 So as a resident physician, I get to work with med students all the time during these experiences. Some are absolutely amazing and others are cringe worthy. Today we're going to talk about how to make sure you're in the right group. Let's get into it. All right guys, welcome to the MD journey. My name is Lux. I'm a resident physician and internal medicine making videos just like this to help people just like you succeed on their medical journey with less stress. If you enjoy these kinds of videos, this piece of content that makes sure you help me out, go ahead and drop a like button on the corner. And while you're there, just go ahead and hit the subscribe button for videos just like this on a weekly basis. Given the recent news that step one is now pass fail. I made a video on this topic earlier. It's fair to say that clinical rotations and step two CK are going to matter more. So in this video, I really want to teach you guys the skills that really will help you separate yourself from the pack regardless of where you are on your clinical training. After working with med students for almost a year now, I can tell you I can probably predict what grade a med student would give just based off their presentations alone. That makes sense because your presentation can speak a lot of your clinical acumen, your critical thinking as well as your ability to manage as well as a rapport problem. So we're going to talk about some tips that I really want you guys to focus on when you're giving your next presentation on your rotations. And if you want a full breakdown on how to give a presentation, I've made a video before where I walk you through step by step on every phase of an HMP as well as an update for an old patient. So make sure you guys check that out. But first I want to talk about like a three step process to really get your presentation styled in and number one is to start with your plan first. One of the biggest things we'll talk about this later in the video is that med students will get into a reporting phase where you tell me kind of everything that's happened overnight and all of the medication changes. And let's be real, the attending knows what's going on, the resident knows what's going on. So you're not really telling me anything like it helps you potentially for your note, but telling me the overnight events isn't really pertinent unless the patient told you something that maybe they didn't share with another individual on the team. And the most important thing to remember is that your job as a med student is to practice being a doctor. And the doctor's job is essentially just to get the history is but to use that information to go ahead and make some kind of medical plan. So start with the plan first. And basically what this means is you want to start thinking about what problems does this patient have, what's problem number one, why are they in the hospital, what are they doing for them? What's problem number two that may also be going on? And then three to six or whatever may also be issues that they have, but things that are more chronic, but you're also managing in the hospital, things like diabetes, blood pressure, osteoarthritis, the right is pain. But problem number one may be acute heart failure or they're in an arrhythmia or they have COPD exacerbation. So first start with a list of asking yourself what's the most important problem this patient has and just go down from there. So that's part one of the three step process. But number two is ask yourself, what is the data say about each of the problems? So if your first problem for a patient is that they have pneumonia and that's what you're treating, then ask yourself what data points do I need to evaluate if I'm actually treating their pneumonia? So things you would be considering are things like their white cow, a chest x-ray, their vitals, like their heart rate, do they have a fever? How is their blood pressure? And also how are they feeling? Are they still coughing? Are they still having difficulty breathing? Are they on supplemental oxygen like a nasal cannula? Those are pieces of data, then you can now put into problem number one of a pneumonia to ask yourself, okay, is there pneumonia getting better? And then moving on to number three is ask yourself what changes could you make? You know, if you're already treating that patient with pneumonia with antibiotics, but their white count keeps going up, they keep having fevers, they keep having high heart rates and low blood pressures, maybe you need to change your medical management, maybe you need to change your antibiotics, or order new studies to see if you're truly treating what you thought you were treating. But that's basically the three-step process. Start with the plans and go ahead and prioritize the different problems. Number two is go ahead and use your data points to evaluate if each problem is actually being handled and managed improving. And then number three is ask yourself what changes could you make? If a patient is doing worse, what labs could you order? What medications could you put on to make them ideally feel better? And if they're actually improving, ask yourself what kind of things could you back off on? Maybe you're treating somebody with heart failure and exacerbation, you're giving them diuretics to help them pee, but they seem to have lost a good amount of their fluid and they're getting close to the normal weight, or maybe we can back off on their diuretics or start to switch them to a medication they'll probably will take at home. These are all great things to start thinking about, but as hard as a med student to jump to this phase, especially when we spend so much of our time trying to figure out what happened overnight, you know, what kind of things do I need to write in my note? Do I need to report their heart rates and things of that sort? Things get in the way. Start with the plan, ask yourself what data works, and then ask yourself what adjustments you need to make. So hopefully you guys found that helpful. We have a lot more to cover in this video, but I want to use it a segue that if you enjoy tips like that, drop them in the comment section down below. Make sure you hit the like button. I still honestly want to stick to talking about presentations because again, I can tell you what grade you'll probably get to space off your presentations alone. And then the second part of that is being thoughtful is really just using that three part system to say this is what information I have from the patient, from their objective data, from their labs, and these are the treatments that we're using. Let's see if we can make adjustments. And the last thing about presentations before we get to the remaining tips for the video is to get into story mode. Ask yourself, you know, when you're listening to a fellow med student give a presentation, how quickly do you just check out? And usually my answer is pretty quickly just because they'll give me again, BS information I just don't care about. You just want to know why is this patient here? What have you been doing? What are you going to do differently? And so one thing about being in story mode is you can understand what pieces of information are likely not necessary. If you put yourself in the shoes of the person listening. So is this data pertinent? If it's not, maybe I shouldn't talk about it. And worst case, if the person asks you about a piece of information, you can have that on your piece of paper without actually having to talk about it. So maybe you don't need to share the creatinine. But if the attending asks, you can share. And as a bonus tip, avoid reading your notes. I've had med students on rotations who would print out their daily progress notes and basically read it. You know, if I wanted to hear about your progress note, I would just read it. I want you to instead have practice working with your critical thinking and your thoughtfulness on putting their medical picture together and seeing how you would take care of them as a future physician. So the bonus tip on this is you can have a piece of paper, but honestly what I would do is I would include each piece of information that I really want to talk about my presentation. And then I would just put them in bullet points. So maybe bullet point number one and two are things that happened overnight, the things that a patient may have told you or an event that may have happened with a nurse in the last 24 hours. And then bullet point number three to five can be objective data. It's like they're vitals, important labs, changes in the physical exam. And then finally, you know, bullet point number eight to 10 can be changes to the plan that you want to make. I'll do this even as a resident. Well, I'll make a kind of a numbered list of their problems one through five. Because usually how many you take care of on internal medicine. And then I'll talk about any changes that I'm making. I'll just put problem number one, heart failure, exacerbation, arrow, lasix down. And that just tells me that I need to remember tell the tending we're going to go down on their lasix or their diuretic. Just by all means avoid reading your paper. It's nice to have it. Just make sure you make eye contact with the person who's talking to you and just don't be that med student who is in reporter stage. So the next tip is on that point. Number two, it's really focused on every aspect of managing the patient instead of becoming a reporter. Now a lot of these things have been echoed in the first steps. I'm going to move through this one quickly, but really the segue and the takeaway is understand that you are a future physician. Act like you're this person's doctor, not this person's medical scribe. You don't want to be in the phase where you're constantly just looking at information, looking at piece of notes and hoping that somehow that's going to help your tending and resident make a decision. You should get as quickly into making decision phase, even if your decision is wrong, because you're not going to be the one putting in the orders. Your resident will be doing it. Your tending will be doing it. So it's okay to provide suggestions and be completely wrong. So again, use the three step process we talked about earlier to get in that mindset of what do I want to do? I'm this person's doctor. You know, maybe unexperienced and somebody else maybe supervising me, but I want to see if I can make a decision and I'll see if that decision lines up with somebody with more experience. And one cool thing that's going to happen as you start to get in this mode is you'll start to pick up patterns. You know, I had a patient who I was paged about maybe two days ago. Nurses freaking out because the blood pressure is 78 over 40. And you know, immediately my mind goes to, okay, what's their blood pressure normally? It was in the 90s. So not that much different. Number two, what have we done for this person that may have brought their blood pressure down? They just had a procedure. We gave them some diuretics, their blood pressure medications went up. So it could be one of those two things. And as soon as I walk in the room, I already know, boom, boom, boom, these are the things I'm going to ask the nurse to do. These are the questions I'm going to ask the patient. And that's going to dictate kind of how I manage them. And sure enough, within 30 minutes, I was able to use these kind of decision pointers to help me kind of manage the patient. And within 30 minutes, their blood pressure was back to where it needs to be. And so you as a med student are also going to start to pick up these patterns. You know, maybe you see somebody's hemoglobin below on their CPC. So the next question is, well, why is that so? Are they always low? Is this new? Are they bleeding? Or are they just always anemic? Should we work it up? If so, what labs do I want to order? The first time you do this, you're going to have some fragments in your knowledge. Maybe you have an idea, but you're not sure what labs to order or what things to consider. So that's a great opportunity to discuss it with your residents, your attendings, and learn little bits of information that you may not have had. Next time you see a patient with something more similar, you have more to your repertoire to offer. And now, no, okay, the person is anemic. I'm considering A, B and C. These are the labs I want to order. And you start to feel more and more comfortable with different forms of diagnosis and problems. And so tip number three is to focus on building rapport with your patients. I cannot tell you how huge it is. As a resident, when I see a med student, I'm not expecting you to know a whole lot. If you do great, if you don't perfect, that is an opportunity for us to help you. But one thing you can do is practice your patient interactions because unless you're going into radiology or pathology, you'll likely be working with patients pretty intensively. And while your residents can help you build your knowledge base, we really can't do that much in terms of helping you build your rapport with patients. So one simple tip that I recommend is see your patients two to three times a day. See them before you round with the team, see them on around with the team, and then see them maybe after lunch or before you go home. This does a few things. The number one is that they just simply see your face more than they do on any other member of the team. I knew when I was a fourth year med student, I was doing my subirotation. My patients would think that I was their doctor and I was still months away from actually getting my MD. And that was simply because I just saw them multiple times a day. Sometimes it was just to give them an update or to check if something we had changed in their medical plan actually made a difference. In doing this, they were able to relate me to their provider where the attending may come see them maybe once a day, the resident may see them once or twice a day. So just build rapport by simply seeing them more, make sure they know your name, make sure you hear their concerns, and give them updates as the team allows you. And if you think that this is just another piece of corny advice, I recently had a med student where I worked with who's still learning a lot, relatively new in their rotations. Presentations were still about the low average. Knowledge Base was still getting there. We're working on it. But when we would go into their patient's rooms that this individual was working with, they would say, you know, this person's always here every single day. She takes care of me. They spoke very highly of her. And when you hear something like that, even if their Knowledge Base needs some work, that patient rapport sometimes takes superiority and allows them to get a better grade. And I feel like I did this on multiple of my rotations where many of my patients spoke highly of me because of interactions we had, but my Knowledge Base was still getting up there. I was still an inexperienced med student, but I would still get high evaluations and grades from my attendings simply because they saw the things that my patients said about me. And that's truly an important skill you need to build as a doctor. The Knowledge Base would come, but no one's really going to tell you how to talk to patients or how to interact with patients, how to deal with difficult situations. So get that practice yourself, build the rapport and make sure you're constantly seeing your patients throughout the day. As we're closing off this video, the last two tips are a lot more practical. I think you guys will definitely enjoy it. And tip number four is to do some kind of case-based scenario on a daily basis. A lot of the times as we're studying for our rotations, it's a lot of kind of multiple choice or just memorizing little pieces of information, hoping we can use them in the future. But sometimes we just don't get that much experience of coming from start to finish on how to manage a patient from kind of problem to treatment. And so one of my favorite resources that I use as a resident is NEJM, which is the New England Journal of Medicine. And they have these interactive cases. So if you get access to the New England Journal through your institution, then you can basically do these amazing cases where they'll give you a piece of information and you can start thinking about what problems or diagnosis you would consider in the patient, then they'll give you their vitals, they'll give you their labs. And you can keep using those pieces of information to start practicing your clinical acumen. And the most amazing thing about the resource is that as you're going through the case, you're going to get more bits of information. It's going to start giving you a little kind of learning modules on specific things. So, for example, one of the recent cases I did, the patient was getting a right heart cat, and then there was a kind of a learning module and teaching me all the different things that go into a right heart cat. And not only do they teach me, then the next slide is about four different patients with four different right heart cats that allows me to practice this patient broadly as this patient has this and this, and then it goes back to the original case. So you do a little bit of individualized learning towards different segments of that patient's care. And then you put it all together to understand kind of how to manage the overall condition they had. So it's a great piece of learning. And the best part is it doesn't take very long. Usually I can do these cases in about 10 minutes. So if you want to just kind of make this a transition between your studying or like do it at the very end of your day before you're going to go ahead and knock out or watch some TV. I think it's a great form of learning that doesn't necessarily feel like studying. And tip number five guys to wrap up this video is to keep a running list of all the things that confuse you throughout the day. Your residents will say things, your attendings will say things, medical jargon, they will read in the notes, and you have no idea what it means, but maybe you're too nervous or maybe you just don't have the time or opportunity to ask about all of them. I knew when I was a med student, I would hear the acronym TAVR all the time, which now going into cardiology potentially I know is a form of aortic valve replacement. But I was just too fearful to ask my residents and I didn't take the opportunity to look it up quickly enough. But it was just a very big lag time from when I first saw it to when I actually finally understood what it was. Keep a running list on a daily basis on like a piece of paper where you have the rest of your patient stuff. Just all the information that you hear that day, they just want to look up. You may not get to all them, that's okay. But maybe during some downtime or free time, you can quickly look up on your phone what an acronym means or how to treat a certain medical condition, what medications would be your best option, whatever questions you have, just kind of write them quickly and then just cross them out throughout the day. Because as you start doing this more and more, you realize you become kind of 1% better every single day and you start to separate yourself from your peers. Then when you go to your next rotation, you just know a little bit more because you've looked it up. Even if it took just a 10 second Google search, if your peers didn't do it, you just have a leg up and you can constantly start building on your ladder of information. But those guys were my various tips to help you on your clinical rotation and to stand out and keep in mind that I didn't mention anything like sucking up to your attending, bringing journal articles or being a gunner and being dismissive and rude towards your peer med students. That's because none of those things are necessary to help yourself stand out and do well. All of the tips that I've given you are things that you actually will have to continue to build on when your resident level as well as when you're a fellow in attending. It's all about becoming a better physician. So start practicing these little skills to help yourself get there. If you guys have more questions about how to do well on your rotations, comment them down below. But before you guys leave, if you are on your rotations and you want to kind of understand the full breakdown of each different specialty and rotation you may do, wants and assistance or wants and assistance on step two CK, now that they're becoming more important, you can check out one of the courses we have on the MD journey called crushing clinicals, which kind of takes you step by step through every rotation on how to do well, what resources to use, different tips to consider. Videos essentially like this one, but made for each individual rotation. You guys can also check out what other students in the past have thought of the course. So if you guys are interested, that'll be linked down below. But if you have any questions, let your boy know, drop them in the comment section like it's hot. And if you guys have somehow made it to the end of the video and that like button is still not pressed, go ahead and consider to help spoke the channel as well as this video, get out to more and more individuals like you who could use the benefit as well as the tips. And if you want more weekly videos just like this one, go ahead and hit that subscribe button as well as that notification bell. But thank you guys so much for watching this video. Hopefully I was a little help to you on your journey. Thanks for being a part of mine. Peace.