Student Handbook
- First Year
· Gross and Developmental Anatomy
· Histology and Cell Biology
· Biochemistry
· Physiology
· Neuroscience
· Behavioral Science
· Computer Literacy
· Biostatistics and Epidemiology
· Introduction to Primary Care (IPC) - Second Year
· Pathology/Pathophysiology
· Medical Microbiology
· Physical Diagnosis
· Pharmacology
- Third Year
- Fourth Year
First Year
Med School, what's it really about?
Congratulations, you've finally made it to medical school! I'm hopefully a little wiser than I was when I began this process four years ago, and here are a few things I wish I knew when I started.
Writing this as a fourth-year student, the perspective I'd most like to impart is that first year will be tremendously more relevant to your medical career than you realize. The obscure information that you're learning now isn't nearly as obscure as you think. Learn the basic science as well as you can because it will come back to haunt you if you don't. That being said, there is NO WAY that you will learn everything you see, and you will remember even less. Nobody will die if you can't remember the difference between Erb-Duchenne and Klumpke's palsy a year from now. The important things will be reinforced at every step of your career, you WILL learn what you need to.
The second thing I'd like to tell you is: try to keep your life as normal as possible. This still isn't very normal, but don't let it get totally out of control. You'll have late nights, but don't become nocturnal. Get away from campus as much as possible. Your friends, family and significant others: visit them as much as possible. At the same time, you won't survive in med school without your classmates. Your classmates will likely be the only people around you who really understand what you're going through, they're a very valuable support. In addition, these people will be your coworkers and referring clinicians for the rest of your life. For better or worse, the medical community is much smaller than most people realize.
The third thing is most people pass, but most people fail at least one test. When this happens, relax, you're in good company. You will still be a good doctor, you will still get into residency. You may need to change a few things, but you will survive.
Gross Anatomy
No other course in medical school is more identified as a part of your medical instruction. Learning human anatomy by dissecting a cadaver is a rite of passage that all doctors undergo.
There is a ton of information that you need to learn before Anatomy ends around Thanksgiving, so until then, you'll have to devote a lot of time to this course. In addition to the lecture hours, radiology conferences, clinical correlations and your personal studying time, you have dissection lab 3-4 times per week. Dr. Pravetz is a great teacher, and he has set up the course very well.
All the portions of the course are helpful and are represented on exams, so do not blow them off.
Some people opt not to attend lectures, feeling that they are "low yield", opting to read on their own or catch up on precious sleep. The countervailing point of view is that it never hurts to see the material again, you get to see what the professors feel is important and they help to clarify and solidify difficult concepts (e.g. embryologic origins, fascial relationships). Everyone learns differently and you will quickly learn what works best for you.
However, definitely do not miss radiology conferences or clinical lectures!
Medical school is often compared to drinking from a fire hose, and never is this comparison more apt than in Gross Anatomy. In the ocean of medical knowledge, often the best you can do is try not to drown. You won't know everything and that's okay, but you should learn as much as you can.
The Anatomy Department recommends Big Moore (versus Little Moore— you'll understand when you see it in the bookstore). Moore is great as an introduction to class material, but he is a bit long-winded in the big version and frequently he focuses on things that are not important for this class. Many people found Little Moore is a comprehensive enough alternative for this course.
Many people choose to use the BRS Anatomy book instead of Moore. The Board Review Series is a group of review books that you will become familiar with during your education. Because they present the bare bones of the course material in outline format, the BRS books provide you with the highest amount of information in the shortest amount of studying time. They are not the most complete and do not replace your texts, but they are often the only thing that you'll have time for. Also, the BRS is a good review for the miniboard, so having already read through it once before studying for the miniboard reduces your stress for the final.
For your lab sessions, you will need two other books. The first is Grant's Dissector, which explains how to dissect everything in the body. It is an extremely helpful book, with great color diagrams. The other, more important, reason why this book is so vital is that it is an excellent guide for studying for the practical exams. The second book you need for lab is Netter's Atlas of Human Anatomy. This book is the Bible of human anatomy, used by every medical school, and it gives you multiple drawings (again color) from every conceivable viewpoint of every part of the human anatomy. You should have two copies of Netter and Grant's, a personal copy that you can study from and one that you share with your lab group. Arrange with your lab group to buy the shared books and your dissection supplies (scalpels, etc.) during the first lab session. Also, most students wear scrubs, white lab coats and gloves during lab; these items are all available in the NYMC Bookstore.
The grading components of Gross Anatomy are: 1) Practical exams 2) In-house written exams 3) The miniboard
The practical exams are great for teaching you not only how to speak medically, but also how to think on your feet. Unfortunately, there is a ton of stress associated with these tests. The second-years will try to quell your anxiety by giving practice orals the week before the exam.
It is a good rule of thumb that there is nothing in Grant's Dissector that you DON'T have to know for the practical exam, but it is far from all-inclusive. If you can't do anything else, learn this first and you'll survive.
Embryology is a part of Gross Anatomy, but it almost seems like a separate course because the material does not overlap completely with the Anatomy material. Dr. Pravetz recommends Larsen, but the text is wordy and it's a slow read. Most people like to use BRS Embryo or High Yield. The most indispensable book for this part of the course is the Larsen study guide. Get this book and go over its review questions before every test!
The tests for the Anatomy course are difficult to prepare for because you need to be aware of material from so many different sources. IT IS EASY TO GET OVERWHELMED IF YOU DO NOT LIMIT THE NUMBER OF BOOKS YOU USE TO STUDY. It is better to know incomplete information well, than complete information poorly.
These are the books that I think are most effective in learning the material: Grant's Dissector, Netter's Atlas, BRS Anatomy and Larsen's study guide. Using more books will more likely confuse you than clarify things. Secondly, you must get a copy of the old exams from the Scribe Service, and go over them. Not only does Anatomy repeat its questions with amazing predictability, using the old exams lets you know the depth of understanding that is expected of you. A caveat, however: There is more to life than exams. Everyone is under pressure to get good grades, you should do as well as you can, and that means learning the old tests. But med school is ultimately about preparing for the rest of your life. Don't memorize the questions at the expense of knowing the material. That will serve neither you nor your patients well in the long run. You should use the tests to guide your studying, helping you to know what you don't know.
Finally, there are 15-20 questions per exam devoted to radiological images. To prepare for this part of the test, you should:
- attend radiology conferences
- look at the MRIs and CTs across the hall from the Anatomy lab
- look at the radiology sections in Big Moore
- go over the radiology program on your module's computer
Good luck, and remember that this too shall pass.
Histology/Cell Biology
The first thing that nobody knows about this class is that it's actually useful. Histology will haunt you for the rest of your life. The second thing is that some of it isn't. You just have to learn it.
Scribes are golden. Know them front to back, side to side, you will be tested on single sentences and bizarrely obscure details. Try as you will, you won't know them all. Know this now and deal with it. But if you know the scribes, the class handouts and the lab manual, you'll be well on your way. When it comes to texts, people will throw out every name in the bookstore: Ross and Romwell, Wheater, Junqueira. Everybody likes some combination of them. They're all different, each has its strong points and weak points. The most important thing about any book is that you read them. The "best books" won't do you any good on your book shelf. Go to the bookstore, pick up a copy of each of them and figure out which ones you want to learn from, buy those and don't listen to anyone else.
Also, You might hear on the street that it is absolutely worthless and a complete waste of time to even go to lab. Some free advice: use the scheduled time to sit down with your microscope and slides and get to know them. Get to know everything about them. The payoff will be for the practicals. A word about the practicals: they aren't "that bad." In fact, you might find that they are "that good" and a relief after taking the written exams. The lectures aren't always captivating and moving, but I thought that overall they were worth attending, especially to see the slides that they show (yes, the slides they show in class are fair game for the practicals). The miniboard: everybody has their own style of studying for these things, but I thought that BRS was pretty legit. High Yield is always an option if you're running low on time. One last thing to remember: the teachers aren't out to get you...really. They can be quite helpful if you find yourself confused or falling behind. If you need help, please seek it early. Good luck!
Biochemistry
Biochemistry is probably the most straightforward class you will take in first year. There is, however, an endless supply of facts to cram into your head, so staying on top of the material is a very good idea. Those adept at pure memorization should thrive in (and even enjoy) this course. Even if you're not a "memorizer," the lectures and the handouts are pretty clear for the most part, and exam questions are virtually all lecture-based, so this course is relatively manageable.
In studying Biochem, most students relied most heavily on the lecture handouts and the scribes, and some didn't even buy the texts. In regard to texts, I have three words of advice: Lippincott, Lippincott, Lippincott. This is a review book, but it is much more extensive than BRS, and I felt much more readable. The diagrams are excellent, and some professors even use these diagrams in lecture. In addition, Lippincott contains all the information you will need to handle the miniboard.
The two recommended texts (Stryer and Harper) are in fact helpful, though a bit pricey.
Different professors lean more heavily on one or the other, making it difficult to choose one text. Stryer is more chemistry-based, whereas Harper is more clinical in its approach. It might be worthwhile to buy one, and find a classmate who has the other, and share. The texts should probably be used for reference only, since most of the important facts can be found in the lecture handouts (and in Lippincott—did I mention Lippincott?)
The lecture outlines (dispensed the first week of class) are extensive, but quite readable. For this reason, some students did not find it necessary to attend lectures, choosing instead to just read the scribes and the lecture notes. This is entirely your call; if you feel that lecture time is more efficiently spent learning the material on your own, go for it. Personally, I found lectures to be helpful, particularly for visualizing chemical reactions or structures.
There are also about a dozen conferences in Biochemistry that focus on a particular topic each week, often expanding upon the material taught in lecture. While attendance is not mandatory, it is GUARANTEED that there will be exam questions pulled from the material discussed in each conference. Student presentations are another part of these conferences. While your presentation does not have much effect on you final grade (lowering the pressure a bit), you must present your assigned topic to complete the course.
This course is very well designed, and very straightforward. There is a lot of material, but what you see is what you get. There's nothing tricky about it—examination questions faithfully reflect the material taught in lecture. Practice old exams to get a feel for the type of questions you will be asked. The miniboard is a pain in the neck (of course), but it IS representative of the material taught – probably more so than any other first year course. A healthy knowledge of Lippincott (or BRS) won't hurt either!
Physiology
Did you ever take a course in college where the material was interesting and useful, the professors were great, and you actually liked attending lecture? Welcome to Physiology, the NYMC first-year equivalent.
There is nothing in medicine that you won't do better with a firm grasp of physiology. In order to gain the necessary comprehension, lecture attendance is key. While the scribes are good for review, they fail to do the actual lecture justice. The physiology professors actually teach and facilitate understanding in that hour or two of presentation. The lectures are extremely active, and often highly entertaining.
The suggested readings come from general texts, like Berne and Levy or Guyton, or from the various monographs (each of which, generally, covers only one system). Some found that Guyton's coverage of cardiovascular physiology was worth the price of the book. To the dismay of many students, BRS alone falls short when exam day looms. The exams will test the student's ability to comprehend the material—no regurgitation here. In terms of preparation, working through old exams is highly beneficial. While repeat questions are infrequent, the old tests are indicative of the expected comprehension level. Going over your own exams after the test is also highly recommended, as the final exam is an in-house final, not a miniboard. Fortunately, the professors will aid and abet you in answering any questions or concerns. Not only do they lecture extremely well and welcome in-class queries, they are extraordinarily approachable and available for questions outside of class. While winter in Valhalla might be chilly, if you go to no other course during your first year of medical school, don't miss a single minute of physiology.
Neuroscience
Neuroscience is an exciting and constantly updated course, and it is the first course where the clinical aspect is emphasized.
Scribes rule for the exams, and like histology, you need to know every word of them. The handouts are useful too. You can use the textbook for the anatomy and pathways (first month) but that is all. The textbook covers very little clinical neuroscience. The neuroscience atlas is useful for getting visualization of things. However, for the anatomy practical you are best off looking at brains in the lab. The professors are good and accessible, and although Dr. Sharma's lectures are a little confusing, don't despair; you can always talk to him after class and what he talks about is cutting edge neuroscience, so a half an hour in his office won't hurt.
The miniboard is fairly clinical and counts for a lot, so study hard. At this point you've likely discovered what works best for you. The study materials for the miniboard that some found useful were: 1) The new edition of Pretest, (useful clinical correlation paragraphs). 2) The neuroscience and anatomy clinical vignette books for the boards. 3) The Ridiculously Simple book. 4) Some also liked the Netter neuroscience book.
It really helps to be able to think globally for the miniboards. It's not just the pathways that are important but also their anatomic location and how this affects the clinical presentation of strokes, tumors, etc. Memorizing anatomy won't help you, rather you need to have an in-depth understanding of the functions underlying the anatomy, as well as the connections. Keep going over the anatomy in terms of determining what would happen if that piece of anatomy was cut or ceased to function, and you will do wonderfully on the miniboard because you will be able to reason any clinical case they throw to you regardless of whether you have seen the syndrome before.
Computer Facilities
Computing resources at New York Medical College are quickly growing and adapting as technology is increasingly integrated with the curriculum. We recently opened our first large "wired" high-tech auditorium. Here, we are capable of using real time video conferencing to simultaneously teach at distant locations including our affiliated hospitals in Connecticut, Manhattan and Staten Island. Our Alumni Computer Lab has scanning, laser color printing, multiple T-line access to the Internet (as do all our buildings and dorms) and electronic whiteboard facilities.
Intranet resources include access to hundreds of full-text electronic journals and the College's E-Learning website. Web-based learning allows professors to distribute multi-media course materials without relying on cumbersome and costly paper reproductions.
Behavioral Science
This course is taught alongside Neuroscience and consists of lectures in the morning two days a week, and afternoon sessions in the hospitals. The morning lectures cover a wide range of material in the behavioral sciences and psychiatry. The afternoon sessions are devoted to student-patient contact, emphasizing clinical correlation of basic sciences material.
The afternoon sessions represent one of the students' first patient exposures. In small groups of seven or eight, students interview psychiatric patients located in either in Westchester or Manhattan. In addition to this, students also attend a large group case conference once a week to observe a psychiatrist interview a psychiatric patient then discuss the interview and case afterward.
Introduction to Primary Care (IPC)
IPC starts around September or October of your fall semester and runs through May or June of the spring semester. It consists of two parts (seminar session and preceptor visit), which take place two Wednesdays a month. The seminar session usually occurs before the preceptor visit. Lectures are usually given before the seminar session starts on the scheduled topic for that month. Afterward, the smaller seminar groups, consisting of 10-15 students with one seminar leader, meet and go into more detail about the topic. The seminar leader is a primary care doctor who leads the discussion, sometimes providing personal examples. There are approximately eight topics, ranging from ethics to educating patients on nutrition. There are also assigned readings for each topic in the primary care binder that is used throughout the year. The seminar session is very interactive.
The other half of the course, the preceptor visit, is a lot more "hands-on." Some of the topics involve taking patient histories, which provides good exposure to interviewing patients. Students are randomly assigned to a general internist, a pediatrician or a family practitioner for the duration of the course. Everyone has a different experience with his or her preceptor, but overall many students find this to be the most enjoyable and interesting part of the primary care course. On the whole, this course is very straightforward and stress-free. Of course, you do have to go to the seminars and preceptor visits. There is a final exam, based on the information in the primary care binder and the discussed topics, but not to worry, it's multiple choice and doable. Your final grade is based 50% on the exam and 50% on seminar leader evaluation. The preceptor grade is pass/fail.
This course is specifically designed for first-year medical students, and it gives you the chance to learn the basic principles of primary care practice. It provides early exposure to primary care, making it more likely that you would choose this as a specialty. What the course is actually good for is providing a much-needed break from the didactic medical classes and an introduction to the world of MDs. You get a chance to wear your white coat, and to see that all these years of studying actually do pay off.
Second Year
Pathology/Pathophysiology
The Pathology/Pathophysiology course at NYMC consumes the better part of the second year and represents a departure from the classical lecture style to which most students are accustomed. Much of the material is encountered in the form of "self-study" hours that are scheduled throughout the year. This allows time for the student to become acquainted with the vast amount of knowledge that must be covered. Faculty members provide an overview lecture to highlight the material; however, the individual student is responsible for learning the material presented in the textbook.
Module exercises allow the student to become familiar with the material in several different ways. These include gross pathology exercises that allow for hands-on examination of various afflicted organs, as well as clinical-pathologic correlation exercises to demonstrate how various diseases present clinically. Periodic case conferences allow for in-depth discussions and often dissertations on various diseases and disease processes as well. A final lecture, affectionately known as perspectives, provides a detail-rich synopsis of the material that you should have learned already or that you will certainly learn before the exam.
Conventional wisdom preaches that the key to this course is knowing Robbins. While approaches differ, most people who were successful in the course thoroughly read Robbins three times. This will only account for 85 percent of the material covered on the test. The next 15 percent reliably comes from the lectures and module sessions.
This course is the cornerstone of your medical career. If you learn nothing else in medical school, learn pathology as well as you possibly can. You can do nothing without a firm grounding in pathology. From your boards to the wards, it all starts right here.
It is not taking anything away from any other course to call this the best and most efficiently run course in the entire school. Dr. Zachrau leads the many talented faculty members to provide the backbone of your entire medical education. Now that you're starting to understand what you came to med school for, work hard and you will reap the benefits for the rest of your career.
Microbiology and Immunology
This course has been designed to train students in the essentials of infectious and immune processes. Although the class does address international medicine and emerging pathogens, appropriate weight is given to health issues encountered throughout third year, such as allergies, streptococcal pharyngitis and AIDS. One of the challenges of the class faced by both students and administrators in the course is that a wide range of expertise is necessary to teach the course. Accordingly, the professors will change more frequently than any other class during the first two years. Dr. Geliebter is a dedicated course director, very approachable and glad to help anyone needing assistance with the course, as are the rest of the faculty.
It is difficult to excel in this class—partly because there is a lot of information, and partly because it is easy to become obsessive about studying pathology. The best way to prepare for this course is to start studying a little bit the summer before, using microbiology flash cards and "Basic Concepts in Immunology." Although lecturers may choose to emphasize different material (and many exam questions come directly from lectures), this will provide a background that makes it much easier to handle the sheer volume of organisms physicians face.
The lab portion of the course is worth a fair amount of one's final grade. The hands-on approach is often a relief to those less fond of memorization. However, one should study before each lab—not only are the questions often what each section leader thinks will be relevant to exams, but also it is good practice for the "pimping" in third year.
Physical Diagnosis
The PD course is a great opportunity to remind yourself of why you came to medical school. It is the first opportunity for many students to interact directly with patients as more than an observer. Here you will begin developing the essential clinical skills of interviewing and performing a thorough physical exam.
The experience you will have will vary depending upon the setting in which you choose to work. In the hospital setting you may find that there is a greater diversity of patients, and always one whose illness correlates with the assignment of the week. In some of the hospitals they also include a didactic component to the course with one of the staff members explaining the weekly topic prior to seeing the patient. In a private practice you will enjoy the benefits of working directly with the physician. Because of the nature of a private practice, however, there is not always a patient who is appropriate for the weekly topic. All topics are eventually covered, but be prepared for anything.
Despite the differences in experiences, all students will walk away with the ability to perform a history and physical and with a new level of comfort in communicating with patients.
It is recommended that students purchase the PD equipment at the beginning of the year. You will hear different opinions as to whether or not it is useful to have this expensive bag of equipment. Most people get it, some people share equipment. The decision is yours, but you will need the equipment during your second year and it can be useful during your third year.
At the start of the year, NYMC will arrange for medical supply houses to speak to you about the equipment and offer it all at better prices than you would normally find elsewhere. It will all be delivered before your first assignment, so you're set the first day with pockets full and stethoscope around the neck.
The grading for the course is based on three things. The first is a subjective grade from your preceptor. The second is a final written exam based primarily on the course text Physical Diagnosis by Swartz, usually given in April. Finally, the third is the standardized patient exam, which really allows you to see just how much you learned throughout the year. You will be assigned a patient/actor who acts out specific symptoms of an illness while an observer quietly marks off all that you do appropriately as you go through the history and physical. After you complete the H&Ps they provide feedback on all accounts —your thoroughness, demeanor, empathy level, etc.
Overall, this course is a welcome relief to the self-study of Pathology, an opportunity to apply some of your textbook knowledge to a clinical situation, as well as a time to develop skills that you will be using the rest of your career.
Pharmacology
Step wisely, second-years: the department has prepared a strong course, poised to battle for your time with Pathology/Pathophysiology during the spring. The wise student heeds the course director's advice to master the pharmacology concepts presented before the first exam. Pathology gives a lighter course load at that time, which is not to be ignored, but the core of Pharmacology is presented early on. After the first exams, the workload switches, weighing in heavily on Pathology. A strong pharmacology base will carry the rest of the load well through the rocky road in the middle of the semester.
Attendance at lectures is important, because many concepts can be confusing if not carefully presented and followed. Your attention in class will make later studying of scribes an excellent review for the course exams. In-house exams test not only basic concepts, but also many of the obscure drug interaction and side-effect trivia that come directly from lectures. To reiterate, studying primarily from the books would be dangerous; exam material comes from what is discussed in class, and a good knowledge of the scribed material is essential. The miniboard is more clinically based, using vignettes and common scenarios for questions. The clinical correlation lectures are excellent preparations for practical pharmacology questions, and the tag-team performances by Drs. McGiff and Frishman are excellent and not to be missed. Some of the best lectures in medical school are presented here, but a few sleepers may tempt you to skip, and probably miss the good ones. Dr. Wormser's antimicrobial lectures and handouts are as good as gospel, and are saved until the end.
The recommended text, Katzung, is fine, but review books such as Lippincott or the orange Katzung board review will help greatly if used from early on. Pharmcards are popular as well, but the best study aid is, of course, old exams.
Third Year
Major didactic sessions and USMLE, Step 1 are behind you, and now you're ready to put all this bottled-up information into practical use. As you begin your third year clerkships, take a look back and see how far you've come. In many ways, Anatomy and Histology are but a figment of your imagination, but rest assured, lessons learned then will be of great benefit this year. Gone are the days of barely rising before 9:00 a.m. to herd into lecture hall. Those days are now replaced with rising prior to the sun for rounds. You'll be placed in charge of a patient's care. In many instances you'll be amazed at just how much of an impact you will have on a patient's well being while under your care.
While you should be excited about your new clinical role, it will not be all fun and games. It will be very unpleasant at times. You will get disrespect, and you will learn how little being a med student means. It will make your life unpleasant, but it should teach you humility. Everyone was a med student at one point in time, and they all think that you have it easy by comparison. There's nothing you can do to change it other than to be friendly to everyone from the Chairman to the unit clerk, work hard, keep your mouth shut, your nose clean and your head down.
Your year will occur in two blocks, "A" and "B." Block A consists of Medicine (12 weeks), Psychiatry (6 weeks) and OB/GYN (6 weeks). Block B consists of Peds (8 weeks), Surgery (8 weeks), Family Medicine (4 weeks) and Neurology (4 weeks). The order of the blocks and the rotations within the blocks is decided by two separate lotteries.
For the most part, although the order of your rotations will flavor your experiences, it is not easy to say that any orders are particularly better or worse. A few caveats: some people felt that starting the year with Psychiatry was "not clinical enough," and Family Medicine was "overwhelming as a first experience." To do an outside elective during your third year you are usually required to have completed internal medicine and surgery. If you are considering a field that you don't get exposure to during your third year, or one with an early match, especially fields like Ortho, ENT, Ophthalmology, Urology or Dermatology, you will need to do an outside elective in your third year and this should be taken into consideration as you make your schedule.
Each of the clerkships is done at one of the vast array of NYMC affiliated hospitals located at a variety of sites in New York City, Western Connecticut and New York State.
There's really no way to anticipate the experience you will have. Make it whatever you want; the burden of education is being slowly transferred to your own back instead of that of the school.
Each hospital, as well as each program within each hospital, has its own strengths and weaknesses. Ask the upperclassmen for insight into individual clerkships. For the best assessment, ask more than one, because you will find a wide variance in personal experiences. The vast array of experiences may range from seeing the most common medical problems and procedures managed at a somewhat smaller private community hospital to perhaps being stationed at a highly renowned tertiary care center where nearly all the cases appear to be incredibly complex. On top of this, the location of the hospital will be grounds for its own individuality in terms of social and cultural issues to be addressed. It's this diversity that gives NYMC its great strength in clinical experience.
Grading this year takes its own twist. You'll be evaluated on the basis of your apparent clinical performance as judged by residents and attendings with which the quality and quantity of your interactions will vary. As a result, when it comes to grading, the most visible and energetic students will get the best grades. Depending on who you are, this is a good or a bad thing. Unlike the first two years, grading is done quickly by clinicians who are likely to view it as an annoyance. As a result the students who impress without being overeager or cutthroat will do best. It is a difficult ledge to walk, and you will quickly arouse the ire of your classmates, residents and attendings if you are not a team player. Your superiors had to deal with insincere and cutthroat med students long before you got to med school and can spot them quickly. Medicine is a very small world, stories spread quickly and you will find that it can grow even smaller.
At the time of this writing, the miniboard is only used on a pass/fail basis, placing much more emphasis on the clinical grade. It is possible that this policy will not continue indefinitely. Standardizing the grading system across sites and rotations continues to be a problem, and though these issues are being addressed by the administration, it is likely that they will continue to be a problem for some time to come. Additionally the methods of clinical grading are being examined and it is likely that a revised system will be in place in the near future.
One will find that obtaining balance in terms of time allotment for both clinical and exam preparation becomes rather difficult. Don't underestimate the amount of time you'll need to read and do questions in preparation for the miniboard, on top of daily preparation for rounds and individual patient management. Maintain a steady diet of reading and question taking. Use your patient's working diagnosis as subject material to read up on. It will personalize the material and hopefully make it less likely to be forgotten; besides, you'll provide much better patient care that way. Above all it's the consistently wellprepared enthusiastic clerk that excels academically.
Your experience this year is likely to be life changing. Not only will it reaffirm personal interests but it will also cultivate new ones. In many ways the medical specialty in which you decide to train will be determined by your experience as a third-year clerk in the hospital. Of course, there is a vast array of specialties not even touched by third-year experience, but it's not really until third year that you get a feel for exactly what type of physician you wish to become. It's during this year that you first become personally acquainted with the "call" schedule. It's during this year that you truly manage a patient's care. You've probably come to medical school with a desire to make a difference in patients' lives, and it's during third year that you're able to finally start doing so from the point of view of a physician. It can actually be one of the more rigorous years of medical school, but concurrently one of the most rewarding. NYMC provides the framework for an unforgettable experience—now all you have to do is fill in the details. You can truly make it what you want to make it. Use enthusiasm, hard work, and dedication as the basic principles and despite hardship, you will not only excel, you will also obtain complete satisfaction.
Fourth Year
The fourth and final year of medical school is quite different than the previous three. There are 14 weeks of required courses, while the remainder of time is used for about 18 weeks of electives and some much-needed vacation time. Electives provide you with a chance to study any field of medicine in virtually any medical school in the country; even some international electives exist. This enables you to achieve a few goals. First, you can broaden your education and concentrate on topics to which you may have had little exposure. Second, you can further assess whether the field you have tentatively chosen is indeed the right fit for you. And third, you can visit any academic institution you choose to better ascertain if it is where you want to do your residency. Some of the popular NYMC electives offered include Computers in Medicine, Radiology, Clinical Pathology, and Multiculturalism in Clinical Practice.
The required fourth-year courses are a Subinternship in Medicine or Pediatrics, Ambulatory Surgical Subspecialties, Geriatrics or Chronic Care Pediatrics, Anesthesiology, and Rehabilitation Medicine. The subinternship is basically the wake-up call of what to expect in your first year of residency. You follow patients from admission to discharge with a level of responsibility intermediate between a third-year clerk and an intern.
In fourth year, you will be required to sit for the USMLE Step 2 examinations and participate in a Comprehensive Clinical Examination (Morchand). Through the use of standardized patients and videotaped observation by an attending physician, this examination is used to assess students' skills, not only in the cognitive areas of medicine, but also in the area of patient-physician interaction.
Two important topics to many fourth-years are away rotations and the yearly rotation schedule lottery. With regard to the order of rotations enhancing your application, there are a few situations in which that may occur. If you are going to do an elective in what you think may be your future field, you should do it early. Some people have done another rotation and decided that it wasn't for them after all, and it's a lot easier to change your application in August than in October.
If you are planning on going into Internal Medicine or Pediatrics, then you may benefit by doing your required subinternship early in the year so that you can get a letter of recommendation and have that grade in the packet the Dean's office sends out on November 1. Likewise, if the specialty you have chosen is not one of the rotations in third year, or if you did not get as high a grade as you wanted in your third-year rotation, the same advice also applies. Similarly, if you consider doing an away rotation, then by the same argument, you should try to schedule it early in the year. A letter from an away rotation could end up being one of the strongest parts of your application. Be sure that if you do decide to rotate at another medical center, you are 100 percent committed and, at the same time, that you are fun to have around.
Finally, the residency application process is at the forefront of everything you do in fourth year. Throughout the year, you meet with advisors and deans to discuss the ins and outs of the Match.
Most people plan to take a month off in December or January (preferably) to interview. The people applying to fields such as radiology that require a lot of interviews will find that they really need two months off.
In February, you are required to submit your final list of programs for consideration in the Match. Several weeks later in March, medical schools across the country participate in Match Day, when at the stroke of noon, everyone opens an envelope containing the name and location of the program where they will train as residents. As you can expect, the last year of medical school is truly the culmination of four years of hard work. After Match Day, the entire class gears up for Commencement week with highlights such as the dinner sponsored by the Alumni Association, the Honors Day Ceremony, and most of all, graduation day in Carnegie Hall.
Fourth year may seem a bit overwhelming, but the flexibility it affords is a welcome change to the previous years. Relax, smile, learn as much as you can, and remember that July 1 is right around the corner.
