Author: Mursi.MD

Elective Clinical Rotation In the UK

My medical school recently added an elective rotation in a small town in England called Corby. There is a massive family medicine practice here called Lakeside Healthcare. You can do a 4-week elective rotation, which is what I did. Medical students from Cambridge and Leicester medical schools rotate here, and now students from my school can as well. Let’s just state it here and now, you are exposed to so many patients in this rotation, AND the most impressive part is that Lakeside Healthcare takes it to another level with their teaching: Medical students have their own rooms and system access to see patients by themselves before the general practitioners (GP) see them. Read on for schedule and experience.

As a Caribbean Medical student, you can be exposed to multiple hospital/clinic practices and I have traveled from NY (Richmond University Medical Center, Kingsbrook Jewish Hospital), to Michigan (Pontiac General Hospital), to Maryland (University of Maryland Medical Center). And now I have just finished my medical school career with my very last rotation in United Kingdom. All of which were my own choosing. This has multiple advantages of seeing how different hospitals run and it brings different exposure that you might not get by being in one single medical practice. Lakeside Healthcare was the first rotation where medical students are a huge part of the practice. It felt good.

A typical day in this elective: Come at 7:45 AM, log on to the medical record system and open the first patient’s chart. Call the patient in and grab history and physical exam. Then document it on their chart. Then present it to the attending either in front of the patient or before the patient is seen by the attending. After the presentation, we are asked about the potential diagnosis and indicate the next step in management. The physician then agrees or corrects. Then they talk to the patient for any further information and provide the final diagnosis and management. The patient then leaves the room and the physician briefly talks about the topic with the medical student. Then repeat! The medical student gets a full 15 minutes consultation time and then the attending gets 15 minutes of consultation time, which totals to 30 minutes with the patient. This is beneficial both for the patients, medical students and the general practioners. The patients get more face time and do not feel rushed; the students get the practice; the physicians get more information. Then after seeing patients for the morning, you go out for lunch, then come back and have a lecture on a topic.

During one of my patient encounterance, I went full Dr. Mursi, MD mode, where I counseled a pre-teenager whose mom had brought her in for depression. Initially I was in medical student mode, getting the history. However, realizing their intentions, I took full control of the appointment while charting everything that was discussed for the general practitioner (GP) to see. It felt really good to know I helped open doors to better conversations between mom and daughter. I was confident in my diagnosis of grief, provided some counseling and indicated the next step in management (of course, I informed the patient that the GP would make the final decision). This along with many of my other patient encounterance reminded me where I belong in the world of medicine. I am really excited to practice and have my own patients. I feel very content. It was also always fun to have the patient ask me where my accent was from.

Side note: In just about all of my rotations (especially fourth year) the patients I encounter, I indicate what I believe their diagnosis may be. Then tell them the next step in management. However, I always state that the GP will confirm this. This way, as a student, I am practicing diagnosing disease/conditions. I am practicing confidence, and also simply showing my knowledge to self and my patient. Often the patients will point out, “oh yeah, that’s what the medical student said”. This also makes you look good with the resident or attending you are working with.

Things I really appreciated:

  1. The patient exposure and student involvement. Rather than simply being asked to just observe patient and doctor interactions and then sometimes get asked to see a patient and present on them, students are expected to take history and physical and make a diagnosis and write up notes on the patient. Then they are expected to present it and indicate the next step in management. This is intimidating but you gain so much from it including confidence, knowledge and more efficient style of approaching patients. You are part of the schedule. It is always nice to be wanted as a medical student (doesn’t often happen)
  2. The coffee breaks! I think this is such a good idea to integrate into practice to allow for a breather for the physicians and the students.
  3. They provided access to a taxi cab company, which allowed me to travel within Corby. I just had to ring up the cab company and within minutes the cab was waiting for me! This was really convenient and it allowed me to venture out into the town center and etc. It definitely made it more comfortable to be there.
  4. They provided access to the swimming pool and the gym. This was great because I have been wanting to tone up and get healthier and it is located right by the practice. I simply walked over to the gym after work and then called the cab from the gym to get to the housing. It felt like a very productive day after work and the gym. I didn’t use the swimming pool so much, but it is one of the biggest one I have seen (it is an olympic size swimming pool).

Overall, it was one of my favorite rotation experiences. I do wish that I didn’t have two weeks of observation. This was due to my start date. I started with one set of students, who were on their last week of their 12-week rotation. Then I began with the next set of group. I ended up doing 2 weeks of observation. I was waiting to see patients on my own. I think it will be different for the next set of students as it will most likely be coordinated differently.


I definitely have to add that I am really grateful to have gotten this opportunity to see what medicine is like in the United Kingdom. I don’t think I can begin to explain how exciting it has been and the amazing opportunity I have been given. It was a pleasure to meet new people and get to know their thoughts in medicine and just as human beings. I have more thoughts and that will come in more blog posts.

My Last Clinical Rotation of My Medical School Career is in the Unit​e​d Kingdom!

I am an American medical student doing my last medical school clinical rotation in the United Kingdom. How crazy is that? I am currently in ENGLAND! I have been sulking for the past year and a half about traveling and wanting to come to England, and here I am, not just traveling but actually experiencing medicine in the UK.

Here is how it happened:
My medical school sent out a notification about an opportunity to do an elective in the UK in May-ish of 2018. One of my friends brought it up during my family medicine core rotation. Shortly after I emailed my clinical coordinator and said, I WANT IN! After about 10 months of going back and forth with emails, it was finally confirmed that I would be going to a small town in England called Corby (it took forever because I am the first person to be doing this from my school and there is a lot of paperwork involved). Corby, UK holds a portion of a very large practice, called Lakeside Healthcare Surgery [Fun fact: Surgery is an interchangeable word which also stands for “practice” in the UK].

The rotation is a 4-week family medicine elective. I am in my second week of the elective rotation and I am learning so much! I will be sharing my experience and what I have learned. Let’s start with what they call Family medicine. Family medicine = general practice – meh, not too far different. The family doctors are galled GPs (General practitioners) here in the UK.

In terms of the practice of medicine itself, yes, very different. KEEP A LOOK OUT FOR MY POST ON THE DIFFERENCE. It is quite interesting.

However, in terms of travels, living situation and etc, here are the details there:
— Housing is offered by the hospital for $170 dollars/week. It is a townhouse set up that you share with 3 Leicester Medical School students.
— Additional offers with your stay here includes gym and pool membership (which is SUPER nice), and Taxi fairs are provided for you to get back and forth to the hospital and into town, grocery stores. This last one is THE BEST, because since I can’t drive it is really helpful.
— The town itself is not big and doesn’t seem to have the greatest reputation, but it is safe and in my opinion, nice. Although, I do have to say the diversity here is SLIM.
— London is about 1.5 hours away by train and train ticket is not expensive.
— In terms of tuition, no additional fees. Of course housing is an addition, but that usually.
— There is a stippen of $500 towards your flight that my school gave.

I have been trying to vlog the experience, but it has been hard because I have been getting really involved with life here and it has been just SUCH an incredible experience. I can’t even explain the feeling. Just a fair warning in case you do this and you don’t find it as exciting –I have been wanting to live in the UK for a long time now. So, I am using this experience to just “live” in the UK. LOL. I think you will love it if you end up doing something similar.

I am going to end this post here. Come back for more updates on my 4-week elective rotation in England. PS, if you are from my school and want more information, DM me on my IG: @MursiMedical

Much love,
Mursi

Step 2CK Study Schedule | 1 Month

Hi, you guys!

I apologize for the delay in this topic. I will have a youtube video and IG post on this topic this month (February 2019). You can catch any one of them to learn how to schedule your study time for Step 2CK. The links provided below. Let’s get started!

First of all, YOU NEED TO PICK THREE MAIN SOURCES:
1. A review book (ONLY ONE)
2. UWorld qbank
3. A video source (OnlineMedED, Osmosis)

One of the worst things you can do is have too many resources. This will not be beneficial. After completing each rotation and studying for each rotation with your chosen textbook for that particular rotation, you should have the details under your belt by now. You now need to solidify the information you have in this dedicated 1-month study time. So, please do yourself a favor and pick just one review book –trust me. Honestly, it does NOT matter what anyone has said in regards to which they think is better. Everyone has their own preference. I have heard just about all of the options attested for. See if classmates above you or a library carries them, and look at a few pages in each and see what you like in terms of your own preference.

Once you decide on one, stick to it and STOP BOUNCING AROUND. Read it thoroughly and front to back. Divide the pages up for the number of days you have. Do questions EVERYDAY!! And review each day any of the notes you made for the day and in addition to the past days. It builds up and fast so stick to it. As you go each day, stop reviewing anything that you have understood well– what we could do is feel better about ourselves by studying what we are good at and avoiding the ones we are not good at (NO BUENO). At this point, you would be wasting time. Learn and keep reviewing things you are not good at.

So, here I have built a layout schedule above where you can insert the topics and build it very specific to you. You can look at this layout as you build your schedule in this empty one below.

I am also providing a sample one that is how I basically scheduled my own here below to get an idea. I also have the 7 most important topics which are the bulk of Step 2CK exam. It is important to have these under your belt because a lot of the questions will come from these topics.

Remember, ultimately, it isn’t about the time you spent, it is the amount of efficient time you spent. Don’t sit in front of your desk and assume you are doing the work when really you are not focused. Put a timer on and study in intervals and give your brain some break as well (more on this topic in a future post)! Come back again for more posts on helpful tips on how to study/how to manage your time/etc.

I hope in writing I didn’t come off mean. You got this!! Focus and soon enough it will be over and you can chill for a bit!!! <3

Check my other social media for more:

Instagram
Youtube Channel


Much love,
Mursi

Surgery Rotation Expereince​

My most favorite memory of all time.

This rotation was one of the toughest, but it ended up being my most favorite and memorable rotation. It was tough because of the hours, the chief residents yelling at you and the amount expected of you. It can break you or it can make you stronger. Depending on your attitude towards it, it can really affect your rotation experience.

I never considered surgery. It is not a lifestyle I care for and nor is it something I am passionate about. However, I LOVED the surgeries. I was fascinated and I think I could have been a good surgeon. I can’t say great because I think you need love for what you do to be great at it. You can disagree with this statement and be correct. Let me give you a breakdown of a typical day then go into some stories.

When the surgeries are all over then the lectures start. Once the lectures are over, you go home. The decision then is to sleep, eat or shower.

Depending on what week you are in, you will get scheduled 9 weeks of Floors, 1 week of SICU (surgery intensive care unit), 2 weeks of Surgery Clinic week, one day of anesthesia (you can get more days if you are interested in anesthesia). Our days began at 5 AM and ended at 7:30 PM. We had M&Ms (Morbidity and Mortality conference) on Mondays 7 – 830 AM. Every Thursday we had 1-4 PM clinic that all the students on the floors went to. We had lectures Tuesdays – Thursdays from 4 PM – 7:30 PM, but often it ended later, even up to 9:30/10 PM.

Everyone had 10-13 CALL NIGHTS. Call nights started 3 PM until 7 AM the next day. On Weekends, day calls started from 8 AM to 5 PM and night calls start at 5 PM and ended at 8 AM the next day.

Story time

I got yelled at a few times during morning rounds by the Chiefs. One was a full out lecture on how I need to improve. It was, of course, harsh. I went with the mindset that it was going to be tough rotation and I would get called out for my mistakes and that I wouldn’t take it to heart. Instead of taking it to heart, I would learn from it and just do better next time. SO, here is the full story: One morning during the presentation, the chief residents had switched (we got new ones). This one was extra loud and yelled. A few people presented before me. The one right before me got yelled at and told she did a horrible job and picked on EVERYTHING she said from the start to finish. Then, OF COURSE, it was my turn! I tried to keep calm. I started and I thought I was doing decently until I presented the physical exam. There was an older PA (physicans assistant) as well rounding with us, and she started to make comments on things that I hadn’t gotten to yet. So, I said, yes I am getting to it. Then it all began. I got criticized for EVERYTHING and initially, I started to defend myself then I just tried my best to stay quiet. It was hard to stay quiet, but it felt that if I were to say anything it would be perceived as disrespect. And for the most part, the chief resident pointed important things that I needed to do better on. It was just frustrating when they didn’t give you the chance to say some of the things you were planning on saying but hadn’t because they remarked on it first. UMMMM HELLO, LET ME FINISH.

Moral of the story: Don’t take it personally. Don’t let it bother you too much. Learn from the lesson and be honest with yourself. It is going to be a tough rotation, and be excited about the challenge. I know medical student friends that had rotations in a hospital that they barely even scrubbed in on one proper surgery. I saw at least 10 surgeries per week. Sometimes you had surgeries from 7AM7PM!! Depending on the surgery case, you had several back to back or just one surgery that lasted all day. One of the surgeries I scrubbed in on was 8 hours long!! It was a vascular surgery. Those are always long. Ahhh, good times!! It was a tough rotation, but all in all, it was one of my most favorite memories of clinical rotations.

PS. if you are about to start surgery soon, be ready to feel like a badass.

PSS. There is another reason why I loved surgery core rotations so much. It has to do with the very first picture I have on here. Remember, to always keep striving and do your best to get the best out of every situation.

How To Take UWorld Notes

When studying for USMLE Step 1 and Step 2 CK, UWorld is the ultimate QBank that is used by medical students worldwide. Why UWorld? Simply because it has all the high yield topics and amazing explanations! With that said, let me tell you how I took my UWorld Notes.

YouTube Video coming soon.

I had not taken extensive notes during Step 1 preparation using UWorld. The notes shown above were for Step 2CK. However, you can use the same idea for Step 1.

What you need:

  1. UWorld QBank
  2. Microsoft Word Document
  3. Patience

There is a trick that I will show you which will allow you to capture the diagrams, pictures & charts and place them in your notes, keep reading…

As I went through my clinical rotations, I did UWorld questions for that core subject. For example, pediatrics – after watching Online MedEd and doing the basic learning, I started doing questions during the second week. And as I did questions, I would take notes on the following questions:

  • questions I got wrong
  • questions I got right but took too long to answer
  • questions I guessed right
  • questions I got right but still needed better understanding of the topic.

Organization is important.
Depending on the core subject, if there were subtopics, such as Peds Pulmonary, Peds Renal, I would categorize them alphabetically and then as I did questions, I would “Control F” and search the subtopic to get me to that particular page and then continue the notes. This keeps it organized and helped when I went back to review particular topics. I made one Microsoft Word document per core subject, and within each document, it was divided per subtopics. EXCEPT, for internal medicine, I made individual sections (one Word Document per system — Endocrinology, Cardiology, etc. This allowed for easier printing).

Let’s say I got a question flat out wrong. I would read the explanation portion that was short and to the point and learn the reason for the right answer. Then I would go straight to the answer choice I selected to read why that was the wrong answer. This allowed me to quickly review before beginning my notes. Then I would read further and start typing a quick synapse of the question at hand and then try my best to explain it in my own words without rewriting the explanation. I used indentations as seen in the photo above. The best and most effective part was taking notes on why the other choices were incorrect. I wrote this out under “differential diagnosis ...”

“Differential diagnosis for a rash that started out on the patient’s face and traveled to the rest of the body”:


This allowed me to associated certain findings with the right diseases or flat out say “this symptom is NOT seen in a patient with ____ because …” Do you see what I am getting at?

Here is the TRICK to putting those charts and diagrams from UWorld Qbank in your Microsoft word document: (Follow the sample screenshots I took below to help you).

  1. Click on “Insert” tab
  2. Look for the camera drop down
  3. Select the one that has the picture you want.
  4. Then crop the picture so that you only include the diagram itself and nothing extra

As you continue to make notes, you will figure out your own preferences. This requires patience and the most benefit comes from typing out the explanations in your own words. Don’t worry about repeatedly explaining the concepts, because it will help you learn the topic more and more. You will find that you will type less on those topics as you go on because you have come to learn it really well as you see more questions on it. Only now, you need to learn the details that you still seem to be getting wrong. Know what I mean?

As you go through your core rotations, you will accumulate a giant binder!! Then once you are prepping for Step 2CK, you will already have your notes ready and you will do the qbank for a second time and review your notes you already took. I turned the Word Documents into PDF and printed them out after finishing each system.Review, review, review. You did not make all those notes to have them sitting there!!!


I hope that was helpful!! See you in the next post!!


Much love,
Mursi