Category Archives: Core Clerkships

Books for the required clerkships and rotations

Family Medicine Question Book Showdown: NMS Q&A vs PreTest

NMS vs PreTest Family Medicine

Family medicine can be a tricky clerkship in many medical schools due to the vastly different experiences based on location. Some are heavily procedure driven, while others are very hands-off. Some experiences are well balanced, while others exclusively focus on family medicine subspecialization such as dermatology, sports medicine, or ob/gyn clinics.  Regardless of whether you experience an urban or completely middle-of-nowhere rural practice, all students at a given med school take the same final exam, and often times that exam is an NBME shelf.

It is not uncommon for students to feel that clinical experiences on a family medicine rotation do not comprehensively prepare them for the exam, especially when the specialty has such a wide breadth and oftentimes unknown depth. For students who know they learn best with practice questions, the below two titles tend to come up for comparison.


PreTest Family Medicine

PreTest Family Medicine by Doug Knutson continues on in the same style as other titles in the series, providing high yield questions and helpful answers that are geared specifically towards medical students. As each book is written by a different author, there is some variability within the series, but Family Medicine is one of the stronger PreTest titles.

The book is about 5.5 inches wide, which allows it to easily slip into a white coat pocket. This really came in handy during canceled patient appointments that created a good amount of downtime. The 500 USMLE styled questions in the book specifically focus on preventive medicine, doctor-patient issues, acute conditions, and chronic conditions. Question explanations generally go into both right and wrong answers, which helps solidify learning.

 


NMS Q&A Family MedicineThe National Medical Series for Independent Study (NMS) produced their own Q&A for Family Medicine, written by David Rudy. The book is full sized, meaning there’s no way it can fit within a white coat pocket. However, it does come with a scratch-off on the inside cover, and every owner is a winner! The prize? Online searchable access to every question and answer in the book, making it easy to use from any computer (if your Family Medicine practice happens to have available computers).

It is important to note that the “nearly 500 exam-style questions” advertised on the cover is actually over 900 questions. This brings up one of the larger complaints of the book. Previous editions had a number of spelling errors and even outdated content. While the content appears accurate, some of the typo issues have remained.

Answers in the NMS question book similarly overview all of the right and wrong answers, allowing for a full learning experience. However, the feel of the questions doesn’t parallel USMLE format as much as PreTest. Content seems to be more advanced overall, with more detail. It can probably serve as an effective learning tool well into residency.

 


The winner: This round goes to PreTest Family Medicine.

Overall, PreTest provides questions that are more geared towards the NBME Family Medicine shelf exam, in both format and content. For a third year medical student who benefits from practice questions and wants a white coat resource, PreTest is the way to go. For those who anticipate blowing through all of the PreTest questions and coming up hungry for more, try out NMS Q&A Family Medicine for more in-depth content as a subsequent resource. Special consideration should be taken by those who plan to enter family medicine as their chosen specialty, in which case the breadth and depth of NMS Q&A may provide a larger challenge with greater long term benefits. Keep in mind that neither of these titles is recommended for USMLE Step 2 CK study, despite both of them advertising it.

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Careful Consideration: Pocket Neurology

Pocket Neurology LippincottPocket Neurology (also known as “The Yellow Book”) can be readily found in the white coats of many Neurology residents. Unlike its Medicine counterpart (The Green Book), Pocket Neurology does not seem to hold the same popularity among medical students. There are a few reasons for this. First, it hasn’t been around as long, and thus it hasn’t had time to built up the full extent of its reputation. Few attendings will readily reference it during rounds, and residents simply won’t expect students to own or have access to a copy. Second, Neurology is usually a clerkship of shorter duration compared to Internal Medicine in most medical schools, and therefore comprehensive pocket guides are less bang for the same buck.

What Pocket Neurology covers, it covers very well.  However the target audience for this title is not the same as for Pocket Medicine as a result of the focus in our medical education. We are taught the core principles of Internal Medicine from an early point on entering medical school, including history taking, physical examination, general findings, and many organ system courses focused on Internal Medicine subspecialties. It is because of this focus that new third year medical students can open a copy of Pocket Medicine and understand the more advanced topics without the need for referencing the basics.

This is not the case on a Neurology rotation, where most students are just starting to learn the specialty’s language, techniques, and the significance of common findings. For example, students may be frustrated if trying to use the book to assess the common presentations of migraine prodrome, despite a concise and comprehensive overview of headache differential diagnosis and workup. Getting past the basics quickly to fully utilize this book is highly recommended, as it will certainly be a strong resource to those who can wield it well.

As with all of the titles in the Pocket Notebook series, downsides include lack of space for annotation, and small print font, but these come with the territory of creating pocket reference guides.  Another consideration for this title specifically is an index section that is somewhat lacking.  Topics not contained within tidy concepts involve a good amount of searching in the appropriate chapter.  As a result, many residents will place labeled flags or earmarks on pages to quickly access commonly referenced topics.

Specific sections include neurologic emergencies, lesion localizing in clinical neurology, neuroimaging, vascular neurology, neurocritical care, acute intracranial hypertension, interventional neurology, seizures and other spells, electroencephalography (EEG), delirium, dementia, movement disorders, behavioral neurology, poisons and vitamin deficiencies, meningitis / encephalitis / brain abscesses, infectious diseases, headache, central nervous system vasculitis, pain, dizziness and deafness, demyeliminating diseases of the central nervous system, spine and spinal cord diseases, motor neuron diseases, peripheral neuropathy, radiculopathy and plexopathy, neuromuscular junction disorders, myopathy, electromyography (EMG), neuro-rheumatology, neuro-oncology, sleep medicine, pregnancy neurology, neuro-ophthalmology, consult issues, and selected pediatric disorders.

Overall, this is a title worth purchasing for all Neurology residents and medical students interested in the field. Medical students who wish to excel in their Neurology clerkship or enter a field that uses neurology such as Internal Medicine, Trauma, or Ophthalmology should consider purchasing Pocket Neurology with the above considerations, based on their personal preferences. This is probably not heavily needed for students who have no interest in neurology.

 

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Win a Free Book: Pocket Medicine (AKA The Green Book) Giveaway!

This contest is currently closed – the winner has been contacted. Thank you to everyone who applied. Stay tuned for the next free giveaway, coming this Halloween!

Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine

Win this book free!

Med Student Books is proud to announce our first of many book giveaways: Mark Sabatine’s Pocket Medicine. You have probably already heard it referred to as “The Green Book” (the newest edition after “The Red Book“), and seen it sticking out of white coat pockets. Pocket Medicine has been previously reviewed on this site as a “Must Have” book for third year medical students on the wards.

Thanks to our friends at Lippincott Williams & Wilkins, we are happy to give away a brand new copy of this highly recommended resource. As this site is dedicated to using the experiences of medical students to help one another, Pocket Medicine will be awarded to the US medical student who offers the best advice to incoming first year medical students in a comment to this post.  It can focus on anything, including but not limited to study tips, ways to adjust to med school life, your favorite anatomy resources, or anything else that you wish you had known coming into medical school.  It just needs to be tailored to first years.

As this book is valued at over $50 and we wish to restrict it to the medical community, we ask that you use your medical school e-mail address as verification of your status.  Alternately, you can use another e-mail for now, but winners must verify their med school e-mail when contacted.  E-mail addresses are not displayed publicly, and will not be used for any purpose outside of this contest.  The winning entry will be selected on Friday, October 7th at 11:59pm, and the winner will be notified by the e-mail they provided shortly thereafter.

See our complete contest rules for further details.

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National Residency Match Program Releases 2011 Match Statistics

The National Residency Match Program (NRMP) and Association of American Medical Colleges (AAMC) recently released the 2011 match statistics, which had not been previously updated since 2009. A copy of this latest version can be found here:
 

pdf icon2011 NRMP: Charting Outcomes in the Match
Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2011 Main Residency Match – 4th edition

 
Specific data included in the NRMP match statistics includes:

  • number of applicants and positions in the main residency match
  • match rates by preferred specialty
  • number of different specialties ranked
  • USMLE Step 1 scores broken down by specialty
  • USMLE Step 2 scores broken down by specialty
  • Research experiences, abstracts, and presentations
  • number of work experiences
  • number of volunteer experiences
  • AOA rates by specialty
  • fourth years coming from schools with high amounts of NIH funding
  • fourth years with graduate degrees
  • all of the above information broken down by individual specialties

This last item is particularly helpful, as breakdowns include graphs that illustrate the percentage of fourth years who matched with a given USMLE Step 1 score. While this is not a perfect indicator of matching chances into your given field, the document as a whole is a good framework from which decisions can be made.

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Tips for Surviving your Obstetrics and Gynecology Rotation

To complement the recent release of our book recommendation for Ob/Gyn clerkship and Step 2 review, we offer the below experiences in hopes that rising medical students can learn from past mistakes and successes. Obstetrics and gynecology is usually perceived as one of the more labile rotations you will face in medical school.  While there are clear differences between hospitals across the nation, and even great variability between teams within the same hospital, this tends to generally be the case with respect to other rotations.

In distinction to many other clerkships, most medical schools rotate students through a number of different ob/gyn sites and settings, usually highlighting outpatient gynecologic exams, inpatient or surgical gynecology, outpatient obstetrics, and labor and delivery. This generally prohibits cohesive or longitudinal teamwork, and leaves residents and attendings with very little exposure time from which they must draw their evaluations. As such, the first piece of advice is to pre-read before starting obstetrics and gynecology.  This is in distinction to other stable rotations where reading can be done along the way. You will get pimped on day 1, and have few days past that to redeem yourself. Come in knowing your basic terminology and abbreviations.

Outpatient Clinics

Outpatient ob/gyn clinics are usually mixed.  Some will probably be shadowing, while others are primary care based, where focus should be on prevention and good planning.  For gynecology, you should know your in-office STD and vaginosis screenings, what to look for on microscopy, and how to treat each. Every exam should have a complete history on sexual partners, obstetrics (G’s and P’s), contraception, pap smears, STDs, vaccinations. If you’re uncomfortable talking about these topics, now is the time to get over it. Be sure to bring your stethoscope.

For obstetrical checkups, you should go in knowing your screening tests, timeline, and the most common reason for first and third trimester bleeding.  Presentations should always start with something sounding like “28 year old G3P1011”.  G (gravity) stands for the number of total pregnancies. P (parity) has four numbers which correspond to full term pregnancies, pre-term pregnancies, abortions/miscarriages, and live children, in that order. You will be commonly treating bacterial vaginosis and trichamonas with flagyl (metronidazole). You should remember this medication has a disulfiram effect, so it should not be taken with alcohol.  Some patients will actually forego treatment until the weekend is over because of this unwanted reaction.  Yes, really.

Gynecology Surgery

Experiences are usually divided between benign and gynecology-oncology. You should have a pair of gloves and lube packets in your back pocket at all times. Each surgery will start with a pelvic exam on your unconscious unconsenting patient. When the resident lubes up, extend your pointer and middle fingers towards them like a handshake for a “high two” to share their lube. This is how Ob/Gyns bond in the wild, along with matching surgeon caps, black zip-up tops, and playing their favorite game: “find then avoid the ureter.” The pre-op exam is a great opportunity to get your pelvic exam down, so don’t pass it up.

You will most likely need to be able to gown up yourself. If you haven’t had surgery, ask an intern or fellow med student to teach you on the first day of your rotation, regardless of whether you’re starting on something surgical. You should also come into this rotation knowing basic knot tying techniques, regardless of whether you’re going into anything surgical. It’s just a good basic skill to have throughout medical school.  If you aren’t familiar with knot tying, a quick search on youtube and spare string or sutures will be helpful.  If you have these basic skills down, you will be allowed to do a few things aside from retract. Remember, if you are down below, it is considered “dirty” even though you are in sterile garb. Never move from pelvis to abdomen without changing gloves. Crazy pimp question: most med students are taught in anatomy that nothing runs with the round ligament, so naturally many attendings love asking about it. The correct answer is the Sampson artery.

Labor and Delivery

obgyn clerkship fetal ultrasoundIf you are interested in catching babies, try to take shifts when there are minimal residents, such as nights. If your hospital has private attendings who allow medical students with them, jump at those opportunities. They’re the ones who will let you actually deliver, whereas many of the interns (especially new interns around July) will soak up the opportunities with staff attendings. A lot of labor and delivery is just going into rooms and asking “is there anything I can get you?” and then fetching ginger ale. However you should push into the action when it starts.

The best way to learn how to deliver a baby is to find someone who will let you put your hands on top of theirs for a few deliveries so you get an idea of just how much pressure and movement is needed. Next step up is having your hands under theirs. Once you have a good feel for that, you’re good to deliver with observation. This technique isn’t necessarily offered or known to many residents, so be sure to ask, but it really works well. Be careful when you put on gloves in the room, because it is not uncommon to get surprise-lubed by one of the nurses, whether you wanted it or not (although you almost always want it). If you have the opportunity, try to spend a little time on triage (be sure you know the signs of labor!).

If you have tips or suggestions you would like added to this article, please add them in the comments.

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Best Ob/Gyn Review: Blueprints Obstetrics and Gynecology

Best Ob/Gyn Book: Blueprints Obstetrics and Gynecology

Best Og/Byn Review: Blueprints

While this site had previously reported on the vast shortcomings of Blueprints Pediatrics, the writers of Blueprints Obstetrics and Gynecology, now in its fifth edition, have thankfully delivered one of the best ob/gyn review resources for medical students who are not going into obstetrics and gynecology. The book itself follows the same format and design as the others in the series, but don’t judge the book by its cover.

The major strength of Blueprints Ob/Gyn is that it is specifically streamlined for NBME exams, which means it strips down all the unnecessary detail and presents the core topics that will aid you in rocking the shelf, as well as the ob/gyn questions on Step 2.  One of the tough areas of ob/gyn is learning all new normal anatomy and physiology while currently learning the pathophysiology.  The book does a good job of breaking this up into an easy to read flow, with chapters that have a manageable length.  This includes both big-picture overviews (e.g. things that go wrong in third trimester) as well as drill down topics (e.g. preeclampsia). Furthermore, the book also has its own question sets which further solidify the topics as you go. This book also doubles as a great guide on Family Medicine as well.

Specific chapters include Pregnancy and Prenatal Care, Early Pregnancy Complications, Prenatal Screening/Diagnosis/Treatment, Normal Labor and Delivery, Antepartum Hemorrhage, Complications of Labor and Delivery, Fetal Complications, Hypertension in Pregnancy, Diabetes in Pregnancy, Infectious Diseases, Other Medical Complications in Pregnancy, Postpartum Care, Benign Disorders of the Genital Tract, Endometriosis and Adenomyosis, Pelvic Relaxation, Urinary Incontinence, Puberty and Menopause, Amenorrhea, Hirsutism and Virilism, Contraception and Sterilization, Elective Pregnancy Termination, Infertility and Assisted Reproduction, various Cancers, and Breast Disease.

Keep in mind that this latest fifth edition has very few changes compared to the previous two versions.  If you can pick up the older copies for cheap or free, they will provide the same knowledge.

 

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250 Biggest Mistakes 3rd Year Medical Students Make

Book Review: 250 Biggest Mistakes 3rd Year Medical Students Make And How to Avoid ThemMany will argue that the first mistake third year med students make is buying this book, while others will claim that it is an essential and invaluable survival guide. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them by Dessai and Katta is the semi-popular successor of the 101 Mistakes book.  As the title suggests, it reviews all of the big issues bound to cause trouble on the wards. But how helpful is it really?  The answer depends upon the direction and perspective from which the book is examined.

If an attending were to be pulled aside and asked to write a list of all the things that bring down 3rd year med student evaluations, it may very well produce this book.  Therefore, many reason that the opposite must be true: buying this book prevents students from making these 250 mistakes, thereby instantly increasing their grades.  That’s essentially the fear hidden in the title of this book: buy it or you won’t get good evals.

Looking at the same scenario from the medical student’s point of view produces different results.  If a fourth year medical student were asked to write a list of all the things they wish they knew for themselves coming into med school (one of the very goals of MedStudentBooks.com), only a small portion of this book would be reproduced.  The reason for this distinction is because the large majority of “mistakes” in this book are common sense items that the large majority of medical students either don’t make, or adapt to with effortless efficiency.

So why the discrepancy in appreciation of this book from readers?  For medical students who have worked in “the real world” or have been held to rigid professional standards previously, pieces of advice such as “show up on time” or “dress professionally” or “get your work done on time” come as an expectation. Others however need gentle reminders that there is a clear distinction in the environment between preclinical and clinical med school years.  The majority of medical students come directly from college, and may face an actual professional setting for the first time in their lives at third year.  This latter group comprises the students who would most benefit from the nuanced recommendations of 250 Mistakes.

The big picture consists of the following.  First, med students should be professional. Second, they should ascertain the characteristics on which they are evaluated by directly asking residents or attendings at the start of each rotation, and reevaluating methods based on feedback along the course of the rotation. It can be an intimidating process for someone unfamiliar with the culture of medicine, but such open communication is a common occurrence.  Most attendings at teaching hospitals are happy to help, and do not mind offering feedback. It should be noted however that this falls under a common rule of medicine: don’t ask the question if you don’t want to know the answer.  Feedback is only helpful if it is used, and being defensive about feedback is looked down upon.

If you can accomplish these goals of professionalism and open communication that seeks out feedback for improvement, there’s not much else this book has to offer.  If however you are new to the working world or want a few gentle pushes in the right direction, this can certainly help.  Despite it’s 200+ pages, it’s a rather fast read with big bullet points.  The book itself is relatively cheap (compare prices below), but it can usually be found at your local medical library, or borrowed from friends or student lounges.

 

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Surgical Recall: Ultimate Pimping Handbook

Blackbroune Surgical Recall for Third Year Med StudentsSurgical Recall is one of those third year med student books that can be your secret phone-a-friend ace up your sleeve, and concurrently your downfall. There are a number of books you will encounter throughout medical school where the outcome of that class or clerkship is dependent on how the book is used. Just as you wouldn’t use Netter’s or Rohen’s to replace an anatomy text, Surgical Recall must be used properly.

As the title implies, Surgical Recall is your guide to all things pimping on surgery.  Unless surgery is your first rotation, you should already be aware that the pimping starts on the very first day. Accordingly, you should ideally grab a copy of this during the weekend before your surgery clerkship starts and dig in quite a bit by time you hit the first day.  This is the book that’s going to help you avoid looking like a total newbie, because common surgical etiquette and culture is not taught in preclinical classes.  This is the book that’s going to tell you all the usual abbreviations, the names of all the different scissors you enounter, why you should NEVER touch the mayo tray (and what that is), and all of the common pimp questions you will commonly encounter.

Like other books in the Recall series, Surgical Recall uses a split page question and answer format that quizzes the reader on all the common things seen in surgery.  The book does a good job in its use of pictures, especially on sections dedicated to surgical instruments and consumables.  This is important as most third year med students don’t know what a JP drain is, what JP stands for, what they look like, and how they are different from other drains. You could responsively google “JP drain” right now, but you won’t know the names of all the other commonly used tools, which is why this book is helpful.

The latest edition (as seen above) has taken on a somewhat retro look.  Perhaps market research has shown med students go for books that are already on fire to quell the need to later set them ablaze in frustration, or perhaps this just allows for the subsequent edition to look modernized in comparison. Nonetheless, we can’t judge a book by its cover, else the BRS series of books would have gone extinct long ago. The first section of Surgical Recall is going to touch on the big picture and background of surgery, including abbreviations, surgical signs, syndromes, cutting, suturing, tying, instruments, preoperative requirements, wound care, hemostasis, nutrition, shock, complications, and surgical anatomy pearls.  Section II goes over the main general surgery areas, including GI hormones, GI bleeds, hernias, laparoscopy, trauma, burns, bariatric surgery, appendicitis, ostomies, fistulas, IBD, portal hypertension, other hepatobiliary diseases, the breast, endocrine, melanoma, vascular, and intensive care unit knowledge.  The third and final section hits the surgical subspecialties, including pediatrics, plastics, hand, otolaryngology, thoracic, cardiovascular, transplant, orthopedics, neurosurgery, and urology.  This book is around 800 pages long, and while the question and answer format allows for a faster read, you should generally focus on the general surgery knowledge and the topics that specifically correspond to your surgical service.

Surgical Recall Illustrations: JP drain and Scalpels

Included with this latest version is the promise of free “Mobile Access.”  As of now, the jury is still out as to whether this is legitimate, as a number of students have had a hard time actually accessing it through their phones without paying the additional ~$45 app price through Android or Apple. It may be fixed in the future, but don’t purchase this book thinking it will instantly be on your phone.

Surgical Recall can be the downfall for the occasional medical student who believes this is the only book needed during surgery.  Indeed it will seem like a cheat sheet, whereby memorizing this book will produce superstar results in the operating room and floors (and it will).  However, the NBME Surgery Shelf Exam doesn’t care about the things that make awesome operating room medical students that get all the obscure attending questions. There is no Surgery Shelf question on one-handed ties, no Surgery Shelf question on drain choices, and no Surgery Shelf question on how your attending likes their coffee.  Make the distinction: there is OR / floor knowledge, and there is NBME Surgery Shelf exam knowledge, with a minority of overlap.  You need both to go for the gold on your surgery clerkship, and Surgical recall is the tool to help with the former.

 

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