Family Medicine Shelf

Family Medicine (and THIRD YEAR) is finished - - - such a good feeling!


The shelf exam was alright. The questions are really broad and varied; I'm glad to have scheduled family medicine as my last clerkship of third year. Classically, it is the most failed shelf due to how broad the information is - the shelf would be pretty difficult if it was your very first clerkship of third year. But as it was my final clerkship, I felt quite prepared and confident in how I did. I ended up with an above-average score (and let's just leave it at that).

Family Medicine is incredibly broad and it is difficult to predict which questions will be asked on the shelf. I was at an advantage, taking this clerkship last, but I don't think it would have been horrible to have taken it earlier. I personally felt like IM was more a bit more difficult. To prepare for the exam, I:

• Followed, managed, and learned from a variety of patients - including those with diseases such as Diabetes, Hypertension, Stroke Syndrome, Pregnancy, Well-Visits, Cellulitis, Musculoskeletal Injuries, Back Pain, Psych Disorders, Dementia, CHF, COPD, Surgical Clearance, etc etc etc etc etc
• Used Uptodate to learn more about each of my patient's diseases and treatment plans.
• We had lecture for a few hours during the course of the clerkship, which were somewhat (but not really) useful.
• Read Family Medicine Case Files. It's a quick and easy read, honestly. And helpful to prepare for all of those "what is the next appropriate step" questions that are asked.
• Read over the Ambulatory Medicine section in my Step Up to Medicine textbook.
• Read bits and pieces of Step Up to Step 2 to review previous clerkship info (like surgery, ob-gyn, peds, psych, neuro).
• Completed about 500 of UWorld's Step2 IM questions - which were really helpful to broaden my base of studies.
• Completed all but 125 questions from USMLE Easy's Step2 Family Medicine's Question Bank.

My final takeaway on how to best prepare for the shelf exams during third year:

• Have a quick review book (like Case Files) stuffed in your white coat pocket, and read over it whenever you have some down time.
• No matter how busy you are (and you will be busy), always make time to read at least an hour each day.
• Do questions every day. This is the part of studying which I dislike most, and I'm not nearly as faithful at completing the questions as I would like to be, but I did notice that once I started to use the QBanks more frequently, my shelf scores (and confidence) improved significantly.
• Take on a variety of patients, even if it makes you uncomfortable. The single best way to learn is through experience.
• Keep your Iphone or Ipad on you at all times, with a QBank open, UpToDate logged in, and the Epocrates app ready.

Family Medicine: Day 16, 17, 18

I feel like I need to get this post in while I'm still officially a Third Year Medical Student - even though I really should just be studying for my shelf!

The past week has been crazy! On Monday, the clinic had over 50 patients. It was crazy. And every patient seemed to need a little extra time, with things like Depression, Pap Smears, Newly Diagnosed Diabetes, Nutrition Advice, etc etc etc. Things were insane. I finally got out of the office by 6:30 after all of my notes were complete (I had no time during the day to finish any notes, so it took me an extra 90 minutes just to finish notes). Also, we had a few patients that we saw in the hospital for a knee replacement and cellulitis. Then on Tuesday, the afternoon slowed down after we left clinic early to deliver a baby. That's always fun!!! I can't believe that I may never get to do that again... The attending even asked if I wanted to repair the episiotomy; I am going to miss procedures so so so much. Finally on Wednesday, I saw a variety of patients in the morning and the attending even let me finish early so I could go home to study. Today, of course, is a big time study day, because tomorrow I take the "most failed" shelf of third year!

I have had a great experience on Family Medicine. I was lucky to work with and learn from such a great family doctor; I know the score I will get on my shelf will be due, in large part, to her education and guidance. I really loved this rotation, and I'm definitely going to miss the freedom I was given while away from my medical school's hospital!

Family Medicine: Day 11, 12, 13, 14, 15

Time to recap on all of the things that I've been doing on Family Medicine!

• Yesterday, I delivered my first baby. The doctor I am working with allowed me a lot of freedom in the delivery, so I did most of it on my own (under her very close supervision). She did the episiotomy and repair, and I delivered the baby and placenta. It was amazing. Witnessing the miracle of life never ceases to amaze me. What beautiful moments!
• I attempted to pull an object out of a child's ear (sadly felt like I had foreshadowed this occurrence by telling a previous patient that day about The Things We Find in Our Patients' Ears!).
• I spoke with a patient - at lengths - about the basic principles of good nutrition. For example, I advised that instead of eating a double-bacon-half-pound-cheeseburger with large fries and a giant-sized Coke twice a week, try to make it more of a once-every-other-week treat. 
• I made *almost* every kid I saw in the past week smile and laugh. (Yes, this is coming from the girl who has openly admitted her significant disinterest in pediatrics)
• I am getting to be quite proficient in pap smears, and could probably now diagnose BV based on the whiff test alone...!
• I continue to be surprised by how people will openly tell me the most personal details of their life without hesitation. Some questions which I routinely rattle off and patients honestly respond to:
• Any new sexual contacts?
• Any possibility of a new STD?
• Number of sexual partners you have had?
• What type of sexual protection do you routinely use?
• Have you had any recent constipation or diarrhea?
• Has urination been painful recently?
• How many times do you get up in the middle of the night to urinate?
• Are you breast-feeding your child?
• Are your nipples sore or cracked?

Family Medicine is so much fun. I can really see the appeal of the lifestyle, the short residency, the close relationships with patients... I actually find it interesting to see a few kids interspersed between adult visits for hypertension, COPD, Diabetes, etc... if only there could be an Oncology Fellowship at the end of its residency, then it would look quite tempting!!!