This list contains advice about how to function on the floor, how to study, and how to handle your work-life imbalance. Click through to find such advice as: • Whatever size scrubs you wear will be the least common size to find. Take as many pairs as you can find and stockpile them. • EVERY procedure in OB requires shoe covers. Better to not need them than to have forgotten them • Night shifts only come in two flavors: Insanely busy or so quiet you can not keep your eyes open. • The best residents will notice when you’re sitting around doing nothing and will send you home—the worst residents will forget you’re even there. • Falling asleep at 9pm is nothing to be ashamed of—in fact be proud of it. • Get comfortable with being uncomfortable. Best of luck all you new MS3s! ON FUNCTIONING ON THE FLOOR 1. The first day of every rotation is like a blind date: awkward, you never know what you’re getting into, you have no idea what you’re doing, you have no idea what you’re talking about, and you can’t wait for it to end so you can go home and reassess your choices. 2. You will spend about 40-50% of your time on any rotation waiting for something to happen or for someone to show up. 3. An additional 20-30% of your time will be spent following your residents around like a duckling. 4. You will at least once start following the wrong resident—long coats, they all look the same from behind. 5. There are a million things you CANNOT do as a medical student. 6. There are about a thousand things you CAN do, so whenever you find something you can do, volunteer to do it! 7. Be kind to nurses. Not only do they know way more than you about… well everything… they also have the incredible power to make your life easy if you’re nice or miserable if you’re mean. 8. You will get incredibly fast at prerounding because you don’t want to wake up a second before you have to. 9. Even if the residents show up dressed more casually, always opt to being slightly over dressed than underdressed as the junior member of the team. 10. Necessary skills: the ability to eat snacks out of your pocket while walking around on rounds because you know you won’t get to eat otherwise. 11. It will take you twice or three times as long to do something as it will take your resident to do it. That’s okay!! Take your time, do it right. 12. Figure out which days the hospital cafeteria actually has edible food, every other day make sure you bring your lunch—dinner leftovers are the best. 13. Medicine runs on caffeine. You run on caffeine. Your residents run on caffeine. The attending runs on caffeine. 14. Buy a backup white coat. You will spill something on yours at some point and won’t have time to do laundry that night. You need a backup because you can’t show up in a stained white coat. 15. Chain of command: Attending > Senior resident > Junior resident > You. Work your way up if you have a question. Seriously. Ask the junior resident the question first and then go up from there if you don’t get an answer. 16. Chain of command also applies when answering questions. If the attending asks a question, you as the medical student get the first shot at it. If you don’t know the residents are expected to answer. 17. It really is OKAY to say “I don’t know”. 18. If you think you actually know the answer speak up! Don’t be so afraid of being wrong or making a fool of yourself that you won’t try. 19. Help other students on your team who are struggling with something. Do NOT be a gunner. If a nurse tells you a piece of information about their patient, give it to them. If you know how to look up the blood cultures on their patient, teach them how to do it. The people in charge of your grade will notice you helping or not helping. 20. Do NOT jump in and answer questions that are not directed at you until someone else has the chance to answer and the question is opened up to the group. It doesn’t make you look good. It doesn’t make you look smart. It makes you look like an asshole. 21. Anyone who yells at you for not knowing something is an asshole. Don’t worry about them. 22. You cannot ask to be sent home. Even if you’re sitting there doing NOTHING and have been for the last four hours. You can’t ask. It’s bad form. Sorry. 23. Pick up whatever you can do to stay busy. Call consults and wait for people to page back. Walk down and see your patients. 24. Follow up on anything you said you were going to follow up on. 25. Do work for all the patients on the team. Not just your patients. If someone needs a PCP appointment scheduled after discharge, offer to pick up the phone and make the call. 26. Never ever ever ever ever ever ever ever lie about having done something on physical exam or having looked up a lab. If you didn’t listen to the guy’s lungs or look at his rash, just say you forgot. It is so much better to be honest and report that you forgot than lie and be wrong and be proven to be a liar. 27. Presentations on the floor should be succinct. Do not read off all of the lab values. The attendings are like ADHD children they have attention spans of about 30 seconds. Read the relevant details. 28. Remember what questions you got asked on rounds about each sort of patient. If someone asked you for the Ranson criteria for a patient with pancreatitis and you hadn’t calculated it, make sure you have it calculated next time. 29. The reward for answering a question correctly on rounds is being asked another more difficult question. 30. Either you like inpatient or you like clinic—not both. 31. Buy comfortable shoes. Spend the money. It’s worth it. 32. You will make mistakes. Own them. Admit it was a mistake, apologize, and offer to correct it. 33. Write notes on all your patients every day even if you don’t have to. It will help you get used to the practice of note writing and will help you organize your thoughts for a presentation. 34. Ask. Ask. Ask. If you don’t know how to do something, ask. 35. Ask to try. If you’re interested in doing a procedure, just ask. The worst thing that happens is someone turns you down. The best thing that happens is you get to do the procedure. 36. Put gloves on. Always. If you have gloves on you never know what someone will hand you. 37. Likewise in surgery, always ask to scrub. You can’t close if you’re not standing at the table. 38. 4 am comes really really early—learn how to get up at that time. You may need a louder alarm, an automatic coffee pot, or some other trick to get up that early. 39. Never leave the house without breakfast. NEVER. You may not get a chance to eat again until 3 or 4 in the afternoon. No food all day = BAD. 40. Learn how to sleep ANYWHERE. It’s important to learn now how to sleep in call rooms so you can do it by the time you’re a resident. 41. Whatever size scrubs you wear will be the least common size to find. Take as many pairs as you can find and stockpile them. 42. EVERY procedure in OB requires shoe covers. Better to not need them than to have forgotten them. 43. A 10 hour day becomes a “short day”. 44. It will not be unheard of that you will walk into the hospital before the sun comes up and leave after the sun sets. 45. Keep extra pens around. You resident will never have one. 46. You may be asked to do a presentation about a learning issue while on the floor—keep it short and sweet. You don’t have to read every research paper ever written on the topic. 47. Never be afraid to ask for help when you’re in over your head. 48. You will spend money on food or coffee in the hospital. It is inevitable. 49. Night shifts only come in two flavors: Insanely busy or so quiet you can not keep your eyes open. 50. NEVER try and guess what time you will be leaving the hospital—if you think it’s by 5pm, you won’t leave till 10pm. 51. The best residents will notice when you’re sitting around doing nothing and will send you home—the worst residents will forget you’re even there. 52. Don’t back out of doing something because you’re “just the medical student”. 53. When you call a consult, speak quickly and firmly. Don’t let someone else bully you into not seeing the patient. You know the patient better than they do. 54. Intermal Medicine will make you never want to get old. 55. OB will make you never want to have a baby. 56. Surgery will make you never want to have surgery. 57. Psychiatry will convince you that it’s too late and you’re already insane. ON HOW TO STUDY 58. There is never enough time to study. Never. Give up on feeling comfortable walking into an exam now. 59. Some days you are too tired to study. You were at the hospital for 13 hours, the idea of doing even one more second of medicine seems impossible. Take that night off. 60. Figure out what works for you and stick to it. Don’t get bogged down in the sheer number of possible resources for each clerkship. Pick one or two books MAX and just work through those. 61. Every shelf exam has at least 5 questions on it you would ONLY know if you had been a practitioner of that specialty for the last 10 years. Don’t worry about it. 62. Learn to split your time appropriately. You can’t spend all your time studying just working on the shelf. You also have to remember to be learning about the patients you have on the floor right now. 63. Ask your attendings and residents which patients would be best for you to follow, they’ll often point you to patients that have the types of conditions that are likely to show up on an exam. 64. Do lots of review questions. 65. Learn to study in the thirty minutes you have waiting for a surgery to start or the ten minutes you have waiting for rounds to start. These times may be the only chances you get to study. 66. Exam meltdowns are okay. ON YOUR WORK-LIFE IMBALANCE 67. Warn your loved ones. Tell them before you start third year that you will be busier than you were in the last two years. Warn them that you will be exhausted. Warn them that you will sometimes get up at 4 am and they should just roll over and go back to sleep. 68. Apologize to them profusely when you do. 69. Sleep when you can. You won’t get to as much as you need. 70. Learn what’s your functioning point. If you can’t figure out how to function on four hours of sleep, make time in your day for six or eight or whatever you need. 71. Try to make time for very important events. It’s okay to ask for time off to go to your brother’s wedding!! 72. Don’t let friends and family guilt trip you about missing the small things. It’s okay to miss Sunday night dinner sometimes because you are at work. You have to be there. 73. Do what you can when you can for the people you live with. Pick up dinner on your way home for the person that’s cooked you dinner the last 3 weeks. Do a load of laundry one night for the person that’s done yours. 74. Say thank you. 75. Get used to being late. Get used to being late for parties or dinner engagements because you got kept at work later than you expected. Always apologize for your tardiness. 76. Continue doing things that keep you sane: workout, talk to friends, draw, cook, play soccer. Don’t give those things up because you’re busy. You need the release. 77. Don’t expect to have standing engagements. Maybe you always had time for date night on Friday before, but now it may not be able to happen that night. You may have always made Thursday night soccer practice but sometimes you’ll be at work till 8 pm. Instead, be flexible. Have a date night on a Tuesday when you get off early by luck or kick the ball around with some friends on a lunch break. 78. Learn healthy coping strategies to handle your stress. Coming home and drinking a whole bottle of wine or eating a whole package of oreos every night is not a liveable method of dealing with the stress. 79. Eat healthy. Eat healthy. Eat healthy. This is seriously so important when you’re working 75 hour weeks and around sick people every day. 80. Wash your hands as often as you can. 81. Don’t work sick. Don’t do it. (You’ll do it anyway. I did it. Everyone does.) But don’t. 82. Sometimes spending time with loved ones is more important than studying. 83. Sometimes taking time for yourself is more important than studying. 84. Falling asleep at 9pm is nothing to be ashamed of—in fact be proud of it. 85. Don’t get stressed out about all your non-med friends getting married/having babies/going on vacation. Be happy for them and ignore the pressure that you’re somehow missing out on doing those things because you’re in medical school. TOP TIPS 86. Get comfortable with being uncomfortable. 87. Let yourself be human—if you want to sit down with a patient who’s all alone with no one to talk to, sit down. If you want to hold an infant who’s been abandoned by their parents, go pick up the child. Do not get so busy you forget how to reach out and touch someone. 88. There’s a greater chance than not you will at least once have to cry in the hospital. Someone will say something horrible to you, you’ll witness something awful, or something else will happen. Know where to go when that day comes: a bathroom or an empty closet is a good option. 89. Do not be afraid to make mistakes. You are a student. You should make mistakes. 90. One of the hardest things about third year is pretending to be interested in everything. There will be some specialties that bore you or some procedures or medical conditions you find to be incredibly boring. Try to pretend to be interested anyway. Remember that the doctors working in that specialty think that it’s the best thing since sliced bread. Don’t offend them by seeming bored. 91. There will be at least one rotation that you hate every second of. You hate the people. You hate the medicine. You hate it all. Get through it. Once you finish the rotation you never have to even think about that specialty ever again. 92. You will learn something from every doctor you work with. 93. Some of those doctors will teach you the kind of doctor you DON’T want to be. 94. Be prepared to learn more in one year than you did in the previous two years of medical school. 95. Someone will dislike how you practice medicine. They will tell you that you are too emotionally invested in patients or they will tell you that you are too efficient. They will tell you that you should do this or do that. You don’t have to change. You are allowed to practice medicine in the way that fits your personality. 96. Be accepting of constructive criticism. People will give you great tips about how to do a better presentation or how to do a more complete abdominal exam. Don’t take it personally. Listen. 97. Be unaccepting of unconstructive criticism. Sometimes someone will criticize your personality. Stop listening. 98. You may catch yourself being cynical. It happens. When you see it happening, try and shut it off. 99. Take chances. If you’ve never done something before, offer to try anyway. If you’ve never managed that type of patient before, give it a shot. If you have no idea what the plan for that patient should be, look it up and report it on rounds anyway. 9 times out of 10 you’ll be wrong, but you learn more by doing than by staying silent. 100. You are not ready for third year. You are not. You never will be. But you must forever be going to the edge of the cliff, jumping and building your wings on the way down. Source
