OMS III and OMS IV

Developed by Emily A Burk: Clinical Clerkships Director, SOMA National Board2012

A Comprehensive Overview for Success and Happiness the Next Two Years of Your Life

Relax

• Okay, so you are probably an OMS II and freaking out about COMLEX Level 1.

• Stick to your schedule.

• Study your best.

• Everything will be fine.

• GOOD NEWS: Third and Forth years are AHmazing!

Overview of Topics• First Day

• How to show up your first day

• What to bring

• Hard lessons

• Professional Development

• Have these on hand

• Specialty???

• Scheduling OMS IV

• Time Line

First Day: Showing Up

How to Show Up Day 1

• Be Confident

• You have learned a lot, no matter how much you have forgotten, you know enough to succeed from the start

• Most preceptors appreciate confidence. Own what you do. Defend what you do with MEDICAL KNOWLEDGE. You have it

• Be Prepared

• Scope out good study sources before your rotations. Know where to look up quick facts you may need during the day or right when you get home.

• Pens, small notebook

• Stethoscope, etc!!!

***No one can fault you for writing a thorough note, having the appropriate paperwork/pt forms and trying

How to Show Up Day 1

• Be Resourceful

• The first day- find out where order sheets are kept, find out where protocols are kept, navigate the EMR extensively. Know how to do these little mundane tasks.

• Ask the MA’s in the office / scrub nurse / residents EVERY question on day 1.

• Day 1- valid question. Day 20, “what have you been doing here?”

• Be Nice

• Be sincere, it’s okay to say you’re nervous if you are, then move on.

• Be nice... to EVERYONE. EVERYONE. Even the mean nurse.

First Day: What to Bring

What to Bring

• In Your Pocket

• Bring a note sample for whatever rotation you are on

• “Google it” and print out a delivery note, a postpartum note, an orders set for OB/Gyn (or post op note, or mini mental exam...)

• ****Medfools.com -SCUTSHEETS- a great site for this. IM and ICU Scutsheets are indispensable!!!!!****

• Maxwell’s isn’t really enough

What to Bring

• Epocrates

• Mobile apps for medications

• Or bring out old pharmacology notes (Antipsychotics, TCAs for psychiatry rotations) and review core meds for the specialty

• Every medical device you have

• Stethoscope, pen light, reflex hammer (err on the side of too much)

What to Bring

• A book. You WILL have down time. Maybe even day 1.

• A smart phone if you can read for a long time on it. (iPads you can’t always carry with you and cannot set around, but a matter of preference)

• Buy your LEVEL 2 COMLEX review right away and use it. You should be writing notes in it all year (I liked First Aid for Step 2 and OMT Review- the green book)

• Case Files, Blueprints, PreTest, StepUp, First Aid are all book series with rotation specific texts. Don’t get locked into one “line”. Buy the best book.

• StepUp to Medicine is a personal favorite of mine for Medicine and has overlap into many others.

What to Bring

• Question Bank

• A really good investment

• Buy one and stick with it. I think it’s a wash brand to brand

• Just get through all of the questions

• Personally, I think this is the best way to study each month, of course looking for more thorough explanations on topics you have completely forgotten

What to Bring

• Other Apps

• Skyscape (Android) / Medscape (iPhone)

• iRadiology (iPhone)

• NEJM App (iPhone, Android)

• OMM Guide (iPhone)

• Glascow Coma Scale (Android)

First Day: Hard Lessons

Hard Lessons

• It’s stressful to start a new “job” every month

• Sometimes you will feel like an idiot. Sometimes your preceptor/nurse/resident will make you feel like an idiot

• Don’t take anything personally

• A good technique with a “mean” preceptor is to “Throw up the Bubble”. Imagine yourself as the “bubble boy” and all the Doc’s rantings and yells bounce off. No one knows why the Doc’s upset. They certainly don’t have anything personally against you, so don’t listen. Zone out rantings, yelling, and any hurtful words. Just ignore it. *I have personally only have done this ONE time in two years, but it happens. And I was saved by this technique*

• Cold hard fact- its your education. You are there to get it

Hard Lessons

• Medical knowledge is important, but don’t expect your attending to give you personal 3 hour lectures. Expect them to teach you what they have found from experience, and to guide you to important studies. You can - and SHOULD - be reading the basics by yourself.

• Be grateful for any attending or resident that personally teaches you

• Clinical years are the GESTALT of patient care. Putting together the big picture on patient care, and learning how health care facilities run.

• The big picture is key, but a tiny abnormal lab value is vital- a delicate balance you will be learning the next two years. (err on the side of too much information)

Professional Development:

Have these on Hand

Have These on Hand

• When you are on a busy rotation and are focused on doing great and are reading for hours each night, barely eating dinner and rounding at 4:30 am....

• Don’t forget to ask the attending that loves you for a LETTER OF RECOMMENDATION

• It’s NEVER too early. But can easily become too late

• To ask, it helps to have a LOR folder on hand. FROM DAY 1. I asked for a LOR after my very first rotation!

• Contents discussed in a few slides...

More on LORs• WHO: Any doctor that admits will write you a good letter. Ask “Do you

know me well enough to write me a good letter of recommendation?” This gives them an easy out if they really didn’t think you did spectacular.

• WHO: As you narrow the field, a doctor in a specialty that makes sense. Orthopedic surgeons probably don’t value a letter from a Family Physician as much as a surgeon they went to residency with, a well published orthopod, the general surgeon from their hospital....

• WHEN: Ask your last day or two or very shortly after the rotation. They (sorry) may not remember you in 14 months when you start applying. Give them a reasonable deadline- a few weeks to 2 months- so they get to writing.

• WHEN: Don’t be offended if they keep forgetting to write the letter. Call them. Revisit them. Leave Post-it notes. Call again. Fax them your file again. None of my letter writers were prompt. AND on residency interviews, I was always told how great my letters were. Late does not equal bad. They’re just busy people.

• WHAT: CV, cover letter about you, cover letter with info- next slides

• THEN: WRITE A HAND WRITTEN THANK YOU

Have These on Hand• #1. Always, always always have an up to date resume handy

• Saves you time when you need one and you don’t have to start from scratch

• Avoids typographical errors and errors of transcription

• A good resume is a work in progress and should be a time consuming task

• Not the thing to rush through

• Addendum: On a February 2012 NPR interview with a NYTs writer, the importance of CVs was demoted in this age of online applications. Tailoring your experiences into the online format for application to include specific key-words seems to be the new trend in hire. However, as we are in a professional that still uses hard copy CVs- even if just for LORs- I highly recommend having a CV on file. It is useful to have a clear, concise description of the activities and accomplishments you are involved with. And if nothing else, helps you cut and paste into your ERAS application.

Have These on Hand

• #2. A cover letter for recommenders / writers

• Many schools have a particular sheet with fax number, etc

• If your Clinical Office does not have one, have the fax number, a statement or your waiving the rights of seeing the letter, and general instructions. TYPED OUT, ready to be handed to an attending that will sing your praises, your ERAS ID# (you won’t have one till early 4th year, leave it out until then)

• #3. A letter addressing “Dr. Smith”

• Consider having a letter expressing thanks in advance, a DUE DATE for the letter, and maybe some basic background about you- where you grew up or anything particular gives the writer a better “big picture” of you

Professional Development:Specialty???

Specialty???

• You aren’t supposed to know yet

• If you do, statistics show, you’ll likely change

• Be patient with yourself

Specialty???• Get exposure

• Talk with other specialists on the floor

• Ask doctors what they like / dislike about their fields

• Pay attention to the medicine (physiology) vs patients (sick, ICU, derm) vs lifestyle (call, nights, shifts)

• Iserson’s Guide to Getting a Residency is a great resource for this and has an extensive quiz you can take

• Cover your bases

• If you are considering orthopedic surgery, dermatology, ophthalmology you might want to lay the road for that

• Easier to decide Internal Medicine or Family last minute than ER or Anesthesiology

• Err on the side of too much preparation and draw back

Specialty???

• Go with what feels right (I know that is totally frustrating, but also, totally true)

Professional Development:

Scheduling OMS IV

Scheduling OMS IV

• Considerations:

• COMLEX LEVEL 2

• AUDITION ROTATIONS (you cannot control the programs’ schedule)

• REQUIRED ROTATIONS

• FAMILY / VACATION

Scheduling OMS IV

• COMLEX LEVEL 2 and PE:

• Do your PE early enough to get your grade back to graduate (December - January at the latest)

• Make sure you are on vacation or can miss time to travel on a rotation

• LEVEL 2 is possible without taking a month to study. Third year prepares you well if you study on your rotations

• Studying during a general medicine month, family month (patients are review) and you’ll have some at home down time; or light hour rotations will be conducive to studying without taking vacation time

Scheduling OMS IV

• AUDITIONS: Competitive specialties (Anesthesiology, Dermatology, Ophthalmology, Orthopedics)

• FILL UP FAST

• Start looking into application for rotation dates in October and November

• Make a list (Excel, notecard) for each program and call until you can schedule a rotation

• GO TO THE PROGRAM GO TO THE PROGRAM GO TO THE PROGRAM

• If you are interested in attending top program, do your research to find out which are best. My best advise is to ask school department advisors, attendings, attend conferences in the specialty, contact physicians to discover the best programs.

Scheduling OMS IV

• AUDITIONS: Less Competitive Programs

• Narrowing down is key

• Location

• Big hospital vs small hospital

• Didactics

• Program / class size

• Personality

• Hometown

• Family

•Considering these things will greatly aid in narrowing your search. This things do matter, so don’t feel bad considering them

Scheduling OMS IV

Program A+Med Ed: (517) 123-4567 (Nancy)

Scheduling Starts: 6 months from start dateApplication- needs Level 1 ScoresProgram Director: Dr. John Smith

___ Scheduling submitted (Dates #1, #2, #3)___ Confirmed (xx/xx/20xx)

• Stay organized in your search

• An idea to keep track of programs, notecard

Scheduling OMS IV

• BUT I STILL DON’T KNOW MY SPECIALTY OR WHICH PROGRAMS TO CHOOSE

• But this is my first rotation, I don’t even know if I’ll like being any kind of doctor...

• Third year you WILL get a sense of what you like

• Pay attention to the differences in your rotations and what you like / dislike

• Size of hospital, size of program are good quantitative measures to compare programs

• Call the programs. Ask questions. No one knows it’s you. You have a valid reason to be asking all of these questions! You may spend four years there!

Scheduling OMS IV

• The schedule itself

• Many schools offer leniency, many don’t

• July - December is the time to try out programs “audition rotations”

• Better too early than too late

• You can call the program and ask the best time check it out

• You can ask when interviews are conducted

Timeline

Scheduling OMS IV

NOW: pass level 1

2 weeks before you start:order board review book.

order rotation specific book

1-3 days before you start:print/make note samples for your

specific rotation, gather exam equipment

ROTATION!

Relax

1 day before you start:how long will it take you to arrivepack a lunch if you’re in an office

Scheduling OMS IV

ask for LORs

November: Look into programs if you are doing a

competitive field

September - January:

Interviews

OMS III rotations

ROTATION!

November/December: Start calling medical education

departments and expressing interest, get details of their

timeline

February: Scheduling underway

May: You should have an idea of what you are really going to do. Maybe down to two.

August: ERAS application opens

July - December: Audition

Rotations!

June/July LEVEL 2

OMS IV rotations