Clerkship Exam Advice
Family Medicine Exam Advice from Students who earned Honors
- The Family Medicine exam is generated by the same group that creates the MedU cases online. Thus, I solely focused on doing the cases and memorizing as much as I could from the PDF case summaries at the end of each case.
- The only resource I used for the family medicine rotation was the FMcases. The biggest mistake a student could make is not completing the cases. They are time consuming and it can be easy to click through them and not really pay attention, but they have a lot of good material and contain a good portion of the test material. I found it really helpful to actually type out notes from each case and then reviewed the material a couple days before the test. That would be my advice to students in the future.
- I studied the FMCases from Med-U as was suggested for the departmental exam. These prepared me well but the difficult part was finding the valuable information amongst all the less important details. I made a study guide with these key facts so I could quickly review them all before the exam (instead of going through the 500 page case summaries we were provided).
- For the Family Med clerkship, I studied almost exclusively from the fmCases. I also would do extra reading on patients with conditions I did not feel very comfortable with. However, since the test is based all on the online cases, I think these are by far the most helpful resource anyone could use to perform well on the exam and in the clerkship.
- For family medicine, for me the main thing was doing all of the CLIPP cases that the exam is based off of. Additionally, not just doing them, but taking key notes. I kept a word document with notes from each case as I went through them of things that I thought were most important / hardest for me to remember (details).
- I typically learn best by learning from my patients as in reading about their pertinent medical conditions. For example, if I had a patient with COPD who smoked, I would read about the management of COPD on Up to Date and read a little on motivational interviewing for smokers. Same goes for an acute upper respiratory infection, rashes, post-MI/stroke management, asthma, interstitial lung disease, antibiotic selection for various infections, and so forth. In general, I would read in more detail at the beginning of the clerkship on sources such as Up to Date while doing the required online cases intermittently in an order in which I had a similar patient. For instance, I would do the "45 year old with a cough" case if I had a 45 year old patient who presented with a cough recently. Doing that made the cases seem much more relevant and made me think about the management of my specific patient in a more comprehensive way. In the weeks leading up to the exam, I would try to ramp up the number of cases I was doing and start reviewing cases that I had done at the beginning of the month. I reviewed cases by looking at the case summaries (even though some details are not up to date). Honestly, that pretty much sums up how I studied that month; simple yet relatively efficient. I hope this helps!
- For the family medicine clerkship I only studied the FM cases that were provided online. I went through cases once and then read back over the synopsis that is provided at the end. I also probably benefited from it being the last rotation and having completed all of the previous clerkships. I think that almost every question had an answer somewhere in the FM cases. Based on people I have talked to, I think people struggle simply because they don’t go through the cases in enough detail or just don’t finish them.
As far as clinically, I didn’t do anything of note. It’s pretty hard to prepare in advance because you get new patients every 15 minutes. Again, I significantly benefitted from all the clinical knowledge picked up throughout the year which helped to make patient interactions, differentials and plans pretty straight forward.
- For the family medicine clerkship I did not feel like I was learning adequately from just doing the online cases. Typically, I would download the summary at the end of the case, read the summary and then go through the case itself. This helped me to understand the information better personally. This is really the only resource I used to study for the exam, aside from reading about my patients and their various conditions.
As far as being successful clinically, I think it is important to show that you want to be actively involved in patient care and express to the attending that you would like to see patients on your own (if they are okay with this). I learned the most by seeing the patient by myself, developing a plan and then presenting the plan to the attending. My attending would then help correct the plan and go over any questions or exam findings I may have missed. If physicians are not willing to let students see patients on their own I do not think they should be participants in the family medicine clerkship because this is really the only way for students to develop how to interact with patients one-on-one.
Medicine Exam advice from students who earned honors
- I really liked the step-up to medicine book. It was in depth enough for the test without being overkill. Specifically the cardio pulm and renal chapters are hit hard on the test. Then I recommend questions. I really find that's the best way to learn anything. Buy the uworld qbank early and work all the way through it!
- The main ways I studied for internal medicine were the Uworld question bank and Harrison's Principles of internal medicine from the library website. I would do one or two blocks of timed practice questions every day to every other day throughout the clerkship, with increased frequency in the last couple of weeks. I would thoroughly read the explanations for questions I had marked or not answered correctly. In Harrison's I would read chapters that pertained to a specific clinic or patient I saw. This amounted to about 10 chapters, each on a subject that ended up being important on the exam. I had the book Step Up to medicine, but it was terrible. The information was either too general to be useful or presented in a confusing manner. I also had the book First Aid for USMLE Step 2 CK, and it was equally terrible.
- Medicine is a good clerkship although it is quite demanding. Preparation for the exam can be difficult to work into the busy clinical schedule. If you have an outpatient rotation you will want to really take advantage of the time to study. The best resources I used were reading from Step Up To Medicine (really the whole book) and getting through as many UWorld Step 2 questions from the medicine section as possible (there are a LOT). You will want to have those resources available on your phone/ipad/computer so you can use them on down-time.
There are several must have apps that will help you to keep on your phone/ipad. UpToDate, Access Medicine, Diagnosaurus, Medscape (good for quick lookup), Lexicomp/Micromedix, and Qx calculate. If you use these consistently you will get quick at accessing information and it can be helpful if you forgot to look something up and you are about to present on rounds.
It’s a marathon and not a sprint. Good luck and be proactive, it will make a difference in your clinical grading!
- I used Step up to Medicine for the clerkship. Specifically for the exam, the cardiac, renal, and pulmonary were highest yield from that book. I would also recommend getting through all the internal medicine UWorld questions. For the clinical aspect of the clerkship, the purple pocket medicine book by Mass General Hospital was great for differential diagnoses, etc.
1) USMLE World Qbank questions - over 1300 IM questions. Far and away the most helpful resource for the NBME.
2) Step Up to Medicine book - pretty basic but seemed to be a nice review.
3) Symptoms to Diagnosis - more of an interesting read. Not sure how much it helped for the NBME.
- The preparation for my rotation and exam primarily involved USMLE UWorld questions (all of them), reading all the way through Step-Up to Medicine, and reading through Emily Ramahi’s High Yield Internal Medicine review online (google this). To prepare for the wards I used UpToDate on my iPad constantly. I also used Diagnosaurus to aid in making a differential diagnosis. I hold tablet applications in high regard to manage the vast amount of information in Internal Medicine and believe that becoming proficient with these can really help you stand apart.
- On the Medicine clerkship, I spent the majority of my time studying the MKSAP book and associated questions. I highly recommend focusing on this resource, as the questions seemed to best paralell the material seen on the NBME. I believe I used another question bank (Case Files or something similar), but the material did not seem as helpful/relevant as MKSAP. On every patient I had during the inpatient portion, I spent a significant amount of time on UpToDate studying their disease, a differential, and potential treatment strategies.
Neurology advice from students who earned honors
- I think I was successful for these reasons:
- Dr. Wong's Neuroanatomy course
- Pre-test Neurology (I bought my own so I could highlight and mark on the pages.) I went through this twice.
- USMLE Step 2 qbank neurology questions. I almost got through this twice.
- For daily neurology rounding, I used the Maxwell Quick Medical Reference neurology note section. I organized my presentation of the neuro exam in the exact order listed in Maxwell. I think I looked like I understood more because I was organized, but I was just following their outline.
- For neurology I made sure to attend all of the lectures and watched the online recommended lectures by the clerkship director. I tried reading the sections of Blueprints that corresponded to those lectures, but I did not necessarily read the entire book. Lastly, and I think the most helpful thing was doing the UWorld questions on the Step 2 CK QBank that corresponded to neurology.
- To start, I think that having neurology as my final clerkship of third year was advantageous in that I knew how to behave in a hospital and what to expect of the NBME exam. As far as studying goes, I studied a little bit each day. I read the Neurology Blueprints book once, and then a few days before the exam, I carefully read the neurology section of First Aid for Step 2. I completed all of the neurology questions on USMLE World Qbank and repeated them until I got all of them correct. I also looked up my patient's conditions throughout the rotation to make sure I understood everything I encountered.
- I was fortunate enough to spend the month in Fort Wayne where I worked one-on-one with my preceptor in her clinic and in the hospital. Not having residents or other students allowed me to see all of the day’s patients on my own. Additionally, my preceptor did an excellent job in asking me to formulate a differential diagnosis and a treatment plan for every patient. Again, there were no residents or other students to do that for me! Thus, my advice to other students would be to challenge themselves to figure out the patient’s diagnosis and think of the next steps in management on their own. It’s also best to talk through your thought processes with your preceptor and ask questions. Rotations in general, not just neurology, really are most enjoyable when I challenge myself to think as though I am the one truly caring for the patient, rather than just being a reporter of the findings and the current treatment plan. At home, I recommend reading about the patients that came to the clinic or were seen in the hospital for consults. I retained information best when I could associate it with the patients that I followed.
- Throughout the clerkship I kept a running list of topics related to patients to look up either in blueprints or up-to-date. I read through the entire case files book and completed all the USMLE qbank neurology questions which I think is a great way to prepare for the test in the last two weeks. Pre-test has some relevant chapters but it's very hit and miss so I wouldn't recommend that as a major resource for the shelf exam.
1) Uworld 1x-entire clerkship
2) Blueprints 1x-entire clerkship
3) Pretest 1/2x-2 days before exam
4) Online Med Ed videos (https://onlinemeded.org/home) 2x-FIRST resource to use! Easy to understand. Broken down simply.
- A big contributor to my success on the exam was being well-prepared by the 2nd year neuroscience class in indy. During the clerkship I used mostly the books that were provided to all of us at orientation. The first week I reviewed neuroanatomy. Then I spent the next three weeks reading Blueprints. I would read whatever chapters pertained to the patients we had that week. For the last two weeks I also studied Pretest. By the test I had done all of the Pretest and USMLE world neurology questions. These resources prepared me very well for the exam. I did not use casefiles because I don't think it is an efficient way to study during a 4-week clerkship.
Pediatrics advice from students who earned honors:
- I found Uworld questions on pediatrics to be the most valuable resource. It had a good variety of questions that I felt prepared me well. There are about 350 peds questions, which I thought was enough to prepare me, while not being too overwhelming to finish all of them. I know not everyone will have this opportunity, but many of the fellows and staff working on the hospitalist service (which I was assigned to) gave great lectures on common childhood conditions. These lectures were separate from the required lunchtime lectures and I found them to be very helpful and high yield. I would recommend students to ask their residents and faculty to teach whenever possible. I found on this rotation in particular, residents and staff are very willing to teach and are a great resource.
- First, I used uworld (filtered to peds) to get a lot of test prep. I'm a very question oriented learner, so that always helps a lot. I also like the kind of books that outline things, like blueprints. It helps me to think of things in a concrete way. I know a lot of my colleagues like case files, but I always found myself too impatient to read them!! Lastly, I used pretest (I believe it has 500 questions) from the library (you can check it out). Often I find that people think question books are "okay I picked a, the answer is c. Next." I will only do about 20-30 questions a day, and read through the whole description of the answer. Then I keep a notebook of "little facts." Basically it's a way to keep me engaged, so that after I read 4-5 sentences of why it was "c not a" I force myself to write in the notebook the key fact that I didn't know or something I thought I knew but had interpreted differently. Students can get caught up in the flow and understanding of concepts, which is of course very important, but they forget that they have to answer questions about those concepts.
Clinically, I would tell students not to fake it. Don't be annoying. Do not constantly ask "what can I do?" Just use your head and ask yourself "if I was a resident, what kind of student would I want to be around?" like if the day before you noticed that the team liked knowing when a patient went to the OR, make sure you know when your patient goes that day. Or go back to the patient’s room after rounds and just double check that they understood the plan and try to answer any questions they have. It's important to try hard, but I also think staff and residents enjoy someone that is just nice to be around. Someone that is positive and engaged.
- As far as questions, I did the USMLE World Qbank pediatrics section and PreTest pediatrics. While I did questions I kept notes on things I missed or things I didn't know when I read the explanations. Once I was done with that I read certain chapters of BRS pediatrics. I didn't get through the whole thing but did focus on any systems that I didn't feel comfortable with. Those chapters have a few questions at the end so I did those too. If I learned anything big from the chapters I added it to the notes I had taken previously. Then basically I tried to go over those notes a few times before I took the exam. Clinically I just tried to find ways to be helpful to the docs and to read up (uptodate or pubmed) on anything I didn't know very well.
- I believe the resource that helped me the most during my pediatrics rotation was searching UpToDate and looking back at some of my notes from first and second year. I would read about my patients and come to my staff physicians and residents with questions. I would look information up even if I was almost 100% sure of the answer. I also found the Uworld questions helpful for the exam. They closely mimicked the style of the NBME and covered many of the major topics. I did not use a textbook, but I did reference First Aid Step 2 CK.
- I think a big piece of advice would be to take the NBME exam very seriously in pediatrics. I personally thought it was one of the hardest shelfs of third year, right up there in difficulty with internal medicine and surgery. In fact, I think the exam mirrored the internal exam in many ways because the questions were not always specific to pediatrics; they were often general medicine questions that would be applicable to someone of any age, they just happen to use a child in the prompt. So, it is very important to study most of medicine and not just very specific pediatric topics. I read all of first aid and case files, did all the questions with pre-test (although these were often too specific and not NBME-similar) and Q bank. I looked through Nelson Essentials trying to focus in on high-yield stuff and a textbook my preceptor had about physical diagnosis. I also used one of my preceptors pediatrics boards books and did all the practice questions in it. The more questions you do, the better you get on the tests. I also think it’s essential to spend some time actually reading a textbook. Everyone is going to have read first aid and case files, so all that can get you is a pass at best. It's taking the time to expose yourself to more topics that sends you over the edge on the shelfs because they will definitely pull out a few obscure or unexpected topics. Also, the test is heavily inpatient-centered, so if you are like me at a regional campus and spent most of your time outpatient, you do need to make sure you are keeping up on inpatient topics.
Clinically, it is important to know the indications for when to use antibiotics, practice physical exam skills, and help your preceptor run a smooth and efficient office. There are many things in a peds clinic you can do to be helpful: strep throat swabs, flu nasal swabs, helping calm down crying babies. The more you become essential to the team, the more your evaluation will reflect your effort. Don't ask questions, just to be asking them. If they are easily looked up in a book, go find them yourself. Save your preceptor's time for more difficult questions. Take the time to look up info on your patient's and know something that will be useful to your preceptor.
- Honestly, I think the main reason I did well on the NBME was because 1) I was on the Hospitalist service, which gives you excellent exposure to the types of clinical scenarios that will be on the exam, 2) I had great residents that took the time to teach me, and 3) I had Winter Break in-between my outpatient and inpatient months, which allowed me to rest up and study. These factors are not all under the control of the medical student.
As for the clinical portion of the clerkship, the usual advice to "take initiative", "take ownership of your patients" and "show enthusiasm" will serve students well. These concepts are constantly stated to medical students, and it's because they are important. Take the extra time to make sure that what needs done for your patient gets done.
- I spent most of my time using Case Files-Pediatrics and Essential of Pediatrics-Nelson. Granted, Nelson is a large textbook so I mainly concentrated on the large topic subjects and research on any esoteric ped cases I encountered. Normal child development is a big topic, so those chapters need special attention. I also did question sets each weekend using UWorld-Qbank to help me prepare for the NBME.
While on clerkship rotation, you really need to adjust your mindset and kinda remind yourself what it was like being a kid and going to the doctor. I tried my best to interact with all the patients from babies to young adults. Silly faces, peek-a-boo, whatever it took to make a kid smile. Don't be afraid to actually handle a baby, unless their greased you won't drop them. Secondly, parents constantly evaluate how comfortable you are with their child. You must develop some rapport with them as well so you can gain their trust. Overall, just try and have a good time.
- For the Pediatric Clerkship, my primary resource was the UWorld QBank. My goal for each day was to complete 10-15 questions. I would review the questions afterward and typed up key points or concepts. I categorized the key concepts according to organ system (i.e. cardiology, endocrine, ...etc). I supplemented my notes with First Aid’s Step 2 CK, Master the Boards, and UpToDate. I continued to add topics that I discussed with the faculty/resident throughout the rotation. During the last 1-2 weeks of the rotation, I reviewed my notes and highlighted concepts that I needed to focus on. I also took the NBME Pediatric practice tests before the exam. I took the first one after my first month to gauge my mastery of different topics and to know what to focus on. I took the second practice exam the weekend before the exam to estimate my score.
Throughout my medical school experience, I had very little exposure to pediatric medicine. Therefore, my goal during the rotation was to be as involved in the patient care as possible. Whenever possible, I tried to talk to the patient and learn about their lives. I really enjoyed playing game with the patients and sharing their medical experience. I feel that the memories that I made with the patients helped me conceptualized their experience/illness into discrete moments of my life that I can recollect.
- I used BRS, PreTest, and uWorld for general knowledge and to study for the test. For the clinical side, I cared about my patients and their families and made sure they had their questions answered. I was also playful with the children and came down to their eye level to be less threatening. I also helped the residents and attendings as much as possible doing H&Ps, drafting discharge summaries, tracking down lab values... I also offered help to with patients that were not assigned to me that the residents or attendings needed help with. I was always happy and helpful.
- I used Pediatric Blueprints as the basis for my individual reading and then I took all of the Qbank pediatric questions a couple times just before the NBME exam which was the highest yield thing I did. With the Blueprints book I read each chapter and took notes so that I had a quick reference when I needed it.
Psychiatry advice from students who earned honors:
- The two major resources I used to prepare for the exam were First Aid for USMLE Step 2 and the UWorld question bank. I'm sure I did some reading out of the textbook, as well, but First Aid gives the highlights, and gives good context for going through the main text. I don't imagine having UWorld specifically is as important as using a question bank at all.
As far as clinical performance is concerned, it's very staff-dependent. I typically worked directly with my attending; he was very easy to get along with and straightforward with what he expected of me, which made it easier to fulfill those expectations. The best I could offer, I suppose, is to study when they go home, focusing first on what they see most of in the clinic, and make sure they are doing what their attending expects of them. Showing interest and following what advice the physicians give can't hurt either!
- I thought the psychiatry shelf was a challenging one. I was at the VA for psych so I had a very limited clinical experience of mostly pretty severe schizophrenia and PTSD and lots of substance abuse. I found that choices of treatment were very staff-dependent. Due to those two things, I found it important to heavily supplement my knowledge base with books rather than rely on clinical experience. As in all rotations, I think supplemental texts work best when you choose one and stick to it. I used only my qbank, Case Files for Psychiatry, and the First Aid for Step 1 book section to make sure I knew drug side effects. I completed all those materials. I also found that on the shelf it was helpful to not focus too heavily on exact symptoms or timelines of symptoms- rather I made a mental picture of the patient's behavior and affect in my mind and compare to those I made when studying (That is, I didn't ask myself "Does this person fit the criteria for bipolar disorder?" rather "Does this SEEM like a person with bipolar disorder?")
- The psychiatry questions on my Qbank subscription were very helpful. I went through them once, then I went through the ones I got wrong the first time again. There aren't that many of them, so this was easy to do. Then I cherry-picked section of PreTest in Psychiatry to go over sections that I knew I was weaker in based on what I generally had trouble with on Qbank.
As far as how I prepared for the clerkship, I mostly used the psych section of FirstAid for Step 1 and Step 2. These sections provided good outlines of psych as a whole. Then any areas I had gaps in, I UpToDate'd.
- I read the First Aid for the Psychiatry Clerkship and did the corresponding questions from the Psychiatry PreTest book every morning before clinic/hospital responsibilities. After finishing that and with one week prior to the NBME exam, I did the Psychiatry questions on the UWorld Qbank. I took notes on every question that I missed and the night prior to the exam, I reviewed those notes.
- first aid for the psychiatry clerkship
- UWorld question bank for psych
- handouts from lectures, especially focusing on common psych meds, mechanisms of action, and side effects
- Lange psych q&a (10th ed.)
- I used First Aid for the Psychiatry clerkship and the Psychiatry Pre-Test question book as my study resources. I made sure to study daily and I did mini-presentations on various psychiatric diseases daily. I paid particular attention to pharmacologic treatments and their side effects. I used Up to Date and PubMed to prepare the presentations.
- PreTest, First Aid for the Psychiatry Clerkship, USMLE QBank, and Lange Q&A for Psych. I did not find Case Files to be helpful but did read about half the book.
- Probably the best resources that I used to study for the shelf exam were the Lange Q&A Psychiatry book and the Psychiatry Pretest book. With over 1300 practice questions combined, they are fairly comprehensive in the amount of material they cover. I felt that Blueprints and First Aid for Psychiatry were useful to read as references to prepare for working up new patients while on the wards (I was at Eskenazi), but I'm usually able to retain information better by doing board-style questions rather than reading through review books so I found Lange and Pretest as better resources for the exam. Although the quality of the psychiatry questions on UWorld was excellent (probably most closely resembling the NBME), I felt that there weren’t enough questions in that qbank to cover all the material that might be tested, so I would encourage doing as many Lange and Pretest questions as possible to prepare for the exam. Even though a small percentage of those questions will either be frustratingly ambiguous or have obvious errors, I still recommend going through them to make sure that the material is understood. Finally, there might be some material (adult/pediatric neurology, possibly some genetics) on the shelf not covered by these resources, so there's really no way to prepare for those questions. The important thing is to be aware and not to freak out when encountering them on the exam.