It’s Christmas Eve and this is actually the last thing I want to be thinking about, but I know the longer I wait, eventually I’ll forget all of my pearls. So lets get to it shall we…
In terms of the rotation itself, if you enjoy clinic, you’ll thrive in Family medicine. For the most part, that’s the gist of it. On my rotation, we also did hospitalist work each morning, but that’s not a common experience. (1) I would use every patient that comes in for routine visit to help you memorize the guidelines set by the USPSTF. Those are super important to have memorized and get you easy points on the shelf exam. Knowing the guidelines can also help you shine clinically, as they are often pimp questions, and can improve your assessment and plan. (2) Another tip, always pay attention to what the patient is allergic to. There’s a lot of go-to medications for different things and you don’t want to be too quick to suggest something harmful. (3) If you don’t have access to the electronic records at your site, you can still show initiative if there are paper charts available. (4) Be willing to ask the nurses to help sharpen any ancillary skills you want to work on. (5) As soon as you see/hear something that you don’t know–look it up. You’ll remember it better when you learn it in the context of a patient vs. reading about it later in case files.
Outside of the rotation, I was sacrificing time for my family trying to be a good sister, daughter, and auntie. My self care went out of the window–again. I probably went to the gym twice, if that. I really let stress eat me, literally–I lost weight by the end of the rotation. Third year is just so much harder for me to fit everything in! And this rotation with this 30 minute commute really sucked my time away from me! One thing I was able to do was continue to wash/co-wash my hair regularly each week, so I’m proud of that, because that is a time-consuming process.
Shelf Exam (end of rotation exam)
First of all there is no magic formula to the Family medicine shelf exam. I never felt like I was ready to take it. There are recommended resources out there but even still.. it’s just a wide open exam that throws everything at you. I began the week before (I was on palliative care) with reading the Ambulatory Medicine section of Step up to Medicine and doing PreTest Questions. Once the rotation started, I was doing AAFP Q’s during the clinic day between patients and PreTest Q’s + OME videos + Case Files at night (I just watched whatever videos I felt were relevant). I took bulleted notes on the CF cases as I read them. I finished PT in 2 weeks and didn’t redo my missed questions until the weekend before the exam. I switched focus to AAFP Q’s and I finished them and CF a week before my exam. I did them all through the day, through my lunch break, and at home after work along with more OME videos. I read 2-3 CF cases each night on average. I took the 2 practice NBME’s available which were pretty difficult and random (like the actual exam). I didn’t meet the threshold I needed on either one of them so that just emphasized me not feeling ready. I think my actual exam had a lot more preventative medicine on it compared to the practice tests that at some points made me feel like I was on internal medicine. I did see practice NBME Questions on my exam. Anywho, the week of the exam I reread the ambulatory medicine section, studied my notes from OME and CF, did more repeat AAFP Questions, did the 125 UVA questions (highly recommend) and searched SDN to make sure I wasn’t forgetting anything lol. There was nothing else I could do but pray and go in and do my best then continue to live my life.
I’d say my favorite resources were Case Files as a text and the PreTest questions. These two taught me the most information. I thought PT was more relevant to the shelf compared to AAFP (but getting outdated so watch out for changes in management). The AAFP Questions are cool too, but it’s not presented in a way where you can review the ones you missed, so you aren’t able to reinforce as much. I felt like I was just doing them just trying to finish them. And I didn’t have the patience to be taking notes on each question, only ones that really stumped me.
All in all, despite the nasty shelf exam, I loved family medicine, and I plan to declare it as my chosen specialty! It’s really amazing what you are able to do for people in this field.
PS. NOLA was a BLAST and a much needed trip that made me forget about all of my troubles. Wishing everyone a Merry Christmas!! I hope you enjoy your time with your family/friends. Our savior is born! Have a wonderful week!