Hi, I just have some simple questions about how you get from medical school into a residency. When do you start applying for a residency? When is the "internship"? How long after graduation from med school do you start a residency? And the residency is a period during which you learn to be a specialist in a particular field (correct?) after which you are said specialist?

Thanks and sorry for such basic questions.

Medical school is 4 years. First 2 years are basic science years. Third year is core rotations in Medicine, Surgery, Pediatrics, OB/GYn, etc. Most include Psychiatry and Family Med and maybe radiology (+/- elective or two in third year).

During third year, you formulate an idea of what you want to do. It is difficult because you don't get exposed to everything- I didn't get much exposure to subspecialty medicine such as hematology oncology, pulmonology, etc. I also didn't see specialties like pathology, radiology except briefly.

Then, most schools allow you to set up your own 4th year schedule (including some requireds like Neurology). Depending on what you like/don't like, you get advisors, get recommendations, look into programs, and send off applications in the summer/fall of your fourth year.

Residency is what you hopefully match into. Depending on the specialty, you are in residency anywhere from 3-5 years. If the specialty is primarily general, patient based, such as medicine, you don't have to do an extra 1st year. For other specialties like radiology, ophthalmology, you have to do an extra 1st year.

Regardless, the first year of residency is always termed your "intern" year.

After residency, most people in whatever field they do elect to subspecialize even further by doing a fellowship. Thus, a medicine resident may elect to apply and go to cardiology, pulmonology, heme/onc, or infectious disease fellowship. These fellowships can be anywhere from 1-3 years.

Are recommendations primarily to be gotten during the third year during your rounds?

Thanks,

Ice

Originally posted by ice_23
Are recommendations primarily to be gotten during the third year during your rounds?

Thanks,

Ice

Letters of reccomendation can come during your third year clerkships, but the best letter of reccomendation would be a strong letter from someone who you did a sub-internship during your fourth year with. In general, fourth year sub-i letter> third year clerkship letter> fourth year elective letter (unless the elective is in the field that you want to go into, then this letter becomes the most important of course). I would not count on your fourth year sub-i being a source for a letter of reccomendation either, because you never know if you just happen to get an attending whose personality seems to clash with yours or if you are like me and get assigned to work on a private medical team where your interaction with the attending is minimal at best. I was fortunate in that I got a letter during my third year medicine clerkship by asking an attending who told me that she was going to write a positive evaluation to write a draft of a letter up for me and keep it on her computer until I asked for it at the beginning of fourth year during our application time. I would definitely try to secure at least one letter from the specialty that you are going to go into during your third year because you always need at least one letter from a specialist in the same field and as I was saying previously, you don't want to put all your eggs on getting a letter at the beginning of fourth year when you don't know what will be going on.

That makes sense, but I have two questions:

First, what if you don't rotate in your specialty of choice during your third year (at least, as I have come to understand it, you don't do ALL specialties in the 3rd year; you can correct me if I am wrong)? Then how do you get a letter from an attending in your specialty?

Secondly, wouldn't getting a letter in your fourth year be too late for you app (which is supposed to go out in the fall)? Also, what is a "sub-internship"?

Your comments are extremely helpful, and any additional help I would greatly appreciate (and I hope I am not hijacking the thread; I am assuming the OP would like to know this information as well! :)).

Thanks,

Ice

Well, a lot of students don't get an opportunity to rotate in their specialty because their school doesn't have required radiology/ophtho/ER, etc rotations during third year. For the most part, most med schools require third year students to do medicine, peds, surgery, and ob/gyn rotations during their third year. Some tack on other ones including subspecialty surgeries, family medicine, neurology, ER, or radiology, while others leave time for students to choose electives (mine is implementing standard third year elective time next year). If you go to a school that doesn't require a third year ER rotation during your third year and you don't have any elective time, what you could do is post-pone one of your third year rotations (say family medicine) for fourth year and substitute that for ER. If your school doesn't allow that, then you still should have to do your rotation at the beginning of fourth year. Third year ends July 1st, while your application or more specifically your dean's letter and transcript don't have to arrive at ERAS until Nov. 1st. So this allows you to use those months in between then to secure letters of recommendation from the specialty you want to go into (some do away rotations to get letters from well known faculty during this time), and complete sub-i's. Sub-i's are basically fourth year rotations where students are expected to bear either the same or similar responsibilities as an intern. You can do a sub-internship in medicine, surgery, the intensive care unit, etc. Of course if you are going for say neurosurgery or ophthalmology, your best bet would probably be to do an early sub-internship in surgery or the SICU, whereas if you want to do neurology or psychiatry, it may serve you well to do a sub-internship in medicine or the MICU. These letters are respected more then your third year letters because program directors believe that these evaluations more accurately reflect how well you will work as an intern since you are almost functioning as an intern during your sub-i.

Originally posted by ice_23
(and I hope I am not hijacking the thread; I am assuming the OP would like to know this information as well! :)).

By all means, its fine.