Tips for Medical Rotations
Commuting Tips: Making the Most of Your Time
For commuting, consider listening to podcasts relevant to your current clinical rotation. Here are the podcasts I recommend:
I recommend following these podcasts on Spotify and adding episodes to your queue so that episodes auto-play for uninterrupted listening.
Morning Routine: Starting the Day Right
I always wake up 2 hours before report time to ensure I have enough time to drink coffee, eat breakfast, and study (Anki or OnlineMedEd).
Managing Downtime During Clinical Rotations
Using Downtime Effectively
Downtime can vary significantly between rotations. If you have free moments, take advantage of them by doing practice questions or reviewing Anki cards. Using your phone during downtime may lead preceptors to assume you are texting or browsing social media, even if you are studying. Completing tasks on a computer tends to look more professional, so bring a laptop or tablet.
Evening Routine: Staying on Track
Once I get home, my typical activities include working on modules and doing practice questions.
Balancing Work and Personal Life
The third year offers more free time than the second year. I incorporated 1 hour of fun time and 1 hour of exercise daily into my routine.
Maximizing Weekends
Weekends are a great time to catch up on modules and work through more practice questions in larger sets.
Shelf Exam Preparation
Scheduling and Pressure
With one exam per month, the stakes may feel high, especially during the initial exams when you’re adjusting to the format. To stay on track, focus on completing your practice questions.
Practice Question Strategy
You may be familiar with the 10,000-question goal I have shared for licensing exams (USMLE or COMLEX). This is how it breaks down:
5,000 questions during the year
Do the math to figure out how many you need to do for each block. For example, aim for 550 questions per block if you have 9 blocks
Then, do the math to figure out how many questions per day you need to do. For a typically 4-week rotation, complete about 20 questions per day (approximately 30 minutes to complete and 30-45 minutes to review)
5,000 questions during a dedicated study period. You can do similar math to break down how many you would need to do per day depending on the length of your dedicated study period. You could also figure out how many questions you could reasonably do in a day to figure out in reverse how long your dedicated study period should be. I speak more about this in another blog post (for Step 1/Level 1).
You will likely need at least two question banks.
Recommended Resources
TrueLearn: Includes COMAT question banks for each subject area (200+ questions per exam) and general COMLEX COMBANK for additional questions.
If you are an allopathic student or taking the USMLE in addition to COMLEX, TrueLearn also offers USMLE Step 2 CK and NBME Question Banks.
For a discount on your TrueLearn subscription, use this link and code firstline
Patient Interviewing: The OPQRST Template
Having a structured approach to patient interviews ensures thorough and efficient data collection. I use the OPQRST template and adapt it as needed.
OPQRST Explained
O: Onset of symptoms
P: Progression, prior episodes, palliative/provocative factors
Q: Quality or quantity of symptoms
R: Region and radiation
S: Severity and scale
T: Treatment tried
A (Bonus): Associated symptoms
Example: Back Pain
O: When did your back pain start?
P: Has it gotten better or worse since it started? Have you had this pain before?
Q: How would you describe the pain? Is it sharp? Achy?
R: Where is the pain? Does it radiate elsewhere?
S: On a scale of 1 to 10, how severe is the pain?
T: What treatments have you tried?
A: Any numbness, tingling, or changes in bladder/bowel habits?
Example: Depression
Some OPQRST questions may not apply, so adapt accordingly:
O: When did your depressed mood start?
P: Has it worsened? Have you felt like this before?
Q: Have you felt hopeless or worthless? Lost interest in usual activities?
S: How does this compare to prior depressive episodes?
T: Have you tried any medications or supplements?
A: Changes in appetite, sleep, energy? Assess for suicidal ideation
Conducting the Physical Examination
Core Components
Always include the following in your physical exam:
Heart and lung auscultation
Abdominal palpation
Edema check
Pulse assessment
Efficiency Tips
I often perform a simple Review of Systems (ROS) during the physical exam to save time, maintain conversational flow, and fill the silence that occurs during the physical exam portion. For example, as I prepare to auscultate the lungs, I'll ask if they have experienced shortness of breath, wheezing, or cough.
Frequently Asked Questions (FAQ)
1. How can I make the most of my commute time?
Listening to educational podcasts related to your current rotation is a great way to maximize learning. Popular options include First Line, Divine Intervention, and Surgery 101.
2. What’s the best way to prepare for shelf exams?
Focus on completing practice questions regularly. Aim for 20 questions daily, which should take about 30 minutes to complete and 30-45 minutes to review.
3. How do I ensure thorough patient interviews?
Use the OPQRST template as a guide. Practice adapting it for different conditions to cover all relevant details efficiently.