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How To Study
Symptoms to Diagnosis, An Evidence–Based Guide, Stern, Cifu, Altkorn is suggested for this clerkship. This text is online through Access Medicine. Your clerkship administrator will provide you with a copy of "IM Essentials" (MKSAP for students) for use during your medicine rotation. You will be expected and required to read extensively during the clerkship. Selection of appropriate references will depend upon your purpose for reading. In general, your reading will have two broad purposes. The first purpose is to learn about individual patients and the second is to broaden your general knowledge of medicine.
Reading to learn about individual patients
Attainment of the knowledge necessary to practice medicine requires two distinct activities: a) seeing patients, and b) reading about their problems. You will be expected to read about each new patient you see during the clerkship. The faculty has identified self-directed learning as one of the most important educational outcomes of the clerkship. Self-directed learning has been defined as a process which requires the learner to define learning needs, identify and use appropriate learning resources, monitor and assess their own performance, cope with frustration, and apply abstract knowledge.
In order to identify learning issues, you need to assess what you know, what you need to know, and any discrepancy between the two. Therefore, before starting to read about your own patients, take the time to carefully develop a problem list. You can ask yourself a series of questions about each entry in the problem list. Questions which you are unable to answer might be good learning issues. When selecting your learning issues, keep in mind the general goals of the course and the list of clinical problems listed earlier.
Appropriate learning issues include, but are not limited to:
- the significance of a symptom or sign;
- the differential diagnosis of a clinical problem;
- the diagnostic evaluation of a clinical problem;
- the pathogenesis of a clinical problem;
- the management of a clinical problem;
- the prognosis of a clinical problem; and
- the prevention of a clinical problem.
Traditionally, medical students have been advised to use the standard, large, multi-volume texts (i.e. Harrison's, Stein, Cecil). The standard texts will generally provide the appropriate depth of information. A number of small, paperback texts (i.e. Cecil's Essentials, Fishman) are popular because they are concise, easy to read, and relatively inexpensive. Unfortunately, they may lack the depth and breadth of information you need when researching a specific clinical problem.
Occasionally, you will find that even the large standard texts do not provide the depth of information you need. At other times they will not be up-to-date. Under these circumstances you should look at subspecialty texts or current journals. When you need the most current information about a specific clinical problem, the best answers may be found by doing a MEDLINE search. Every student should know how to search MEDLINE, and should have several opportunities to do so during the clerkship. You also need to begin to learn to critically interpret the research literature. This task will continue throughout your education.
Try to identify several learning issues for each new patient. You may also identify learning issues when making rounds with your team, when discussing cases with other students, etc. Many students find it useful to write down potential learning issues during the day in a notebook or on an index card. If you don't write them down you will forget about them!
Find the most appropriate resource (don't forget that faculty and other colleagues may be excellent resources) and start learning! If you are unsure where to look for information, ask someone. Our librarians are very helpful, but they are underutilized. Find out what learning resources are used by other students, residents, and faculty. Try to schedule time for reading. You will probably find it difficult to schedule large blocks of time during the day. You will need to learn to take advantage of brief opportunities during the work day. Larger blocks of time may be available early in the morning, or in the evening.
Ask yourself questions while you are reading. Always try to integrate what you are learning with what you already know. "Compare and contrast" exercises can be especially useful when learning about diagnostic reasoning. For example you may have a patient who presents with complaints of chest pain and dyspnea. Your differential diagnosis may include myocardial ischemia, pulmonary embolism, and other possibilities. Ask yourself, "In what ways are the clinical findings in the entities similar? In what ways are they different?" Many learners find it helpful to make notes, outlines, or diagrams while reading. Look for opportunities to present what you have learned to other students, your team, or a faculty member. You know you have learned a concept well when you can explain it to someone else. You may be able to explain things to your patients as well. Patient education requires professional knowledge, knowledge of your patient's educational needs and abilities, and the ability to communicate using language your patient can understand.
Reading to broaden your general knowledge of medicine
Learning is most efficient when reading follows experience. In an ideal world, you would need to read only about the problems of specific patients. Unfortunately, we can not guarantee that you will see an ideal variety of patients during your Internal Medicine clerkship. Satisfaction of the expectations of the faculty of the School of Medicine and the National Board of Medical Examiners requires that you obtain a core of knowledge in internal medicine. Therefore, you might want to consider supplementing your reading about particular patients by reading a concise synopsis of internal medicine. Across the nation, Medicine by Fishman, is becoming a popular choice of medical students for this purpose. Reading to broaden your general knowledge of medicine should carry a lower priority than reading about the problems of specific patients.