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2
How to Thrive Webinar Series
Family/Internal Medicine
Dr. Mark Duncan, author of
Shelf-Life Medicine
WELCOME AND INTRODUCTION
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What year in medical school are you?
A)
B)
C)
D)
E)
MS1
MS2
MS3
MS4
Pre-med
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BEFORE WE GET STARTED
• Qualifiers
• Wellbeing during the rotation and
avoiding burnout
• Doing well in each clerkship depends on
your interaction with the patient, the
team, and scoring well on the shelf
exam
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OUTLINE
•
•
•
•
•
Background
Part 1 – The Patient
Part 2 – The Team
Part 3 – The Shelf Exam
Q&A
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PREPARATION
• Know your team, where to meet the first day,
etc.
• Know what resources you will use to study for
the shelf exam in advance
• Have all your equipment ready to go
– Maxwell, pen, penlight, stethoscope, scutsheets,
reference material, study materials
• Scutsheets
(http://www.medfools.com/downloads.php)
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INPATIENT MEDICINE
• Very different than ambulatory medicine and
family medicine
• Structure:
– Non-call days: pre-round, run the list with the
intern/resident, rounds, help with the workload
(calling consults, procedures, outside records,
etc.) + educational activities
– Call days: same structure as above while admitting
new patients throughout the day (may formally
present the patient that day or the next day)
• THOROUGHNESS is key
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AMBULATORY AND FAMILY MEDICINE
• Ambulatory medicine and family
medicine are similar
• Structure: short patient visits, on-thespot assessment and plan, may work
directly with the attending
• EFFICIENCY is key
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PART 1
THE PATIENT
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GENERAL PRINCIPLES
• The patient ALWAYS comes first
• It may not feel like it, but you have much
more time than your residents, so read about
your patients and know each of them well
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PATIENT CARE
• Good rapport goes a long way
• Take full responsibility for your patients, but
still rely on the rest of the team
• A good history and physical exam,
documented in a well-written note and
presented during rounds, is FOUNDATIONAL
– Medical students are expected to be good
information-gatherers
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PROBLEM LISTING
• Inpatient:
– First problem: chief complaint, or most serious
problem
– Any other patient complaints, abnormal physical
exam findings, abnormal labs/studies
– Chronic problems
– Finish with FEN/GI/PPx, code, disposition
• Outpatient:
– Finish with health care maintenance
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REFERENCES
•
•
•
•
Medicine handbook
UpToDate
PubMed
Read case reports
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PART 2
THE TEAM
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“Show me a [med student] who only triples my
work and I will kiss his feet.”
- Law #11, House of God
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GENERAL PRINCIPLES
• Team structure, inpatient vs. outpatient
• How to impress your attending
–
–
–
–
Good patient presentations and notes
Teaching
Staying engaged during rounds
Being a team player and NEVER throwing your
coworkers under the bus
• Ask for feedback, letters of
recommendation
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PRESENTING YOUR PATIENTS
• Inpatient vs. outpatient presentations
• There is no perfect presentation, each attending
is different and has different expectations!
• A concise presentation is the hallmark of clinical
maturity, but you have to first earn the trust of
your team
– Include only the pertinent items
– Exclude extraneous information
• HOWEVER, you must first earn the trust of your
team before making your presentations concise
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PRESENTING YOUR PATIENTS
• Assessment/Plan section is where you display
your reasoning, and is how attendings will
judge you
• A good A/P sets you apart from many
students that act only as information
gatherers
• Oral presentation guidelines, Steve McGee
(https://catalyst.uw.edu/workspace/medsp/3
0311/202905)
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TEACHING
• Provide teaching to the team:
– Short summary of a topic
– Presenting a paper
• When and how this is done is
team and workload dependent
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PART 3
THE SHELF EXAM
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OVERVIEW OF THE EXAMS
• Inpatient Medicine: 110
questions, 2:45
• Ambulatory Medicine: 100
questions, 2:30
• Family Medicine: 80-100
questions, 2-2:30
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How do you feel about the Shelf exam ?
A)
B)
C)
D)
Prepared
Alright
Nervous
Freaking out
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GENERAL ADVICE
• Studying begins on day 1 (kind of)
• Read to learn, not just to finish the material
• Pick the resources that fit your learning style
the best
• Flashcards for important topics/questions
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QUESTION TYPES

Pathophysiology (AKA Step 1 type questions; eg, patient presents with hemoptysis and hematuria – mechanism
by which this condition causes renal damage is most similar to which other disease process? – bee sting, Graves
disease, SLE, poison ivy)

Diagnosis (eg, HIV patient coming in with fever, cough, and shortness of breath – what is the most likely
diagnosis?)

Next step (eg, Alcoholic patient presents to ED with confusion, ophthalmoplegia, and ataxia – next step in
management?)

“Health and health maintenance” (Other category with random questions about disease screening, prognosis,
ethics, etc.; eg, Older male patient presents with UTI, found to have urinary retention relieved with
catheterization, prostate exam revealed a diffusely enlarged prostate – he asks you about his chance of having
prostate cancer – or he asks you about screening with PSA
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RESOURCES
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Which of these resources would you consider
using? (Check all that apply)





Step-Up to Medicine
Case Files Internal Medicine
Blueprints Medicine
PreTest Medicine
USMLE World
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RESOURCES
• Text: Step-Up To Medicine, Case Files, (Master the
Wards, Blueprints)
• Questions: USMLE World, MKSAP, (NBME Practice
Exam, Pretest)
• Coming soon: Shelf Life Medicine
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Q&A
???
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Thank you for
joining us!
Make your calendars for the next Thrive
webinar on Physiology with Dr. Linda Costanzo,
author of BRS Physiology,
Tuesday January 20th at 8 pm (ET)
www.amsa.org