Advice for 3rd year is very difficult to give as each experience is variable as is

each students studying strategy. Below is a description of one AOA members

approach to the 3rd year and advice on how to succeed.
Books: I used one book as a base for each block which I read first adding
notes into it like we did with FA for boards. I did this in order to have one
source to review important points the week of the shelf. For this "base" book
I either used First Aid for each specific rotation (not FA for step
2) or Kaplan notes (there are circulating copies of them). I also used Case
Files and Pretest for each block as well as the Kaplan Qbook questions
(also circulating copies). Again, I am not a text book reader and need to go
over things multiple times before they stick. These aspects of my studying
style guided my schedule and choice of books. If yours differs, you may need
to tailor these suggestions to fit your learning style. Here's an example of
how I set up my studying for each rotation:
week 1: read FA or Kaplan notes (depending on what I chose to use as my
base book)
week 2: read Case Files - taking notes from case files into my "base" book
(what wasnt already in there, or highlighting important points)
week 3: Pretest questions - taking notes from questions in "base" book
(these are generally harder than the qs you will face on your shelf, which is
why I liked them b/c it made the shelf qs not seem so bad)
week 4: review "base" book with added notes and do Kaplan Qbook
questions
Time periods were extended for longer rotations, however longer rotations
generally cover more material so be wary not to get behind. Also I would
highly suggest stuffing case files/pretest into your white coat pocket (fits
perfectly in the inner ones) for down time while at work/on service - some
rotations have more than others. In terms of my "base" book I used the First
Aid series for Psych and OBGYN and Kaplan notes for Surgery and Peds. I
chose these in particular because they were short enough that I could review
them the last week of the rotation for the shelf but seemed to cover the most
salient points. Rotation specific notes:
Medicine: I read Step Up and didnt really feel like I got a lot out of it, but
dont have a good alternative. Maybe blueprints? I would try to get through
as many questions as possible for this block as you will get Qs from every
field on your shelf. MKSAP questions with explanations were very
good. Kaplan Qbook has 8 tests (400 qs) and if you do those along with
mksap you should be in a good spot (although I didnt and dont know if this
is possible with time allotted for studying). I hadnt yet gotten into my
pretest groove for this rotation so Im not sure what to tell you about those
questions. This is a long rotation but be sure to pace yourself with studying,
there's a fair amount of material covered.

Surgery: When on service I would try to look up the cases I was going to
scrub for the next day (if you're here Charity or the new person who serves
as Charity will send the schedule out, if not ask your chief) and briefly looked
up indications, contraindications, complications, relevant anatomy for the
next day. A good resource for this after "surg recall" and your kaplan/FA notes
are the specialty specific electronic books found as links on our library
website listed under the "electronic books." Once you've done this for a few
on each service, you will see repeat cases and wont have to do this anymore
so you'll still have time to study. I used NMS surgery casebook instead of
case files, but have no recommendations for or against this approach. I
ended up loving the case files series and didnt think NMS was stellar, but I
read it instead as the previous 4th yrs told me they thought the case files for
surgery was the weakest of the series. I think NMS may be more detailed in
its discussion and breadth of cases when compared to what I know about the
case files series. I also did questions from appleton and lange but thought
they were too short (unlike the shelf questions) and were too straight
forward. The shelf is heavily weighted in the medical management of
patients perioperatively and trauma considerations.
Psych: Very straight forward and our second yr classes prepped us well for
this rotation. Do a lot of questions b/c the diagnoses can have subtle
differences that are sometimes hard to pick up on with the first pass.
Family: There arent any Kaplan notes for family so I just used Blueprints as
my base book. There are also no Kaplan Qs for family or distinct Qs from
USMLE world (they're both merged with medicine) but I thought pretest was
enough for the shelf.
OGBYN: Again I think questions is the name of the game here. I would
definitely do the UWise questions they recommend. They are solid and
supplement the Pretest Qs well. I would also definitely read through
blueprints for this rotation as it is the best of the series. This translated to
one book per week (wk1 -FA, wk2 - blueprints, wk3 - case files, wk 4 - UWise
Qs, wk 5 - pretest, wk6 - review).
Peds: nothing really unique.
On the Wards:
One of my first attendings during medicine (my first rotation) said this and I
think it really put into perspective what was expected of medical students as
we advance through the clinical years. He said that each year our role
progresses through the acronym R.I.M.E = Reporter (3rd yr), Interpreter (4th
yr/Intern), Manager (resident/senior), Educator (senior/attending). This meant
that at beginning of third year we should be proficient at gathering
information and reporting it (the S&O part of the SOAP note). Throughout

third year we would become better at interpreting the gathered information

and formulating a plan (the A&P). For now this means you should get
proficient at thoroughly gathering information while taking a stab at
interpreting it and formulating a plan. You will get better at asking the
important questions/looking for the important signs as you progress through
third year and experience will help you know what is important on your
presentation, but for now just focus on being thorough. Your attendings/team
will further guide you with their questions and suggestions.
In terms of reading up on your patients, if you encounter something you
dont know or you need to brush up on go ahead and find an uptodate/NEJM
article about it but otherwise dont go crazy. I pretty much started third year
looking stuff up on every patient because I thought that was what was
expected. I feel as though I wasted a lot of time reading detailed articles
when I should/could have been reading to learn the general principles.
However, bringing in a pertinent article for your team/for rounds on a
particular subject is a great way to impress your team and show your
interest. Bottom line: you should be looking stuff up, just put general
studying first and don't go overboard.
Never be afraid to ask to do more in terms of patient care. If you want to go
see a patient, perform a physical on a patient with abnormal findings, or do a
particular procedure just ask. This is your opportunity to learn and everyone
knows that you are paying the big $$ for this. You will learn much more from
hands on experience than from shadowing. Now is the time to experiment
and try things you never thought you might get to do without consequence if
you are unsure of what you are doing or perform something incorrectly. So
dive right in and get your feet wet (hopefully not with blood).
Things I wish I knew about presenting when I started third year: Your
"assessment" is extremely important as it ties everything you have said
together. Be sure to mention all salient points leading into your plan (ie POD
#2 s/p herniorrhaphy with +BS and flatus if you want to advance diet in your
plan). Also your assessment will remind the team/attending of what you have
just gone over as attention spans wax and wane through presentations (esp
those 20 min medicine presentations) and they may not have caught
everything you said. As you get better at presenting you will start to paint a
picture with your S&O part demonstrating the pertinent positives and
negatives of the history/physical/labs based on your differential and leading
towards your plan. Again, this is what you should try to work towards but not
what is expected of you at this point.
Pimping: At first I was afraid to be put on the spot in front of a team and
thought that if I didnt know the answer it was going to reflect poorly on my
evals. I then realized what the purpose of pimping was. They are attempting
to get you to think like a physician and pass on pertinent teaching points

with their questions, not embarrass you. 1/2 of the time they dont even
expect you to actually know the answer to the question, but get excited
about something they think is important that most people might overlook or
not consider. Take it as an opportunity and a learning tool instead of a
challenge to your intelligence. If you get something wrong or miss something
(which you will), you will remember it much better than if you were never put
on the spot. Speak out loud as you think through their question - this
will show them what you DO know (even if you dont get to the right
answer) as well as demonstrate your thought process.
Some things to consider as you progress through third year: always ask
yourself "why/what" when coming up with an assessment and plan (why did
we order this test - what are we going to do with these results?, what is on
our differential diagnosis/what is most likely? what are we doing to rule in/out
our top conditions on our differential? why are we treating with this abx what are we covering for? What is the next step? What labs are we/should we
order, why? etc.) This is how you should be thinking when you're responsible
for the pts as an AI, and is how you will start "interpreting" what you have
gathered in order to formulate your plan.
Some specific things that I picked up at the end of my 3rd year which will
impress your team if you consider early on:

Lines - be aware of what lines your pt has (central, IV, NG), why they
were placed, and how long they should stay in/when they could come
out (as you are aware every day a line is in is a greater risk of infection
so this is very important to keep thinking about each day and ppl can
often lose track of them)

Lab schedule (look this up under orders on powerchart- ie BMP ordered

qAM) - do you need daily BMPs - what are you looking at with the labs,
what will the results tell you? this will help you decide when you should
increase/decrease what you are running based on what your are
testing for on your differential/what you are monitoring

Diet - TPN, NPO, softs, clears, diabetic, etc. when to advance, when to
alter

Dispo/discharge - what social services are needed, what needs to

happen for this patient before D/C.

Sometimes it is very helpful to think of/present a plan based on

systems- especially with complicated patients that need many tx in
different areas (ie CNS, CV, Heme, ID, FEN/GI, Renal, Lines, Labs,
Dispo, etc.)

What do you do when rounds are over/cases are finished? Whenever there is
down time, always asking the team if there is anything you could do to help
goes miles. In doing so, you will learn what is important in patient
management (contacting outside physicians, updating sign outs, checking up
on labs/tests, planning for discharge, etc.). Also as you progress through
third year you will become an integral member of the team, accepting more
responsibility, which means that what you actually do will start to matter.
Therefore when the team gets comfortable with your skills they will ask you
to do things that will actually be helpful and purposeful to patient care which
is where you will learn how to fully manage patients. In addition, if there isnt
anything that can be done, this will also afford you a way off of work/time to
study if they say 'no'. This is usually how I started to ask to leave or if it was
too early for that, just sit and read the book I had with me.
When they tell you to leave - do it! It took me a while to accept the fact
that this was not a test of my will to learn or dedication to the rotation/team.
Mostly they are saying that the education you would receive from staying is
less than that you would gain from studying so take the opportunity to
bounce and get your study on/enjoy your afternoon/evening off.
Affiliate site rotations
I remember the unease of having to leave and not knowing what I would
need at each site. I just thought Id give you a few essentials that you should
bring wherever you go:
- power cords/extensions
- extra lamp/clip on light - lighting can be very poor at some locations
- shower shoes/flip flops for dorm living
- your own sheets/blanket/pillow
- lock (potentially useful if roommate unknown)
- alarm clock
Attitude: Having known what I want to go into from before med school
started I can attest to the fact that when going through some of these
rotations it is hard to stay motivated and excited about what you are doing,
especially when you know you wont need the expertise once you graduate.
Just remember as you go through each rotation, the purpose of medical
school is to become a well rounded physician while residency is to become
proficient in your field of interest. If you know what you are going into, there
are aspects and teaching points from each rotation that will apply to your
future career. Focus on the positives and the pertinent fund of knowledge
and it will get you through rotations you may not be interested in. There is
nothing worse for a team or an attending than a student that doesnt try or
doesnt show any interest. Ive been on rotations with students who have
taken this attitude and it brings the entire team down and definitely gets
reflected on evals. I can attest to the fact that the opposite holds true as well
- a positive attitude can significantly impact your evals. Asking questions is a

good way to learn, and can demonstrate your thought process to your
team/attending as well as can show your interest and inquisitiveness. There
is obviously a time and place for them (I would generally start low to high intern upward) but if used appropriately can be helpful in many ways. Teams
are usually impressed with students that are excited about learning
(especially if they know that you are not going into the field you are rotating
through - more true for the 2nd half of 3rd yr). I know this goes without
saying, but third year can wear on you with its long hours and it is important
to remind yourselves of this point when the going gets tough.
Good luck and again feel free to contact any of the AOA members who have
provided their emails for mentorship purposes which can be found on the AOA
website!