Below I will outline some tidbits that helped me succeed in the clinical aspect of the rotation. 1. Be familiar with USPSTF guidelines fora patient’s age and gender. By knowing these ahead of time (or looking them up between patients) and presenting these suggestions in the assessment and plan for a patient, you will look like a rockstar. 2. Streamline your presentations to attendings. In family medicine, the experience largely focuses on outpatient medicine, and clinic tends to be fast paced. Therefore, developing thorough yet streamlined presentations of your patients is critical. By focusing on positives and negatives, you can quickly guide the listener to the same conclusion as you for an acute complaint or wellness visit. Also, even for an acute complaint, don’t forget USPSTF guidelines! Sometimes these are the only visits a patient may have, making it crucial to deliver age appropriate screening in these settings. 3. Focus on the assessment and plan. As a spin-off of the last point, the assessment and plan is the most critical part of your presentation, and a well-developed A&P is what sets apart a third-year medical student from an intern. As a third-year, you are likely more than apt at obtaining an HPI, collecting data, and performing a physical examination. Developing a thorough A&P with synthesized findings, suggested diagnostic steps, and options for treatment are crucial to your development from a student to a physician. This rotation offers a great opportunity to work on this as the complaints are varied, and you have limited time between patients to prepare for presentations. 4. Refine your auscultation techniques. In family medicine, you will likely be listening to the heart and lungs of most patients you encounter. This is a great opportunity for learning what “normal” sounds like, and for being able to pick out pathologic murmurs or adventitious breath sounds. I suggest listening to YouTube videos as a primer, then applying these to patients. THE MORE HEARTS YOU LISTEN TO, THE BETTER YOU WILL BECOME. By the time I arrived to internal medicine, several attendings commented on my ability to pick out subtle murmurs, and I largely attribute this to deliberate practicing during the rotation. 5. Become comfortable examining rashes. In family medicine, you never know what might walk through the door, but you can almost certainly bank on a patient presenting with a skin lesion. It is extremely high-yield (for both clinic and shelf exams) to be able to describe skin lesions and begin to attempt to develop a differential diagnosis. These lesions can be isolated or a sign of systemic disease, making them an important diagnostic clue. 6. Read about your patients. In family medicine, it is incredibly difficult to know everything, and it is impossible to learn everything in a four-week rotation. I suggest allowing the patients you see to guide your reading. If you see many patients with COPD, read about the conditions and the treatment for it! If you see patients with diabetes mellitus (which I can safely assume you will), learn about the specifics and intricacies of treatment and propose treatment plans/changes for your patients! Even if you are wrong, your attending will appreciate the initiative and your ability to think independently. 7. Take every opportunity given to you. Family medicine presented many unique opportunities to me. In this rotation, I got to use an otoscope on a screaming toddler with otitis media, perform a pap smear, and help freeze off skin lesions with cryotherapy. If you feel comfortable performing a task with supervision, take the opportunity if given to you! By performing some of the aforementioned tasks, I was more comfortable with physical examinations in future rotations.

The family medicine shelf is incredibly broad, and there truly is no way that one can truly master everything on the shelf in the four weeks on the rotation. It is a notoriously difficult shelf exam due to the breadth tested. For this shelf exam, I solely studied using UWorld, NBMEs, Case Files, and USPSTF guidelines and performed reasonably well. In hindsight, had I taken the shelf near the end of the year, I feel that I would have performed much better due to overlap with other exams. However, do not let this dissuade you from taking the rotation early, as I felt it helped me clinically throughout the rest of the year.