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The great temptation in MPS 1 is to become cynical early on about the value of the course. Don't. Though the small group discussions on ethics and medical anthropology may seem more like a group therapy session for post-trauma victims who happen to be medical students, the course changes, zigs and zags, and you'll do yourself a favor by realizing that MPS 1 is really MPS 1.1, MPS 1.2, and MPS 1.3 -- three entirely separate courses, unified by a preceptorship.
Preceptorship
That's right -- the doctor you shadow on Thursday afternoon. If you're lucky, you'll spend more time actually seeing patients than you will on the commute. The MD-PhD students will be happy to know that historically they've been granted preceptors nearby for the fall semester of first year, but that changes in second semester, when you are assigned to your new preceptor. Although space prohibits us from publishing comments on every single preceptor, it behooves you to ask around to find out what your old preceptor and his or her office practice was like, or at the very least, good road directions. This is, however, not necessary if you keep a few things in mind.
First of all, preceptorship can be a boring time unless you get aggressive -- lay it out on the first day that you need to learn history taking and physical exam techniques (the H&P), and any other procedures you're allowed to do. The course directorship is obligated to say that you mustn't do anything beyond H&P's, e.g. injections, etc., because of liability reasons. I'm not going to tell you what actual practice is, since I'm sort of obligated to keep my mouth shut on that, too, for liability reasons.
The other thing I found helpful was to carry a small stack of index cards, although a memo book can also be used. This allows you to record your thoughts and impressions of patients and your preceptorship as you go along. At a busy Brooklyn practice where my preceptor was always running late, I'd interview up to 20 patients on my own in a given afternoon, and log my impressions on note cards. One warning: do *NOT* record the patient's full name, under any circumstance. Patient confidentiality is a Good Thing, although I'm not going to argue about it here. The notes you keep will be exceedingly helpful when you have to log each one of your visits and submit it at the end of each one of the three parts of MPS 1.
Also, though you're reluctant to do work, still, make it a point to look up the more interesting cases if you get them, i.e. "zebras", or the pathology that the preceptor points out in particular. Most of the other time, you'll be seeing the same stuff -- if your preceptor is an internist, then it'll be hypertension, diabetes, and other essentially chronic conditions. An allergist, Claritin city. It falls into a rhythm, and it's good to get an idea of the typical kind of patient your preceptor sees, and note when it deviates. The other thing that you can aggressively pursue is getting a feel for the medications, since pharmacology is covered in a somewhat haphazard way (although secretly methodical) during your other courses. Buy Lippincott's "Pharmacology" book (the red one) and look up the classes of drugs that you don't understand.
Despite all that being said, though, preceptorship is not a time to be playing doctor. You do not have the skills or knowledge base to diagnose yet, nor will you obtain them for some time. H&P, H&P, keep going until you can rattle through a history interview and do the physical in one clean sweep. At the same time, pay attention to asking at least one or two patients the MPS-recommended questions for the week, related to the study topic, and note the answers and discussion so you can put it in your log. At the very least, make a conscientious effort to interact with every patient -- even if your Spanish isn't too good.
The other key thing you can really benefit from during your MPS 1 preceptorship is not only learning how to take the H&P, but to report your findings in two ways: (1) the brief 1-minute update, and (2) the complete H&P. You'll find guides on how to do this in Bates, but chances are you'll seem like a babbling idiot the first dozen or so times you try to efficiently tell someone else about a patient. Best bet -- listen in on an emergency physician briefing his or her colleague about another patients, and you'll get a good idea how they describe the patient, his or her chief complaint, concise history of present illness, signficant positive and negative findings, and general impression all within a minute or two. It can be done, e.g. "Patient is an otherwise healthy 23-year old male complaining of bilateral non-radiating wrist pain that started two days ago and which he describes as "burning". History was remarkable for extended computer keyboard use and possible repetitive stress injury. The physical exam was unremarkable; no gallops, rubs, murmurs (etc., reviewing all systems). The sooner you get this format down, the sooner you'll be picked up by hospital clinicians as being more than just a doofus in the corner.
(Your mileage may vary. The contributors, editors, and owners of this site are not responsible or liable for any damages or losses incurred as a result of anything published on this site. Hello, meet our lawyers.)