Austin Wininger, MS3

Indiana University School of Medicine
Age 24
From Danville, CA

What was the most difficult adjustment you had to make going from second to third year?

This jump was the most difficult educational barrier I have faced. There is dramatically more self-studying with no clear best resource to use. Despite feeling like I gained a tremendous amount of clinical knowledge, my first NBME exam taught me that I did not prepare adequately for this formative assessment.

Additionally, clinical evaluations can be subjective, so learning how best to approach faculty in regards to feedback and constructive criticism definitely took an adjustment. I was not the most vocal student during 1st and 2nd year, so I had to break out of my shell to build the confidence to seek this information out.

Can you describe the basic structure of rotations at your institution?

IUSM has 8 core clerkships during 3rd year (Surgery, IM, OB/GYN, Psychiatry, Family Medicine, Anesthesia, Pediatrics, and Neurology) with surgery, pediatrics, and IM each being 2 months long. Every rotation has an NBME exam, except family medicine and anesthesia, which use a department exam. There are very few lectures and didactics, and typically these were only a minor supplement to the information that you need to know for the NBME. Grading is P, HP, H. There are some assignments (quizzes, H&Ps, researching a clinical question) that are due for a grade, but >70% of grade is determined by clinical evaluations and the NBME exam.

Are there are any resources that stick out to you that helped you through exams/a particular rotation? An alternative question, how did you approach learning the material necessary for a given rotation?

I used Online Med Ed (OME) and UWorld the most. OME is very good at hitting the highlights for each specialty and explaining what you need to know. When using UWorld, I would complete all the questions regarding whatever clerkship I was on prior to the NBME exam. I also referenced various books during each clerkship (FA, BRS, step up to medicine), but the bulk of my studying revolved around those two resources.

How would you describe your role as a team member during third year clerkships?

This depends greatly on the clerkship and hospital you are placed. For example, you could do psych at the children’s hospital and not do many patient interviews on your own, or do it at the VA and see many patients on your own. Typically, you are functioning at an intern level and seeing patients first and presenting to a resident or attending, with the goal being to see how you can improve your interviewing and physical exam skills to build an adequate differential diagnosis.

What advice would you give to a student that is starting their third year rotations but is still unsure what specialty interests them?

Always be open minded. Don’t give up on a specialty based on one bad day or one preceptor. I knew going into 3rd year that I wanted to pursue some kind of surgical field, but I still enjoyed every rotation and built lifelong relationships with residents.

How did you approach asking for feedback from preceptors throughout a rotation?

We all know that feedback is critical to improve as a med student toward functioning like a resident and then an attending. Getting feedback during 3rd year is not easy. Most residents and attendings try to avoid this. Make sure to be vocal about wanting feedback and making a point to meet privately to discuss feedback. This will let them know you are truly invested in your education.

What rotations were your favorite and why? What features of a clerkship make a particular rotations stand out from others?

For me, whether I liked a rotation or not really came down to how I was able to get along with the residents and staff I was working with. I go to work every morning in a much better mood when I enjoy the people I work with. For example, I heard horror stories about OB/GYN and how mean some of the residents could be, but honestly this was one of my most enjoyable rotations. Overall, I enjoyed being in the operating room the most, so surgery and neurology (neurosurgery) were my favorite.

How did you balance clinical responsibilities with studying?

Make a point to do UWorld for each rotation. Watch all the OME early during a rotation. It is impossible to study as much as you did 1st and 2nd year, but aim for an hour per night. One thing that I realized early during 3rd year is that when your clinical duties are done for the day and the residents dismiss you, you should leave and use this time to study.

Did your career goals change during third year rotations, and if so, what particular experiences led to your decisions?

No, 3rd year confirmed that I wanted to pursue a career in surgery. In fact, during my neurology rotation at the very end of 3rd year, during which I did only neurosurgery at the VA, I really started to feel confidence in the OR that confirmed my inclinations for surgery.

Are there opportunities to personalize your third year rotations that you believe are unique to your institution? (i.e. different site opportunities, elective opportunity within clerkship)

Yes, IUSM has 9 campuses throughout the state, all of which house rotations. Additionally, the downtown Indianapolis campus has 4 hospitals, including a county, children’s, and VA hospital. The ability to work in a community setting and in a major city with level 1 trauma gave me a great foundation of clinical knowledge.

What is one way your outlook on medicine or understanding of medicine has changed in your time doing various rotations?

I had very little clinical experience going into medical school. What 3rd year taught me was how dramatically you can change a patient’s life and how much trust the patient has in their physician. Surgery elucidated this the most to me and that is why I hope to one day become a surgeon.

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