I’m halfway through my third year of med school. I’ve already completed family medicine, general surgery, pediatrics and internal medicine rotations (along with the shelf exams for each). Somehow, I’ve reached a realization that I never saw coming: I miss studying for Step 1. Yep, I said it.

While I have enjoyed third year (for the most part), I really dislike studying for shelf exams. Aside from UWorld, everyone recommends different resources. Online Med Ed is nice, but it makes me miss Boards and Beyond. You have to muster the energy to study after coming home from a long day at the hospital or clinic. And suddenly, residency applications and the match, which once seemed so distant, are now closing in faster than Troy Polamalu chasing down a ball carrier in his prime. The beast of Step 1 has been conquered, but a million other anxieties rear their ugly heads: away rotations, evaluations, letters of recommendation, and so on. In short, you no longer have one “big thing” to focus on, but rather a myriad of small things that you need to attend to.

I miss having that one big thing to focus on. I miss the process. I miss having complete control over my day-to-day routine. So, since I’ve been reminiscing on that journey, I’ve decided to finally publish this post (which I wrote like 5 months ago). Here you’ll find a collection of Step 1 advice that didn’t seem important enough for an entire post. I’ve sorted the advice through the following phases: first year, second year (pre-dedicated), dedicated, test day, and post-test.

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In the third and final installment in my three part series on my general surgery rotation, we’ll close out with the fun stuff – my favorite quotes and conversations from my surgery rotation. Some were funny, some were insightful, while others simply made me smile.

For reference, GS = General surgeon, PS = Plastic Surgeon, PGY = resident

To check out my favorite quotes from family medicine, check out End of Rotation Review: Family Medicine

Enjoy.

• [Closing for the first time after a lap chole on my first day]
• [Surgeon]: Did you actually try to suture or, uh, did you just watch those wounds heal naturally? I mean, I could’ve eaten lunch and run three miles in that time. And look at me – I don’t run fast.

• [Anesthesiologist]: So do you know what you want to do yet?
• [JS]: Not entirely sure, but I know it has the be in the OR.
• [Anesthesiologist]: Well, would you rather sit or stand?

• [Surgeon talking to new intern]
• [GS]: Look at this young man. Nice beard. Polite. Smart. Worked his ass off to get where he’s at. And now he has to listen to me bust his balls and there ain’t a thing he can do about it.

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If you read my End Of Rotation Review of General Surgery (aka a synopsis of my experience), you know that I not only had an excellent educational experience, but I also made some friends along the way. Know that hospitals and institutions vary widely in culture – use any advice I give with extreme discretion. Have situational awareness. Stay out of the way. Don’t do anything stupid. Try to be helpful where you can. And have some fun.

Here are my 9 rules to honoring your general surgery rotation.

1. Be Kind and Respectful to Everyone

The most basic advice on this list, yet often overlooked. On your rotations, you’re not going to be remembered by the number of pimping questions you got right; you’ll be remembered by how you treated others and how you assimilated with the team. No one is below you. Not the nurses. Not the scrub techs. Not the orderlies. They’re all people the same as you.

So use those manners momma taught you. Smile and say good morning, even if you’re tired and don’t want to be there. Show up on Mondays and ask, “how was your weekend?” Simple stuff like that. When they realize you’re a genuine and kind person, they’ll look out for you. The scrub techs will make sure you get a good spot at the table. The nurses will help you in any way they can. The CRNAs/Anesthesiologists might even let you intubate. As a rule going forward, the better you treat others, the better your experience will be.

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So as I wrote in my previous, and first, entry to my “End of Rotation Review” series, family medicine was super chill (click here to read it). My attending was very empathetic to the med student experience and ensured that I had a good time during my month with him.

During my last week, he said to me, “are you ready to get your ass kicked by surgery next?” Most med students dread surgery as it’s notoriously known as an arduous, soul-crushing experience. Despite being pretty sure I wanted to go into a surgical field, I was a little bit intimidated. It’s natural. I had shadowed a handful of surgeons in the past few years but only scrubbed once before. As a first year med student fumbling my way through the foreign land of the operating room, I was kicked out of the procedure for breaking sterile field twice. Not my finest hour.

After showing up on my first day dark and early, I waited to meet the educational coordinator person (idk what her title is) who didn’t arrive until forty-five minutes after we had planned. After a brief tour of the O.R.’s, pre-op, PACU, endoscopy suites and all that jazz, I eventually arrived at my attending’s office, sat down and discussed the expectations for the rotation. “Do you know what you want to do yet?”, he asked.

As always, I like to keep my answer to this question relatively vague (i.e. if you’re on pediatrics, hate pediatrics, and would rather quit med school than pursue it as a career, you keep that to yourself and say you’re undecided but interested in what every specialty has to offer). However, it was surgery, and I want to do a surgical subspecialty. I am still remotely considering anesthesia as well. So I conveyed this to him.

He outlined the plan:

“So recently we’ve decided to start doing something different. You’re going to do whatever you want. You are not going to be tied to me or any other attending. You have the freedom to make this rotation yours. If you see something on the schedule that interests you, ask if you can scrub in. You pay so much money for every day you’re here and you have so little time to explore and figure out what you want to do for the rest of your life.”

These were his terms. My grade would be determined by comments from surgeons, residents and other staff. As long as I logged enough bread & butter general surgery cases (lap choles, appy, hernias, etc) and worked hard, I was given full freedom to spend my time with whatever specialty, surgeon, and procedures caught my interest.

Again, I struck gold.

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The two months (or whatever) of the autumn season is probably the only time in the calendar year I can say I’m actually not jealous of those who live in more stable climates.   I mean, just look at those colors – pumpkin orange, marigolds and bright red. It’s beautiful, man. Spooky season. Football and chili. Cozying up with a scary movie. Crisp weather and cool fashion. Ghastly decor and candy that we don’t need. Memories and music. Something about the fall is so introspective, nostalgia-inducing, and eerily atmospheric.

This aint your typica fall playlist full yawn-inducing acoustic indie songs tailored to the Pumpkin Spiced Latte crowd.   Certain songs, albums, and even particular sounds are associated with the crisp cool air of the autumn season.

Here’s a collection of my favorite songs that perfectly capture the fall atmosphere. (click the song titles for a link to each song)

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Another day at the office.

Snooze on the alarm clock as many times as you possibly can. Quick shower. Get dressed. Lace up the oxfords. Burn your tongue on cheap coffee. Fix your tie in the car mirror before walking in.

Another day at the office.

Say good morning to the staff. Make small talk with the attending physician. See some patients. Present them. Get asked, “well what do you think? What should we do?” Trepidly reply. Get it wrong. Feel stupid. Get the next one right. Feel smart. Here’s your cookie for the day.

Another day at the office.

Patient after patient. Well check. Med follow up. Ice and ibuprofen. Antibiotics. You’re fine. Refer to ortho. A day in the family med office. A fine-tuned machine with the health care tyrant’s corporate logo plastered on every wall, white coat, and welcome mat. The TVs in the waiting room no longer play the news; rather a 30-second loop of stale advertising from our overlords.

Lunch time is approaching. See patient in room three. Do the little half-hearted “doctor knock” on the door as you’re opening it. Goooood morning, I’m Jsoze and I’m a third year medical student. I’m just going to ask you a few questions and do a quick exam then we’ll get the real expert in here. Chuckle chuckle. What brings you in today?

She was in her late twenties. I think. Maybe thirty. She was dressed in fashionable clothing. Diamond ring on the left fourth digit. Though well put together, she appeared to have malaise. Perhaps she was ill. She said, I am depressed.

Then tears welled up in her eyes.

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Third year began with the familiar anxiety that accompanies each transition in life. In my case, the transition from sitting in my apartment studying constantly to the clinical environment. It’s truly amazing how in the span of a few weeks away from medicine, you can go from feeling like you know so much during dedicated to feeling like a complete idiot when you show up on day one of your first rotation.

While I’m currently on surgery, I started with family medicine and I thought it’d be a good idea to write a little review of each rotation after completion. I’ll include comments about the rotation, my experience/strategy for studying for shelf exams, as well as memorable quotes and interactions (inspired by the “overheard on X rotation” posts on Reddit).

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I have some free time today so I figured it’d be a good time to finally write this post. After spending months alone behind a computer screen, sitting down at my laptop is my least favorite activity. It’s too nice out. Anyways..

Score: > 250

I’ve chosen to omit the exact score for the purpose of anonymity and also because I’ve grown tired of the neuroticism I see on the internet. It’s between 250 and 260. Could be on the high end, could be on the low. Doesn’t matter. As an elder recently reminded me, board scores are the gateway to an interview. The rest, the you, determines where (if) you are ranked, and ultimately where you match.

(Simply glance at the 2018 NRMP Program Director Survey to see what I’m talking about)

Before I dig into my preparation, let’s get a few things straight.

First, what worked for me may not work for you. Like any advice you read on the internet, absorb what you feel is good information and ignore the rest. Nobody is infallible. There are multiple routes to success. I would go as far to say that UWorld is the only resource you absolutely cannot do without.

Second, don’t define your success by an arbitrary number. You don’t need a 250. You don’t need to go into a competitive specialty. Leave your ego at the door, and gravitate toward what you enjoy. Not what will impress whoever it is that you’d like to impress on match day. One person may be disappointed with a 240, while it may be your dream score. And there is nothing wrong with that. Forget about everyone else; you’re competing against yourself. Everyone should strive to do as best as they possible can on this exam, but remember, please remember that the three digit score can vary a decent amount depending on how you perform on actual test day and which 280 questions they generate for you. Learn to love yourself. This test is a game and it should never determine your happiness. Work as hard as you can. Beat the test. And move on.

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