I’m sorry that you died before I got chance to hear your story. While I was fumbling around, trying to get blood from your dehydrated veins, you were trying to tell me about a special day you’d experienced 30 years ago. You were so proud and I promised to return some time later to hear about the day in full.

But I also cruelly cut you off mid-sentence because five other patients on my ward needed blood samples taking. My other 31 patients also needed critical and urgent tasks that I had to perform in order to keep them safe and help them heal. Right before you rapidly deteriorated and died, the last thing you experienced was a harried, overworked doctor interrupting your joyful reminiscence.

CENTOR score is a simple and easy way to assess the likelihood of a bacterial throat infection. Some places use the age modifier, some don’t. But the important thing is, once you know what you are looking for, it makes the job easier. 

Absence of cough

Tonsillar exudates

History of fever

Tender anterior cervical adenopathy

One of the things that I remember being important during Step 1 studying with regards to embryology is the pharyngeal arches/clefts/pouches. I have a concept map for these, but I can’t really take much credit for it because my drawing basically came from an awesome youtube video that you can watch here: https://youtu.be/r18fexJ-UnE (it’s worth the 20 minutes)

Dear rising MS3s,

Welcome to the big show - sorta.  Third year is this magical time where you are expected to know how to take care of real patients.  Rather than worrying about that, I am sure you are busy taking selfies with your white coat on and stethoscope around your neck while tweeting about how early you have to start getting up, #medschoolproblems.

This may come as a shock, but you are a clinical moron.  The sooner you accept that, the sooner we can move on to improving it.  I don’t care if you are coming off your 260 step 1 score, real patients don’t present with multiple choices.  All that score means is you are good at diagnosing and treating paragraphs of words, not people.  I am only saying this from experience.

When you start your first day on the wards you are going to realize you got pushed into the deep end of the pool, sans floaties.  Like someone truly drowning, you will be tempted to flail about, reaching out for anyone to save you.  Don’t.  No one has time to hold your hand, and you will quickly make people hate you if you constantly beg for advice/help/guidance, etc. 

Have no fear, I am going to give some tips to make the transition easier and help you look semi-competent.  Behold my list of life-saving resources for third year. 

1. Scut Sheets (http://www.medfools.com/downloads.php) - you will likely follow 1-5 patients while on the wards.  This sounds easy, but things move fast and you don’t want to be presenting old data on rounds.  Scut sheets allow you to organize your patient information in a way that is easily accessible and portable (iPads are great, but in my experience you can’t beat good old paper).  Further, the H&P sheets help to remind you of all of the things you need to examine/inquire about.  You don’t want to be the student who comes back to report on a patient with epigastric pain in whom you never examined the cardiopulmonary system.  Print a couple of each style to find one you like.

2. Stanford 25 (http://stanfordmedicine25.stanford.edu/index.html) - remember that time before step 1 studying, when you had to practice actually touching people?  That was called the physical exam, and you are expected to actually do that… on every patient… everyday.  Better refresh on it so you don’t look like a fool palpating the thyroid over the thyroid cartilage.  Go to the website, click “The 25″ button and see the 25 physical exam skills every student should know, along with detailed explanations.

3. MedCalc (http://medcalc.medserver.be)

Enough said.  Qx Calc is also worth downloading (http://www.qxmd.com/apps/calculate-by-qxmd).  

3. Journal Club (http://www.wikijournalclub.org/wiki/Main_Page) - I guarantee that during the year some jerk-off attending is going to ask you, “what is the best NOAC for atrial fibrillation?”  Obviously, like most, you will stutter because all you know to use in Afib is warfarin.  Then he or she will smile, knowing they have established their superiority, and tell you to look it up and do some sort of presentation.  Welcome to the best tool ever for such scenarios.  This wiki is run by a team of physicians who synthesize large trials into digestible snippets.  The app is well worth the money too. (The answer to the above question is apixaban, by the way, as determined by the ARISTOTLE trial; not that this scenario is based on a real event that occurred to me or anything). 

4. Smart Medicine (http://smartmedicine.acponline.org) - this app is amazing.  Seriously.  It is free to American College of Physician (ACP) members; and membership is free to students.  You should join just for this app.  This is much less cumbersome than UpToDate and will will make you shine when you present your assessment and plan (also, rumor is that DynaMed and ACP have teamed up to create an even more amazing tool that is coming out in August, also free to members).

5. Medscape (http://www.medscape.com) - this is an awesome resource that is free. Medscape is one of my go to apps for understanding disease pathophysiology.  Another feature, which most students don’t realize, is the articles on surgical procedures.  This is HUGE for your surgery clerkship.  You can read over the procedure, see relevant anatomy and know just enough to be one step ahead of this guy:

Plus you get updates on medical news, have access to practice questions, etc.  Get it, use it, love it.

6. Online Med Ed (https://onlinemeded.org) - aside from learning real medicine, third year is about preparation for the step 2 of the USMLE.  I advise finding a question bank and organized program to keep your studying on track throughout the year.  Enter God’s gift to med students.  This is one man and a mystical dry erase board that will make learning clinical medicine easier than cooking a Totino’s pizza.  And it is one of the few things cheaper than a Totino’s!   

So there you have it.  You now are better equipped for the coming onslaught of pimp questions.  My suffering is your gain.  Below I will list a few other apps I have used this year that were less important to my success.  Happy studying.

ASCVD Risk Estimator (http://tools.cardiosource.org/ASCVD-Risk-Estimator/) - I believe there is an app in the app store as well.

Anticoag Evaluator (http://www.acc.org/tools-and-practice-support/mobile-resources) - see the risk factors for coagulation

CDC vaccine schedules app (http://www.cdc.gov/vaccines/schedules/hcp/schedule-app.html)

Read by QxMD (https://www.readbyqxmd.com) - allows you to get medical articles directly to your phone using your institutional access.

Sensitivity and Specificity (http://lifeinthefastlane.com/techtool-thursday-055-sensitivity-and-specificity/) - link to the app and review 

I have such productivity guilt that sometimes I feel bad for being tired?? Which is kind of ridiculous and totally unreasonable. ^^; So please don’t be like me and let yourself be tired! Our bodies and minds are only capable of so much!