the CLIPP cases.
- Milestones and Vaccination Schedules: Learn your milestones. You’ll notice that different resources have small variations in milestones. I’d recommend using the tables from UptoDate and loosely memorizing a few examples for each stage. You can expect 1-2 milestone questions so it’s not worth going completely crazy over! Try and memorize the vaccination schedules. General rule: killed vaccines are before one year of age; live vaccines are after one year of age.
- Questions: UWORLD is a reasonable first start in regard to questions for the shelf examination. Keep in mind that if a pathology is bridges the pediatric and adult populations that it is likely to show up on the examination. So don’t ignore the fundamental medicine concepts. I also worked through the questions in Shelf Life: Pediatrics. These questions are absolute gold and I strongly recommend them. The question book is small enough to fit in your white coat pocket – easy to work through during your down time.
If I could repeat the clerkship: I was extremely nervous this rotation because I want to go into pediatrics. I went overboard by reading both BRS Pediatrics and Blueprints Pediatrics. I recommend against Blueprints Pediatrics but if you’re a fan of that series – go for it!
Psychiatry at TUSOM: Psychiatry is a 4 week rotation and the experience depends greatly on where you are placed. Northlake Behavioral was, in my experience, a very schizophrenia/schizoaffective predominant population. The VA in Biloxi cares for a population with diagnoses depression and PTSD. Other placements included the two Tulane institutions, consult service, forensic psychiatry in Jackson, Louisiana, and child psychiatry. We all had the opportunity to participate in an ER shift and to see addiction medicine at River Oakes (in Metairie). Aside from the shelf examination and attending/resident evaluations, other components of the final grade included: a submitted H&P, a standardized patient encounter, and a reflection on mental wellness.
On the Wards: This is undoubtedly an extremely interesting rotation. One way to be useful to your team is to help make collateral calls. You can ask your resident what you should address in these calls but often times you want to make sure: weapons are locked away at home, get the story on the patient’s baseline, and determine if the family members or whoever feel comfortable with the patient returning home.
- Presentations: I was worried that the psychiatry presentation would be extremely different. It’s really not. Here’s how I structured mine!
- One-liner: Jane Doe is a XX year old female with past psychiatric history significant for XX who presents (describe how he/she presented; e.g.: self presented) with a chief complaint of “XX”.
- History of Present Illness: The story (given chronologically). Pertinent ROS. Any recent and important illnesses. Course in the ED.
- Psychiatric Review of Systems: Detail + and – symptoms.
- Past Psychiatric History: Include diagnoses, suicide attempts, hospitalizations, rehabilitation, outpatient therapy, and medication trials.
- Family Psychiatric History: Include substance abuse and suicide attempts.
- Past Medical History & Past Surgical History
- Home Medications
- Developmental History
- Social History: Home environment (location / apartment or house or mobile home / who lives at home). Legal status. Occupation. Education status. Relationship history. Alcohol intake. Tobacco use. Illicit drug use.
- Vitals: Tmax, HR, RR, BP, O2 sat (on room air or otherwise specified)
- Physical Exam: Appearance, Behavior, Speech, Mood (in patient’s words), Affect, Thought Process, Thought Content, Insight and Judgement.
- Labs / Studies: Urine Drug Screen
- Assessment & Plan: Include Risk Assessment
- Patient Tracking: At Northlake, we used paper charts and so I used blank paper to take my patient notes. On my ER shift, I used this template to keep myself organized.
- Resources: I did not happen to wear a white coat on this rotation and so I didn’t have many resources on hand. If you run into trouble, UptoDate is the first place to go.
In the Library : This rotation is perceived as an easier rotation but I don’t think that means you should not take your preparation seriously!
- Textbook and Videos: I was nervous about being able to read a textbook in a four-week rotation so I watched OnlineMedEd even though I am not the biggest fan of the series. I bolstered my OME notes with information from First Aid for Psychiatry. The material is very high yield but I was not a huge fan of how the book is structured. I do think you should try to work through the book 1-2x prior to the shelf examination. I really enjoyed Case Files: Pyschiatry. I found that if there were any gaps in what I learned from OME or First Aid for Psychiatry. I completely restructured my notes and placed them in my Step 2 CK notebook (I’ll discuss this is another post).
- Questions: UWORLD is always the way to go to prepare for a shelf examination but I wanted more practice prior to going into the shelf exam. I completed the questions in Lange Q&A. These questions are extremely nit-picky but leave you over-prepared rather than under-prepared. I worked through USMLE Rx questions for psychiatry and these were gold! If I had to choose questions based on utility, I would say: USMLE Rx > UWORLD > Lange Q&A. I did one NBME which terrified me and was way more representative.
If I could repeat the clerkship: I wish I had reviewed more of the medical/neurologic conditions that could masquerade as psychiatric problems. Also, if you can review neurological conditions that overlap with psychiatric conditions, you should bone up on those.
EDIT (5.26.17): I recently realized that a newer edition (11th) of Lange Q&A (which is consistent with DSM 5) is out. It was published just a week before I bought my copy of the 10th edition. I recommend purchasing the 11th edition which is linked here.
Neurology at TUSOM: Neurology is a 4 week rotation and our options are stroke service/consult at Tulane, consult service at UMC, pediatric neurology (in Baton Rogue or New Orleans), and placements in Baton Rogue. The clerkship grade is determined by shelf, evaluations, and a standardized patient encounter.
On the Wards: I know that I typically take a moment to share how I approach the clinical aspect of each rotation but I don’t feel comfortable doing so for this rotation. Most of you will be on adult neurology services which are extremely different. I tailored my pediatrics presentation style so that it focused on what I came to realize my attending cared about more. Check out the bloggers I linked at the top of the post to see if they have clinical pearls for the rotation!
In the Library : This shelf is notoriously difficult and I had so much anxiety going into the shelf. Surprisingly (or unsurprisingly to my friends who know me better than myself), the shelf was fine!
- Textbook and Videos: I heard through the grapevine that Case Files: Neurology is one of the weaker books in the series and I had no intention of ever reading another copy of Blueprints and so I picked up my first textbook for MS3 year: Introduction to Clinical Neurology. This book is an easy read, extremely well organized, and just an all-around great resource. I outlined the facts from the book into my Step 2 CK notebook and added in any addition notes from OnlineMedEd (watch: Neurology, Brain Inflammation – under Infectious Disease, Brain Bleeds and Brain Tumors – under Surgical Subspecialties, and Pediatric Seizures – under Pediatrics). I reviewed Pediatric Neurology in BRS Pediatrics.
- Neuroscience Review: I realized this may not be necessary for everyone but I really needed to review some basic neuroscience prior to reading my textbook for the rotation. I reviewed Nolte’s atlas and High Yield Neuroscience which I regaled in my MS1 neuroscience recap.
- Neuropathology Review: I made a quick pass through Pathoma’s CNS unit, Golijan, and First Aid 2016 just to get my bearings.
- Questions: I made sure to go through all four of the NBMEs and I think that was really a key to my success. The American Academy of Neurologists has a practice exam for medical students (~ 100 questions) and this exam was actually full of amazing questions. I did USMLE Rx and UWORLD as well but I think the exam from the AAN and the NBMEs were the most similar to the real deal!
If I could repeat the clerkship: I would have spent less time on my neuroanatomy and neuroscience review but I did feel more comfortable going into the shelf after having done so.
If you have questions, you know how to reach me!