Things to Know Before Graduating Medical School

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So what are some things to know before graduating medical school? Such an answer is not cut and dry, nor can it fit into one sentence. How can you possibly sum up the most important things in all your years of hard work and study? According to some graduates you’re going to need to know some practical things like how to work a fax machine. You’ll need to know how to call nursing homes to give them sign out on patients. Communication skills and time management are a must, but the single most important thing you will need to know when you become a resident is how to do what you’re told in an efficient manner.

What follows is just a short list of questions and facts that doctors are asked (and sometimes forget) on a daily basis:

  • Sodium, potassium, calcium derangements
  • AMS
  • chest pain/ACS protocol – be comfortable reading EKGs
  • hypertension – inpatient vs outpatient
  • CHF
  • Pneumonia – specifically when is it CAP/HCAP/HAP and treatment for each
  • Spiking a fever – CULTURE
  • ESRD
  • AKI
  • Pain regimens – know your patient’s renal function before you give anything
  • Patient desatting – ABG/CXR
  • GI bleeding – PPI drip +/- octreotide, egd
  • Pancreatitis
  • Cirrhosis
  • COPD exacerbation
  • Febrile neutropenia
  • SIRS/sepsis/septic shock (in ICU)
  • ARDS
  • hypercapnic respiratory failure – don’t give only O2, provide ventilation
  • DKA/HHKS/general DM management
  • Be able to assess volume status – JVD/rales/peripheral edema
  • Pleural effusions/ascites

At a minimum, graduates should be well versed in basic treatment algorithms for emergencies that have relatively standard protocols (e.g., ACS, DKA/HHKS). Medical school graduates should also have a comprehensive understanding of preferred treatments for common health issues like UTIs, CAP/HAP, etc.

What many former med school students say is that you will learn (and relearn) these things and more, once you start residency. But don’t worry, what you’re reading may seem like a lot, but you will never be on your own. You will have multiple levels of support – including your co-interns, a senior resident, and your attending at a minimum.

Need more advice? Former med students also advise taking a look at medicine-specific books from your clerkship. If you have the opportunity to do something like a bedside procedure service or other rotations that allow you to get familiar with common procedures (e.g., LPs, thoras, placing and pulling central lines, etc.), those experiences will prove useful further down the line. You will still likely need a great deal of supervision, but having some familiarity with the procedures will make the first few that you do less painful.

The reality is that no matter how smart you are, or how much you study, you will still have plenty to learn and will likely be running around like a chicken without a head. Many hospitals and practices have their own specific variations on so many different protocols, so it’s unlikely that you’ll be perfect prior to starting residency. A lot of the difficulty will come your way. Even if you have the steps memorized in your head, actually executing that plan may be unfamiliar to you.

The best advice is to have faith in yourself and all that you’ve studied. If you got through medical school and successfully matched for a residency program, you know that you can work hard and succeed. And P.S. never shy away from using the Internet! It’s there to help you too.

Justin Kravcik
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