DIP Episode 501 - Common Sense For 2024 (a guide for medical students and residents)

Welcome to episode 501 of the Divine Intervention Podcasts. In today's podcast, we're going to be addressing a topic I title, Common Sense for 2024. Common Sense for 2024. This is a podcast I think you're going to find to be profoundly helpful for every level. And this is pretty much going to be a guide for medical students and residents. And just as a quick shout out, if you know you're taking your USMEL exams soon, I have a class that actually starts today. So step one class runs from today to Saturday, but it's not just for step one, social complex one. Or if you're preparing for step two or step three or complex two and three, and you want a very strong foundation for those exams, this class will be exactly what you need. And then next week I have a series of classes studying on Thursday with a test-taking course. That's for step one, just step three on Friday, I have a bio-stats class. Also for step one, just step three on Saturday. I have a social sciences and ethics class for step one, just step three. And then the week after that, I have a 20 hour class for step two, complex two, step three, complex three. So if you're interested in any of those classes, just shoot me an email the all over Zoom, and I can give you some more information. Okay, so let's just jump right into it. So common sense for 2024, right? Obviously, happy new year. I was really glad that we were able to hit episode 500 last year. But now we're in a new year.

Last year is gone, 2023 is in the review mirror. But now, what are some things you should be doing right now? How can you structure your year so that you can get a lot out of it? How can you structure your year so you can succeed and prosper in this year? I'm going to arrange this podcast in a certain way. I'm going to literally start from first year of medical school. So like, oh, if you're an M1, this is what you should be doing. If you're an M2, this is what you should be doing, M3, M4. Then I'm going to residency. But for residency, I'll stop at year three. Because many residences are three years long. But honestly, if you're a resident and you're in the seven year things like neurosurgery, for example, you're still going to find this to be profoundly helpful. So honestly, even if you're a resident, even the stuff I tell medical students in this podcast, you're going to find it to be helpful. So let's just get right into it. So first year, what I'm supposed to be doing your first year of medical school. Your first year of medical school is for deep learning. I'm going to say that again, you heard me right, deep learning. And fact, I know as I make this podcast, I'm making this right now like January 8th, 2024. A bunch of you have at least probably finished the first half of your first year. If you pretty much wasted that first half, I will strongly encourage you to get your acts together in this second half. Literally, get your act together.

One thing that many people don't realize is that your entire medical career, your success on board exams, your success with residency, your success as a third year student is built now early. Many people ignore the importance of a good foundation. And the benefit that you have going for you now is that you don't have a board exam coming up right now. You have like so much time before you have to take your board exams. So because you have that so much time, a wise thing you can do right now is to learn slowly and deeply. Slowly and deeply. Slowly and deeply. It requires a lot of dedication. It requires a lot of time. It requires a lot of effort. But it's something you need to start doing. If you didn't do it last year, do it this year. That's the truth. Like a very smart way to go about this is get a copy of first aid. As we know, first aid has a lot of facts. Those things necessarily have the most context with it, although it's a phenomenal book. So you may want to say you know what as I'm going through my different routine, as I'm going through my different blocks. I will read through first aid and then I will use like a board study resource, learn the material well. So your job now is not to memorize things. No, just learn it well. That's all you need to do. Literally learn it well. As you learn it well, then annotate into your first aid. Now please be careful. Don't annotate stuff from your lectures into first aid.

It's only if it's directly applicable to what is in first aid because unfortunately, many medical schools, they go for a lot of stuff that has like no board exam worthiness. So you don't want to make your first aid become an unconscionable book to read. You certainly do not want that. So annotate things from like a board's resource into first aid. And again, don't annotate too much. I just feel like people go on extremes. I'm honestly even the Bible talks about like, man, people are going extremes. Stop wise. Just do a reasonable amount of annotation to where you're like, okay, first aid will almost read like a textbook to me. Come when I'm taking my exam. Right. So that's just like a smart thing to keep out of back of your mind. Right. First year and honestly, this advice also applies for second year deep, deep, deep learning. Learn things slowly for learning well that first time. I'm telling you, this is probably one of the smartest decisions I took for my life. And he helped me tremendously going forward to this very day. Some of the things you see me being able to explain very well right now are things I learned well the first time when I was a medical student. Where was a first year medical student at Hopkins? So I was strongly strongly encourage you deep, deep, deep learning. Now, what is another thing? So really this advice I'm giving honestly just applies for first and second year. So I'm just going to merge both together.

One other thing you should also be doing is find research. Find research. You'll be amazed at the number of medical students that wait until it's too late in the process before they start finding research. To be honest with you, even if you think you're going into an uncompetitive specialty, which that is slowly becoming a dying breed. Like many of the disciplines and I'm not going to mention any discipline, but many of the disciplines that we used to think before that, man, you don't need research. What was true years ago is no longer true right now. There are some disciplines where people thought that, oh, you could literally slip walk your way into those residences. That's not really a thing anymore. Especially with the way Eras is now set up and with the match is now set up and the increased competition. Right. There's just more people applying for residency today than they were even just three years ago. That's the truth. So I will strongly encourage you to seek out research. Don't wait till third year. You see some people, they start researching their third year. No, no, that is not wise. Study early. Third year, you may not have as much time to do quality research. And the thing is if you are doing a lot of research in your third year, your studying for your shelf exams is going to suffer and you're going to pay a price for it.

So honestly, if you're kind of wondering, man, like, divine, what are some things that should do with my first two years, honestly, deep learning and rotating to your first date and research. Those are the two things you should be doing. Right. Extra curricula. That's a good time to also latch on to that. Right. Your first years of med school, extra curricula is very, very smart thing to do. Right. Because again, the amount of time that you have control over is going to diminish progressively as you progress in your career in medicine. You're going to have less control over your time as a third year. You're going to have even less control over your time as a resident. So those things that require you to be prudent with your time and employ big chunks of your time to get those things done. Get those things done in your first and your second year of medical school. Again, I know some of these things like hockey, hockey advice, but I promise you, if you don't follow this advice, you will pay a price at some point. You may not pay it now, but I can almost assure you, just give yourself a few years. You know, by the time like 2026, 2025, 2027 hits, you're going to be paying a pretty steep price for ignoring this advice. So those are the things you should be focusing on in your first two years of medical school. And another thing you should also focus on in your first years of medical school is building up your physical exam scales.

Building up your physical exam and patient interview skills. Good or say that again, building up your physical exam and your patient interview skills. Many medical schools, at least in the US, they have many programs that they run that will pretty much force you to become good at these things. Take those things seriously, right? Like at least know the basics of like the cardiovascular exam, the respiratory exam, the neurological exam, the abdominal exam, the extremity exam, the skin exam, know those basic things. Have just a basic approach. Honestly, this is a good time to build up basic approaches to things, right? Basic approaches to interviewing patients, basic approaches to interviewing kids, basic approaches to doing certain physical exams. Oh, giving this presentation or physical exam and over should I do these are things you should be building up your first two years. But honestly, that's pretty much my advice for the first two years. There's many other things you can be doing. I have no issues with that. But honestly, the critical things, research, deep learning, extracurriculars, physical exams, patient interview skills, that's your big, big, big focus. Okay, now let's get to a third year. What are you supposed to do with your third year of medical school? That's a great question. So your third year of medical school, obviously you're going to be doing a lot of rotations. Let me do a lot of rotations.

Okay, so what do you want to do with your third year of medical school? The thing you want to do with your third year of medical school is again, number one, number one, study for your shelf exams. You may be like, man, divine. Why did you start off with build your clinical skills? Well, here's why. There is an insane study for your shelf exams is that many things flow from studying for your shelf exams. You see many people, they go into 30 and they're like, oh, you know what? I'm going to learn everything on the words and I'm going to just focus on improving my patient care skills. The thing is, unfortunately, those things may not necessarily control how good your grades are. The thing is, it's better to build those things from the place of studying for your shelf exams. What are some of the benefits of studying for your shelf exams? Number one, you're going to crush yourself exams. Number two, you're going to answer your PIM questions very accurately as the truth. Number three, it would be very good at clinical care. I kid you not. People that are great physicians have good knowledge bases. The thing is, the more you know, the more comprehensively and the more accurately and the more astutely you can take care of your patients. Many people ignore this fact. They think that, oh, again, this is just divine selling some snake oil, but it's not. I kid you not. It's very important. Many people that struggle clinically, most times check their knowledge base is terrible.

That's the truth. Most people that struggle clinically have very awful knowledge bases. So that's not something you want to be your testimony with your third year. First and foremost, study for your shelf exams. And let me tell you this, the best predictor of your performance on step two is your performance on your shelf exams. I'm going to say that again. The best predictor of your performance on step two is your performance on your shelf exams. The people that you see that are getting in the 90s, in the high 80s on the shelf exams, you can almost pencil it in that you're probably going to get in the 250s or in the 260s or thereabouts on their step two exams. Again, I'm not saying for sure for sure, but is highly likely that that's going to be your outcome. Right. If you see them consistently have those grades throughout the third year. Right. So learn, learn, learn, learn, learn, learn this material and learn it well. Right. Go through a Q bank. Pick your world. You wrote is an excellent Q bank. Go through that Q bank. Oh, divine. How can I study for each shelf exam? I have many podcasts have made on these things. Oh, how do I use dedicated periods? I have many podcasts have made on these things. Check out episode 447. But honestly, like just check out my website. There are so many things I have. Have like many shelf review videos. I have many podcasts. I have many things that I've done. Right. That you can use to learn for these things. Right.

And also have many review courses that I offer that many people find to be profoundly helpful. That can also help you achieve success on these. So study for your shelf exams. And then the second thing I'm going to say is start developing algorithms. You're going to see that again. Start developing algorithms. Start developing algorithms. What do I mean by start developing algorithms? Start developing algorithms. I mean start developing like an approach to use for things like note taking things like pre-rounding things like around it, things like discharge summaries, things like admissions, things like transfers, start having written templates for these things. Literally, type it up. Have it somewhere. I promise you maybe like divine. What am I going through all this stress for my third year? Honestly, this is something that will help you not just for your third year, but it's going to help you as a resident as well. I kid you not many of the approaches that I used as a resident in interviewing patients, blah, blah, blah, blah. These were all things I picked up during my time as a medical student. I kid you not, especially during my internal medicine rotation. So I'll strongly encourage you have these templates because it will make you more efficient with patient care. I'm telling you when you have an approach, when you have an algorithm, when you have a pattern that you follow, when you have a checklist that you follow, it's going to make you extremely efficient.

It's going to make you extremely accurate because many times speed and accuracy don't go together. But the person that works with checklist is able to combine speed and accuracy, able to combine speed and accuracy. Okay. Now, what is another thing you need to be doing as a third year? As a third year, you need to be planning for your step two exam. And I guess I forgot this for the first and second year folks. Obviously, you're going to be taking your step one exam. Plan for that. Plan all you get it, period and stuff like that. This is going to kind of make sense. Right. But for people that are third year medical students, I strongly encourage you plan for step two. And please plan to take step two before the end of what July. I'm going to say it again plan to take step two, why before the end of July. I'm going to tell you this right of the bat. Do not apply for residency. If you don't have a step to score. I mean, you can apply obviously I'm not going to hold you back. But what are your chances of you getting any kind of interview? They're almost zero. I can't you not. They're almost what? Zero. If you don't have a step to score. Right. Back in the day. And again, back in the day, it was like as recently as three, four, maybe five years ago. You could take step two during like November of the year applying for medical for residency. And it's not a problem. You'll still get some interviews. You know, they're like, okay, when you get your step two scores of data.

But I'm telling you one of the quickest ways to DOA your application or DNR your application immediately is just having no step to score. Right. So you see people again, that's just the thing. If you plan many of the problems that people face and struggle and stress through. You don't have to deal with any of those things. So plan. So since you are if you have a plan, then you can make your start studying well ahead of time. Right. Please don't wait till September to take your step two exam. No, you see some people they're like, well, that's one thing that really boggles me sometimes when I hear this question from people. Oh, divine. What is the last possible date I could take step two so that my score school come out on time for ira's see see those are words of a person that is irresponsible. That's the truth. Those are literally words of a person of an individual that is absolutely irresponsible. You should not be depending on the last possible time I scores will come out for you to whip yourself into shape and study for your exam. Right. Why don't you go through things see many of the things many people say, Met School is stressful, stressful, stressful. Don't get me wrong. I see why that can be the case. Met School is stressful, but I kid you not most of the stressors that people encounter in med school in residency and in life is from a failure to plan.

I'm going to say that again, most of the stressors that people encounter from med school residency and life is from a failure to plan from a failure to plan from a failure to plan. Don't be that kind of person. I'm telling you your life will be way less stressful and your risk of mental health crisis will be quite significantly reduced if you just planned out your life and defense on an early schedule. Don't wait till the last minute literally don't wait till the last minute. I kid you not my step to exam. I took it like very early in the summer before he asked how even went out. So I didn't have all these stresses like I already had my scores like I had a scoring hand asking people for recommendation letters. I had a scoring hand for many things already. When you see people they wait till like late August early September last possible need to take the exams and then they were like wow. Maybe some program director at their home institution wants to speak to them and say let's talk about your application. See if you're competitive for this year. Have you taken step two or I'm taking it in September. They don't have any score to assess you with right and that's one thing you don't realize if there are other people in your cohort in that same med school that I tried to get into that same specialty that have scores. What do you think the program director at your home institution is going to grant interviews to what you think is going to take more seriously.

So take those people that have taken the exams and have scores in hand. So please take your exams on time. It's better to take your exam to schedule your exam very early and okay I have to postpone it till like August or something because I don't feel prepared. Then to schedule your exam right off the bat for a very late period in the cycle that is not smart. I kid you not. I kid you not. If you don't have a step two score before ERAS goes out of like oh programs can start downloading your application. Again I'm telling you your chance of getting an interview even if you're from a US medical school is very low and your chance of matching is extremely low as well. So plan now right generally you know divine see one principle I found that really helps me my life is I tried to ring the alarm early. It's better to ring the alarm early than to ring the alarm late. Ring the alarm in your life early is better to start stressing about those things now than to wait till the summer and start stressing about those things. Okay now what's the other thing should be doing as a third year medical student now right what's the common sense because again many of you that are 30 years right now you've gone through half of your third year what are some things you should be doing right now arrange your away rotations.

I range your away rotations I cannot tell you how many medical students we feel like me just that I range in a ways and then at that point they're getting the bottom of the bar or they're getting away rotations at in opportune times. You see some people they're like man divine I couldn't find anything for June for July for August for September so you see them there stop doing away rotations in the month of November when the application cycle is well underway don't you think it's better for you to plan your schedule get those ways now when there's not much competition for medical students and then you do it at an opportune time you get recommendation letters even before he has goes out. And the thing is some of these away rotations are informal interviews from the program you go to right when you see people I don't know people like to wait for things when there's much more competition no that's not the smart way to go about life big see be a value investor with your life let me say it again be a value investor with your life for those of you that have a background in finance or the stock market you understand what I'm talking about right you go for things when no one is doing them you step away when everyone is doing it.

So why don't you arrange your way rotations now where everyone is not seeking for those why don't you arrange for recommendation letters that's the next thing I want to talk about recommendation letters why don't you start arranging for them where the rush is not too much but you see people they'll wait till July or August to start acting asking for rec letters what I personally asking for rec letters in August the competition is fierce like 30 people have as that same person for rec letters so what's going to happen well the person to fulfill the needs of the 30. The person will have to write like a crappy recommendation letter it will not be as good it will not be as thorough it will not be as well thought out versus if you ask the person now you'll be the only person on the applet it can write their best work and give you a good letter I'm telling you the more people ask a person for a letter the worst the quality is over time right so just plan your life plan your step to date get your rec letters get all your docs set them up.

I'm telling you if you do those things you notice that the era process is very mellow right like for me when I hear people say that's wow is the night before ira sees you and you're like sweating bullets I'm like what are you doing with your life there's some people that literally the way they leave their lives you can almost tell what the outcome will be is such to say what it's true you see them you had all of the year but you're like jeez I'm going to wait till the night before to get all these things sorted out and you see this post on my phone.

I read it and you see people telling these people Godspeed that no you should be chasing those people because those people are foolish they're not fools but your behavior is foolish your behavior is foolish don't leave things for the law I just don't get it I don't understand why people lived in for the last minute right is very common place that's why you see I I tattoo this podcast common sense common sense is not very common and many people lack the most basic levels of common sense again I feel very sad seeing this but it's true it is absolutely true right so just plan out your life right like when ira comes out like in June why don't you start feeling see let me tell you this your 30 a medical student once ira comes out spend five minutes a day on it just see five minutes five minutes a day if you spend five minutes a day by the end of July you've crafted this gorgeous personal statement you've checked off all the programs you're applying to you've filled in all the information you've answered all the essay questions you've filled in all your experiences that's a small thing to do and here's the thing if you do those things well then when your school is asking for comments for the MSP and whatnot because you've already filled out your ira's application comprehensively you already know what to tell them so that the MSP that you're giving them much is perfectly with what is in your ira's application right so I'm encouraging you please please please please make your life easy make your life easy make your life easy right as a third year start coming up with a criteria for where you want to be for residency because now we inform the kinds of programs that you apply to although without fiercely competitive the process is now I tell people apply to as many programs as you can afford right and then obviously in your third year you do these things you set yourself up nic

ely for success okay now one thing I want to say about third year is don't do aware rotations if you don't have to right they are certain disciplines where especially if you have like strong scores you have solid research you've done a very solid rotation at your school you probably don't need a weird rotations I feel like sometimes people just do a weird rotations because it's like the fun thing to do always like wow they want to really set themselves apart but there are some disciplines where an aware or rotation doesn't really set your parts that much differently from a person that just did not do an away rotation and again if you want consulting on all these things you can always shoot me an email I do meet people one on one at rate and we can talk through some of these things okay so fourth year right let's go to fourth year what I supposed to be doing as a fourth year medical student well the first half of fourth year of mid school is tough the second half is amazing the first half tough second half amazing what is the first half tough we're gonna be going for interviews you're gonna be doing a weird rotations you're gonna be getting the final parts of the application together right get a suit right get good good dress like one or two sets of clothes that you can use for interviews that's a smart thing to do right and the thing I'll also see should be doing as a fourth year is especially when you get to the second half right so like now for most people stop preparing for step three start preparing for step three oh divine you're such an intense guy come on well if you listen to a podcast I made a few weeks ago you'll understand why taking step studying for step three and getting done as quickly as you can is a smart play right what do you want to do again don't do anything crazy I'm not saying wow putting hours and hours every day studying for step three no that

's not what divine is saying what divine is saying is that see spend like 30 minutes a day or an hour a day gently studying for step three get the your cuban for step three stop practicing the CCS cases refresh on the material from your shelf exams just go through those things right go through those things so that when you graduate because you cannot apply for step three until you've literally graduated from med school but once you are walking a graduation the day after putting that application so that you can get step three done as quickly as possible why the material from your third year is still fresh in your head because when you're getting a residency trust me I can't tell you how many times I've heard this story or divine I will study in residency and we study so hard in residency and that study so hard time never comes why because you see some people when they become residents depending on what you're going to your time is completely gone you start a family do all these things you notice that cheek I don't have time to do many of these things I thought I'll have time to do so again be wise don't be foolish right make your life simple now 13 I'm going to say about fourth year is you need to start being a more realistic with your life start becoming what more realistic with your life more more realistic with your life the thing is the first three years of med school people have this very romanticized all realistic view of the realities of life right so the thing is we become a fourth year study coming more realistic with your life like for example like okay let's be reasonable like where do I want to go for residency right let's see if interview the bunch of places you're like okay where am I going for residency I need to start getting my finances in order kind of deal okay like do I want to be close to family do I already have kids because I'm telling you as a r

esident child care is very important because trust me you will need it so like who should I stay close to my family okay maybe the place close to your family may not be like the crime the lacrope residency but it's decent these are all considerations you should start having these are all what considerations you should start having and then another thing I'm going to say about fourth year is this is a time for a person that uses marijuana to go ahead and shut it down go ahead and shut it down here's why here's why here's why oh divine come on let me explain why there's a very practical there are many reasons but there's a very practical reason I'm going to leave myself to that because I'm not a politician this is not a space where I'm going to be talking about political issues that's not my cup of tea right yeah I'm sure there are many podcasts you can listen to on that stuff but here's the deal here's the deal the day after the day you match for residency one of the first things I can almost promise you're going to do within that first week you're going to submit yourself to a urine drug chest many residences do this and the any state in the country they'll have a place that they prescribe that you go for background check and one of the things they're going to do they're going to get your urine you know that marijuana can stay in a person's urine for 30 days or more in some cases so if you're a person that uses weed shut that down right now because again I'm not saying things out of a lack of experience and same things that I've literally send with my eyes you hear this unfortunate story a few people every year they get drug tested marijuana is found in the urine and then the residency spot they got that they've worked for four years all this undergrad M-CAT step one step to everything they lose that spot they lose that spot you don't want to be in that kind of situat

ion right so if you're if you're a weed user shut it down shut it down so that is completely out of your system so when you get a urine drug screen you're not found guilty you're not putting trouble oh if I my state of my legal license marijuana my state legal license marijuana okay good luck to you right good luck to you remember you're not going to be working for a state you're going to be working for a hospital system right at some point you need to stop being a child and stop becoming an adult right again that's why I tell you this comments and this is me just literally pouring out my heart to you guys that are listening to this podcast okay to you guys and girls that are listening to this podcast okay so um okay so we're done with fourth year of medical school all right so residency first year all right what are you supposed to be doing as a first year residency to be honest with you if you're resident one of the or your medical student about to start residency one of the smartest things you can do listen to my podcast on I think is called avoiding trouble in residency and pretty sure it's a podcast I made fairly recently avoiding trouble in in residency avoiding trouble in residency I think it's something that you'll find to be very helpful I think actually it's episode 497 on my website episode 497 is literally titled avoiding trouble in residency and medical school check that podcast out there's so many wonderful tips for residency but just brief overview what should be doing as a first year resident well early in your first year take step three take step three I'm telling you don't wait you see somebody will say oh I'll take it like in the second half of my first year no I'm telling you your responsibilities will only increase as residency continues the expectations of you will only increase as residency continues when you start residency that is the period o

f lowest expectations for you that is the period of probably the most amount of time for you right use that time study for step three take it and get it out of the way put that in your review mirror be don't with the USM at least forever we don't with complex forever so you don't have to deal with any of these things get it out of your way I'm telling you I graduated from medical school close to the end of May I took step three close to the end of July of the year graduate from Med School and I think served me well is served me well make your life simple get it out of the way because that knowledge atrophy of the stuff from med school is exponential once residency starts right so get that thing sorted out now the second thing I'm going to say is if possible so this is something that you don't need to if possible stop paying down your debt start paying down your med school loans stop paying down your med school loans again I know this is not always possible for poor living places like California right or New York right that's not always possible but if it's possible even if it's a hundred dollars you can stop paying down that's future interest that you're saving yourself stop paying down your loans if you if you can stop paying down your loans if you can and then I'm nothing you really want to try to do on this also applies to second years but honestly this is something you should really should for in your first year try to get a license try to get a state license like a full on restrict that state license you know in many places this is something you can only get after you're done with your first year but most places as well you can only get this if you've taken your step three exam hmm right so the earlier you can get this done the better the early I can get this done the better it's beautiful for both that are doing like pre-linear years or transitional years many o

f these residences you're going on to like radiology or anesthesia or ophthalm whatever they allow their residents to moonlight but quite a number of programs the requirement for moonlight is a full on restricted medical license for that states that you are a resident in so try to get that license and you again maybe like divine and I just like apply and get it any time no you cannot you absolutely cannot there are some states we're getting a license the whole process takes like six months to a year right especially like Texas for example like they think is a pretty long journal process right but I will say that just in general get this process straight away study as early as you can as early as you can as early as you can so you can get that license in time because I'm telling you moonlighting can make you a lot of extra money right so get that license and the thing is many times residency programs will pay for that license for you because that process is not cheap and sometimes you can be more than a thousand dollars right so many residences offered to pay for that so just might as well take advantage of of that and then the other thing I'm going to say is as a first year resident again a lot of these things I'm saying you're going to find it is for 4.97 kind of gloss over them study for your training exams I kid you not study for your in training exams your goal should be to do what crush your in training exam because I'm telling you for many people you're in training exams performing poly on them is the beginning of many sorrows in residency many sorrows I kid you not in residency right so study for your in training exams study for your in training exams right and the thing is again what is one of the best predictors of success on your board exams just like oh wow do you well on your shelf exams is the best predictor of success on step two well guess what do you

well on your in training exams is one of the best predictors of success on your board exams right on your board exams so study for your study for those things and I'll also tell you in first year your first year of residency make checklists right now your those checklists are going to be more very important to you because you're going to use them on you're not doing the catch all stuff for for med school right like you know med school is the time where you're exposed to everything but now you're in residency you're literally doing the stuff that you want to do for the rest of your life right so you might as well get good at like you know like your job so I will strongly encourage you make checklist for things you see allotting your discipline right I kid you not you'll make your life so so so so so simple and you'll make you a much more effective resident a much more efficient resident you'll get good evaluations right many people forget this they think that oh wow evals any med school no evals don't end the med school right after every rotation as a resident you're going to get evaluated right so again make checklists make approaches to these things you'll make you are much much better resident and the thing is if you study for your in training exams you're also going to do well clinically when you are attending PIMTS you because PIMM questions are not just for med students they also for residents you can answer very confidently you can evaluate patients very accurately very visibly very wisely if you have a good fund of knowledge okay now what should you be doing in your second year of residency again if you've not got your license go ahead and tee that up start studying for your board exams set up a dedicated study plan something that again is 30 minutes right again remember great things come from small things that are done consistently great things come from small

things that are done consistently start studying for your board exams start studying for your board exams you don't know I can't tell you how many people fail board exams and then oh obviously you're going to take it after your don't with residency but I can tell you how many people they fail their board exams and then you have to retake it like two three four five six times before they can qualify for it and the problem with these board exams is they're not administered very often not like the USM is that you can take it like almost any time no most of these specialty board exams the administer like once a year so you feel it you're going to wait till the next year and here's the thing you may be like you divide who cares you know finish residency you know I'm going to be making the big box let me explain why that's what's going to be a problem for you number one there's a difference between being brought certified and being board eligible people that are board eligible you didn't usually get the best jobs going to say that right now number two the jobs you're going to get are going to be low-paying jobs you you'll get paid more than you've probably ever earned your life because you're an attendant after a residency but you're going to be getting the low-paying stuff the low-paying stuff right so those things can have some very especially if you understand what you know things like compound interest mean you I I kid you're not you can have some very significant financial implications for your for your future okay and then start looking for a job start looking for a job again it all goes back to this principle of living things for the last minute right when you're desperate because the thing is here's the thing I've seen this story play out so many times you see people they don't bother looking for a job they're like well I'm a doctor I can find a job easily and then

the wait till residency is about to end before they start looking for jobs so because they're desperate anything that is thrown their way boom they grab it because they're like I need to make money because guess what after you don't re-residency if you have no job lined up are you still going to be getting a paycheck no you're not you're not residency at least gives you a guaranteed paycheck once you're done you're left hanging out in the code you ain't got no paycheck so guess what start looking for a job the wise smart resident has a job lined up months before residency is over I kid you not months before residency is over and also in your second year of residency again I'm assuming you're graduating your third year after that right obviously this advice titrate it to your circumstances right but under the age you should also be keeping in mind is fellowship so if you know you're applying for fellowship right then you want to get this done in your second year right and you need to stop planning for it in your first year as well because they have certain fellowships let's see you're an I am person trying to go into GI or pulmonary critical care or cardiology or allergy and immunology you need research in residency you need experiences in residency so just kind of like the same advice from medical apply to you right stop planning for those things ahead of time right and then your third year of residency right you should be looking towards taking your board exams the earliest time you can right again make sure you have a job already lined up make sure you have a job already lined up right and again just start thinking more about your future so I think you more about your future right start thinking more about your future like you know what what I want to do my future where do I want to live what kind of job am I looking for right start thinking about your future do I

want to start a family I want to do this I want to do that don't want to do this I'm not going to talk about all those things I'm not a personal counselor right but start thinking about your future okay so I think that's kind of like the big thing I want to talk about but I want to see one last thing some general things that pretty much apply to anybody right um first thing I'm going to say here is look for something that gives you meaning outside of medicine I'm going to say that again look for something that gives you meaning outside of medicine this is one of the sad realities of medicine in the US but it can be very consuming of a person's life it can be extremely consuming of a person's life so and the thing is when your life lacks diversity your risk of mental health crisis increases your risk of dissatisfaction increases your risk of burnout increases your risk of just not feeling stable with life increases because once medicine if whatever is in medicine sticking away from you you feel completely empty because medicine is the only egg you have in your basket so find things that give you meaning outside of medicine like for me personally I have many other things out of my life that give me meaning right many many things outside of my life that gives me meaning right I have my own personal things I have my network of people you know you know that gives me meaning I have my faith maybe if you don't have a Christian that gives me meaning I do a lot of work with my church that gives me a lot of meaning making the spot cast gives me a lot of meaning making the divine intervention life lesson podcast giving you a lot of meaning right so I have things that bring meaning to my life things that are tangible not just like watching basketball or scrolling on social media those things honestly most times are pretty meaningless activities those things do not really feel tha

t void of wanting to belong to something so find something that gives you meaning right I kid you not and the thing is if this is something you prioritize early med school is is a habit that you are more likely to stick with second thing I'm going to say is work on your mental health prioritize mental health in fact honestly I almost I almost wish that people will declare the year 2024 themselves for themselves as the year of good mental health take care of yourself take care of yourself right again medicine can drive a person to the wrong end especially in this country right so take care of yourself mental health things like exercise if you need more specialized help speak to someone speak to a psychiatrist speak to a psychologist speak to a counselor right just do things for your wellness take care of your wellness in this new year right exercise having a good network of friends like physical network people you see with your two eyes what people you see on social media right again there's a big difference between connections on social media and connections like in the real world in person connections right so again pay attention to your mental health now what's the third thing you want to do in this new year that is a smart thing for many people a smart thing for many people is training your brain to focus training your brain to focus I'm telling you this is one of these things I think we're going to see become a pandemic in human life as the years go by but I'm telling you these days people just massively massively massively struggle with being able to focus with being able to focus so train your brain right I'm telling you one of the things that has maybe we lose that ability is the amount of time people spend on social media and a many of these video related applications right like You Tube Tik Tok uh snapchat and stuff like that I'm not disparaging these companies

they clearly have good products right but those hours you spend scrolling through getting those dopamine hits in your brain oh my goodness you don't know how you're pretty much ruining yourself right so start small and then build your tolerance so tell yourself you know every day I'm gonna start off with 15 minutes of no phones no screens nothing I'm gonna pick like a book something that is worthwhile for like my future and spend some time reading it no phones no screens no speaking to anybody and I'm gonna sit down I'm gonna engage with our book productively for 15 minutes and then every week at like a minute or two minutes right try to get to a point where you can really focus for hours on end or one activity with no screens no social media no music playing in the background nothing just you and that thing just focus on it and then the next thing I'm gonna see here is pay attention to your finances start building financial skills oh I could almost make a podcast on this and maybe in the future I need make a podcast on this I may really fuck make a podcast in the future on this what I'm telling you this one of the best times to build for good financial habits is now in five year first year medical student and you listen to the spot cast start building financial habits now you will thank me later and again please I'm gonna give up put out the disclaimer all the stuff I'm saying is just my own personal advice none of this is supposed to be for a medical decision making not for financial decision making speak with a financial advisor speak with your whatever you know so please this is just just for educational purposes that's it so build good financial habits things like budgeting things like begin to educate yourself on things like events on things like 401k on retirement accounts on more gauges on investment avenues start building your knowledge on these things I'm t

elling you when do most physicians start thinking of their finances when you've graduated from residency at that point it is extremely late I'm not saying you cannot be salvaged but I'm telling you that point is extremely late the best time to become financially savvy is before you have money I'm gonna say that again the best time in your life to become financially savvy is before you have money if you don't become financially savvy early you'll be shocked at how setback you will be in life I kid you not because most people in medicine because they've lived without money for a long time they don't pay attention to being better with your finances and then they're like when I start any money I'll get better of my finances no those bad habits those good habits you've not built right you're getting trouble with those right because think about it you don't have any financial savvy you don't know anything about savings you don't know anything about investing you don't know anything about 401k is a retirement account and then you you graduate from residency let's say you graduate and you're like An anesthesia or an anesthesiologist for example right your first paycheck is probably gonna be like 20,000 that's probably much more money than you've ever seen in your entire life wow 20 grand you know what I've lived I've not spoiled myself I've worked hard let me go out and get this very fancy car that costs a hundred thousand dollars you know it's not that big of a deal I mean my neck five paychecks will cover this thing and then oh man I believe in an apartment I need to trade up man hmm let me find this very nice part of town and buy this very big home now that interest rates are so high and I'm gonna be paying like half of my salary in mortgages every month right but what are these people not thinking about they're not thinking about saving they're not thinking about investi

ng let me tell you this many residences offer retirement accounts that you can sign up for they'll be taking a small amount out of your out of your paycheck and sometimes they move on much some of those things these are things you can start doing to start building up your future because again don't forget the power of compound interest I think it was Albert Einstein that said this a person that does not understand compound interest will be a very unparfraising will be a very very steep price for it literally you'll be a very very very steep price for it right get this things like things like white coin investor it's a website it's amazing many wonderful resources there go ahead and check those things out again I may make a podcast on this stuff in the future I may make a podcast on this stuff in the future but again I may also not make a podcast on this stuff in the future because again I don't really I don't really want to be giving financial advice to a big public audience because that that can begin to get into the weeds for a lot of a lot of people okay so I think I'm gonna go ahead and stop here again I also want to want to learn for all the US Emily and complex exams step one to step three complex one to three I have review courses again I have a step one complex one review course starting in about four hours from now again if you're presenting in step one or complex one or you have a very poor foundation I prepare for step two step three or complex two or three this class is exactly what you need and I promise you is gonna help you a lot and then I offer again many other review courses I mean lady pro slash most of me I have a 100 hour step two step three complex two and three review course again it's a very comprehensive course extremely helpful species for that one I'm much more limited because I want to be able to reinvest in the lives of people that are att

ending so if you want to sign up for that shoot me an email and I can give you some more information and then I have these podcasts on Apple Google and Spotify I have a You Tube channel divine intervention US Emily podcast and videos and then I have another website called divine intervention on life lessons.com there's actually an Apple podcast associated with that called the divine intervention life lessons podcast every week I post two podcasts and from a biblical perspective address a life lesson so if you're interested go ahead and check those things out so I'm gonna go ahead and stop here again I know this was a long podcast but I promise you this is one of those podcasts listen to it apply the advice from it your life will literally take a turn for the better if you do these things so I'll see in a episode 502 we're gonna go back to the academic side of things in that podcast oh god bless you have a wonderful week happy new year and bye for now thank you

Deep learning; focusing on building a strong foundation rather than just memorizing facts.

Early (M1/M2); waiting until third year is too late, as it will compromise shelf exam studying time.

Building physical exam skills and improving patient interview skills.

Performance on shelf exams (and, by extension, consistent knowledge base building).

As early as possible, preferably before the end of July, to ensure scores are available for residency applications.

Building financial literacy (budgeting, 401k, investing) because the best time to become financially savvy is before having money.

Deep learning and understanding context; only annotate material from board-specific resources that are directly applicable to the existing text.

To avoid competition, secure recommendation letters when the program director has time to write a thorough letter, and get these done before the application cycle begins.

In-training exams; performance on these is cited as one of the best predictors of success on board exams.

Failure to plan (procrastination/waiting until the last minute).

Finding something that gives meaning outside of medicine (e.g., faith, hobbies, community involvement).

Because financial habits are formed early; waiting until residency/graduation means starting with bad habits and missing the opportunity to benefit from compound interest.

Deep learning and understanding context; only annotate material from board-specific resources that are directly applicable to the existing text.

To avoid competition, secure recommendation letters when the program director has time to write a thorough letter, and get these done before the application cycle begins.

In-training exams; performance on these is cited as one of the best predictors of success on board exams.

Failure to plan (procrastination/waiting until the last minute).

Finding something that gives meaning outside of medicine (e.g., faith, hobbies, community involvement).

Because financial habits are formed early; waiting until residency/graduation means starting with bad habits and missing the opportunity to benefit from compound interest.