YEAR 3 - SHELF / COMAT OPERATING SYSTEM

YEAR 3 | PAGE 33A - ROTATION WORKFLOW: PATIENTS -> QUESTIONS -> RETRIEVAL

CK / Level 2-CE retention.

Lane	Daily / weekly behavior	Evidence that it is working
1. Clinical lane	Pre-round/prepare; see the patient; build a one-line problem representation; rank the differential; propose the next test and management step; follow results; present and close loops under supervision.	Feedback improves; presentations are shorter and more prioritized; you anticipate deterioration and disposition needs.
2. Shelf / COMAT lane	Most clinical days: 10-20 rotation-specific questions or an equivalent small block; one larger timed block weekly; review every incorrect, guessed correct and low-confidence correct.	Domain accuracy rises, repeat errors fall, timing stabilizes and management-sequence errors become less frequent.
3. Cumulative lane	Keep prior-rotation high-yield rules alive with brief spaced retrieval and periodic mixed questions; do not let one shelf replace everything learned before it.	Old clerkship material remains retrievable when mixed questions reappear and Step 2 / Level 2 preparation becomes integration rather than relearning.

Moment	Action	Output
Before clinical work	Review today's patient list or likely complaints; scan yesterday's 3-5 highest-value misses; know the rotation objective you are currently trying to strengthen.	A short retrieval target, not a full study session.
At the bedside	Ask: What is the syndrome? What is dangerous? What single finding changes the differential? What would make the patient need escalation or a different disposition?	Problem representation + dangerous alternative.
After rounds / encounter	Create a six-line patient-to-exam card: syndrome -> top diagnosis -> dangerous alternative -> best next test -> initial/definitive management -> disposition/complication.	One reusable illness script tied to a real patient.
Question block	Answer first under exam conditions. Do not open a reference before committing unless the block is deliberately tutor mode.	Independent reasoning signal.
Review	Read the explanation for the right answer and the closest distractor; record the smallest rule that would have prevented the miss.	One-line correction, not copied paragraphs.
Close the day	Choose 1-3 errors to repair with a targeted video/article and fresh questions; leave the rest in the queue for scheduled review.	Controlled remediation instead of resource sprawl.

Who / context? Age, setting, risk factors, medications, pregnancy status, immune status, recent procedure/exposure.
What syndrome + tempo? Acute vs subacute vs chronic; dominant organ system; stable vs unstable.
Dangerous alternative? The diagnosis that cannot safely be missed even if it is not most likely.
Best next step now? Stabilize, test, treat, consult, observe or discharge - not the eventual step later.
What changes disposition? Vital-sign trend, oxygen need, inability to tolerate PO, social support, follow-up reliability, procedure/monitoring need.
What will the shelf turn this into? Diagnostic sequence, management sequence, adverse effect, complication, prevention or prognosis.

Checkpoint	Execution
Start of rotation	Read school objectives + official NBME or NBOME discipline blueprint. Select one primary Qbank and one primary content source. Establish a baseline list of weak domains.
Midweek	Review error categories, not just percent correct. Repair the highest-frequency reasoning gap with one targeted resource and a short fresh-question set.
Weekly	Complete one larger timed block; read around 1-3 representative patients; request one concrete clinical-performance feedback point; preserve 5-10 cumulative facts/rules from prior rotations.
Mid-rotation	Use Qbank analytics + clinical feedback to redirect the second half. If available, use a formal self-assessment when it will still leave enough time to remediate.
Final phase 2026/27 clerkship-expanded edition - verify school and official exam updates before testing	Shift toward timed mixed rotation questions, official-style self-assessment, high-yield algorithms, error-sheet retrieval and sleep/endurance rather than broad new content.