Cleveland Clinic away in Oct/Nov?

[dermhopeful]

Any thoughts on whether this would be too late? I am mostly looking for purposes of increasing my chances of matching there and overall in general, as I obviously know that no letters would be helpful from there and any research would also not be very meaningful since my application would already be in. Thanks!

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[asmallchild]

Any thoughts on whether this would be too late? I am mostly looking for purposes of increasing my chances of matching there and overall in general, as I obviously know that no letters would be helpful from there and any research would also not be very meaningful since my application would already be in. Thanks!

Not a bad idea if you are solely looking at increasing your chances of matching there (this is obviously contingent on you doing a good job at the away). You are correct that it would likely be too late for a letter at that point. Research can still be meaningful as it would allow you to develop more of a relationship with attendings/residents there. You are also correct that it would be unlikely to benefit you in terms of being able to list it on your application

 

[dermhopeful]

Not a bad idea if you are solely looking at increasing your chances of matching there (this is obviously contingent on you doing a good job at the away). You are correct that it would likely be too late for a letter at that point. Research can still be meaningful as it would allow you to develop more of a relationship with attendings/residents there. You are also correct that it would be unlikely to benefit you in terms of being able to list it on your application

Thanks for the quick reply!

Yeah I forgot about research to just help me form relationships with the department.

Does anyone know if the program tends to interview or favor rotators, again assuming good performance?

 

[Dermione Granger]

Unless things have changed now, they used to interview all rotators. It may be hard to make an impression as a rotator since you would be observing more than actually seeing patients on your own.

 

[DermViser]

Unless things have changed now, they used to interview all rotators. It may be hard to make an impression as a rotator since you would be observing more than actually seeing patients on your own.

I think they also require Step 2 CK if I'm not mistaken.

 

[username456789]

I think they also require Step 2 CK if I'm not mistaken.

When I was applying, their website said they required you to take Step 2 CK no later than Nov 1 of that year. My classmate took the exam in mid-December, but still interviewed there anyway. Clearly it's not a hard and fast rule for them.

 

[DermViser]

When I was applying, their website said they required you to take Step 2 CK no later than Nov 1 of that year. My classmate took the exam in mid-December, but still interviewed there anyway. Clearly it's not a hard and fast rule for them.

Or I guess they have to have your Step 2 CK score back in time before they make their rank list.

 

[dermhopeful]

Unless things have changed now, they used to interview all rotators. It may be hard to make an impression as a rotator since you would be observing more than actually seeing patients on your own.

Lol at your username

Anyways, is making an impression hard particularly at Cleveland Clinic or bc I am rotating late? Because in my current rotation I have had plenty of opportunities to see the patients first, present, write notes, etc.

Thanks!

 

[username456789]

Or I guess they have to have your Step 2 CK score back in time before they make their rank list.

Most likely. I just found it odd that they explicitly stated that you had to have actually taken the test by Nov 1 to be considered for an interview, yet didn't enforce that.

 

[Dermione Granger]

Lol at your username

Anyways, is making an impression hard particularly at Cleveland Clinic or bc I am rotating late? Because in my current rotation I have had plenty of opportunities to see the patients first, present, write notes, etc.

Thanks!

It is more difficult to make a positive impression in those instances. You may ocassionally get some pimping questions and you can jump on it if you know the answer. But you don't really get to show demonstrate your interviewing and presentation skills, and clinical judgement if you are mostly observing. You can certainly offer to be more involved if you feel confident about your skills, but it may backfire (i.e. residents and attendings may find you annoying if you try too hard on aways)...But to answer your original question, it will definitely help to rotate there if you would like to match at CCF. Be nice, be enthusiastic, attend all lectures, and offer to participate in case reports/presentations.

 

[dermhopeful]

Or I guess they have to have your Step 2 CK score back in time before they make their rank list.

Does this mean they most likely care about score or just care if you passed?

 

[DermViser]

It is more difficult to make a positive impression in those instances. You may ocassionally get some pimping questions and you can jump on it if you know the answer. But you don't really get to show demonstrate your interviewing and presentation skills, and clinical judgement if you are mostly observing. You can certainly offer to be more involved if you feel confident about your skills, but it may backfire (i.e. residents and attendings may find you annoying if you try too hard on aways)...But to answer your original question, it will definitely help to rotate there if you would like to match at CCF. Be nice, be enthusiastic, attend all lectures, and offer to participate in case reports/presentations.

Love the creative username!

I don't see how students can get a great letter coming out when they're just watching. If you don't get to do the interviewing, presenting of skin descriptive findings, and get to answer pimp questions, then you don't really get to show what you know and that you've been reading. The ones that have rotated with us and been superstars are the ones I could tell had been reading aggressively. That being said, there are always rotators who you can tell are "trying too hard" and it ends up irritating attendings and resident so the audition elective ends up boomeranging and hurting them. The ones with good social skills and can understand where that line is are the ones who impress the most.

 

[DermViser]

Does this mean they most likely care about score or just care if you passed?

Well they want to actually see your Step 2 CK score. So definitely not just passing.

 

[dermhopeful]

It is more difficult to make a positive impression in those instances. You may ocassionally get some pimping questions and you can jump on it if you know the answer. But you don't really get to show demonstrate your interviewing and presentation skills, and clinical judgement if you are mostly observing. You can certainly offer to be more involved if you feel confident about your skills, but it may backfire (i.e. residents and attendings may find you annoying if you try too hard on aways)...But to answer your original question, it will definitely help to rotate there if you would like to match at CCF. Be nice, be enthusiastic, attend all lectures, and offer to participate in case reports/presentations.

I'm sorry for m brain fart, but still not understanding exactly waft instances you are referring to.

I am mainly concerned about rotating through Cleveland Clinic. Do students rotating there not get to see patients alone and present?

 

[asmallchild]

I'm sorry for m brain fart, but still not understanding exactly waft instances you are referring to.

I am mainly concerned about rotating through Cleveland Clinic. Do students rotating there not get to see patients alone and present?

I don't know specifically about Cleveland Clinic but at most rotations, you will not be able to see patients alone and present. Dermatology is a high volume specialty and while it sucks on the student end, letting students see patients alone first and present would bring most clinics to a grinding halt. As others have noted, your chance to shine will be in:

- your interaction with the residents/attendings
- interaction with fellow students
- occasional chance to answer a pimp question or two
- being helpful in assisting the resident while in clinic (set up biopsy trays if allowed, assist during the biopsy with pressure, skin traction, hemostasis if allowed, go over wound care instructions with the patient if allowed, etc)
- ability to be nice with all people you encounter
- ability to stay enthusiastic even if it's the 9000th shave biopsy you've helped with
- attend all lectures
- show up early
- leave late (within reason)
- participate in research activities if there is time
- participate in resident social activities if invited
- and knock your presentation out of the park (most programs will make rotators do a presentation of some sort in the final week)

 

[DermViser]

I'm sorry for m brain fart, but still not understanding exactly waft instances you are referring to.

I am mainly concerned about rotating through Cleveland Clinic. Do students rotating there not get to see patients alone and present?

I don't think there is any rotation that you see patients completely "alone" and present - at least not a General Dermatology rotation. There might be instances in which a resident allows you to present the patient and add on to what you're saying, but this is very resident dependent. There may be times in which if an attending is seeing patients without a resident (rarely) you may be able to show your "smarts". When you're with a resident, the key is to not get in his/her way, or be "annoying".

A lot of audition rotations are more Kabuki theater - outside of your presentation at the end of the rotation. When you're rotating - programs assume you have the stuff on paper -- academics, scores, maybe even some research, etc. or if you don't have that but are awfully close, an audition rotation may tip you slightly over the line come rank list time.

 

[username456789]

I don't think there is any rotation that you see patients completely "alone" and present - at least not a General Dermatology rotation. There might be instances in which a resident allows you to present the patient and add on to what you're saying, but this is very resident dependent. There may be times in which if an attending is seeing patients without a resident (rarely) you may be able to show your "smarts". When you're with a resident, the key is to not get in his/her way, or be "annoying".

A lot of audition rotations are more Kabuki theater - outside of your presentation at the end of the rotation. When you're rotating - programs assume you have the stuff on paper -- academics, scores, maybe even some research, etc. or if you don't have that but are awfully close, an audition rotation may tip you slightly over the line come rank list time.

Weird. I did two away rotations and one home rotation. In 2 of those 3 rotations, I saw patients independently and presented to the attendings.

 

[DermViser]

Weird. I did two away rotations and one home rotation. In 2 of those 3 rotations, I saw patients independently and presented to the attendings.

I did too, but that's bc there were times there just weren't enough residents to be spread out to all the clinics. Also there weren't like 5 rotators rotating that month. It was quite awesome. It can be a little nervewrecking bc you're "on" the entire time, but you also have the ability to be "the resident". I also think it's resident/attending dependent.

People I talked to said they only "shadowed" on their rotations but I've come to realize people's definition of this varies greatly.

 

[Dermione Granger]

I'm sorry for m brain fart, but still not understanding exactly waft instances you are referring to.

I am mainly concerned about rotating through Cleveland Clinic. Do students rotating there not get to see patients alone and present?

I know someone who rotated there last year. I believe there were about a few rotators with her. She wasn't allowed to see patient on her own until the last week because clinics were extremely busy and attendings would like to get things moving quick. She never get to write notes neither. Hope it helps!

And I agree, the culture is institution dependent. My program lets students see medical students on their own in clinic and on consults, and even take a few biopsies. I know some other programs with very hands on experience for students too. But many other programs only let students shadow or see a few patients. Again, it is much easier to make an impression if you see patients and present. Residents will also appreciate your presence more because you are actually helping

 

[dermaway]

I did too, but that's bc there were times there just weren't enough residents to be spread out to all the clinics. Also there weren't like 5 rotators rotating that month. It was quite awesome. It can be a little nervewrecking bc you're "on" the entire time, but you also have the ability to be "the resident". I also think it's resident/attending dependent.

People I talked to said they only "shadowed" on their rotations but I've come to realize people's definition of this varies greatly.

Yeah at my current rotation I see all of the patients first without the resident, present to the resident, then go back in the room and examine the patient with the resident. Sorry for asking so many questions, I honestly just assumed all rotations were like this.

 

[DermViser]

Yeah at my current rotation I see all of the patients first without the resident, present to the resident, then go back in the room and examine the patient with the resident. Sorry for asking so many questions, I honestly just assumed all rotations were like this.

No, not at all. I think this also highly varies depending on the institution, your experience may not at all be isolated. It also depends highly on the derm resident you're with - some will be extra nice and make you shine, and others will consider you to be an impediment (Mean Girls-esque). This can be magnified by the attending you're with.

 

[WaylonS]

I don't know specifically about Cleveland Clinic but at most rotations, you will not be able to see patients alone and present. Dermatology is a high volume specialty and while it sucks on the student end, letting students see patients alone first and present would bring most clinics to a grinding halt. As others have noted, your chance to shine will be in:

That's pretty sh@tty. I'm glad my home and aways have not been like that.

- your interaction with the residents/attendings
- interaction with fellow students
- occasional chance to answer a pimp question or two
- being helpful in assisting the resident while in clinic (set up biopsy trays if allowed, assist during the biopsy with pressure, skin traction, hemostasis if allowed, go over wound care instructions with the patient if allowed, etc)
- ability to be nice with all people you encounter
- ability to stay enthusiastic even if it's the 9000th shave biopsy you've helped with
- attend all lectures
- show up early
- leave late (within reason)
- participate in research activities if there is time
- participate in resident social activities if invited
- and knock your presentation out of the park (most programs will make rotators do a presentation of some sort in the final week)

Are you f'ing kidding me? Who the hell would want to spend a month at a place that doesn't even allow med students to apply pressure without receiving permission first?

 

[asmallchild]

That's pretty sh@tty. I'm glad my home and aways have not been like that.

Are you f'ing kidding me? Who the hell would want to spend a month at a place that doesn't even allow med students to apply pressure without receiving permission first?

YMMV. My home and 1 away were solely exercises in observation. They were plenty popular in attracting rotators.

With regards to the 2nd point, it's all about the culture of the place. Some students don't have the luxury of asking prior rotators about their experience. I agree it may not be the most welcoming experience but if that's the hand you're dealt, I suggest playing it the best possible way.

I can assure you at my residency program (also a different program from my med school home and my away), jumping in on a biopsy without the resident's invitation or without asking the resident is a recipe for disaster. I always looked forward to working with students and would frequently let them perform the biopsies for me after watching a few. But there are cases where I like to use electrodessication vs AlCl vs Monsel's and I want a chance to dictate what I'm using and explain why before a student just does what they want to do.

 

[dermaway]

But there are cases where I like to use electrodessication vs AlCl vs Monsel's and I want a chance to dictate what I'm using and explain why before a student just does what they want to do.

Wow do some students actually do this? I just try to be as helpful as possible without getting in the way and assume every student with any sense at all does the same thing.

 

[DermViser]

YMMV. My home and 1 away were solely exercises in observation. They were plenty popular in attracting rotators.

With regards to the 2nd point, it's all about the culture of the place. Some students don't have the luxury of asking prior rotators about their experience. I agree it may not be the most welcoming experience but if that's the hand you're dealt, I suggest playing it the best possible way.

I can assure you at my residency program (also a different program from my med school home and my away), jumping in on a biopsy without the resident's invitation or without asking the resident is a recipe for disaster. I always looked forward to working with students and would frequently let them perform the biopsies for me after watching a few. But there are cases where I like to use electrodessication vs AlCl vs Monsel's and I want a chance to dictate what I'm using and explain why before a student just does what they want to do.

Wow, any medical student hopping to do a biopsy without telling me: or

 

[1dayatatime]

@asmallchild would you mind teaching me about when you personally would use electrodessication vs AlCl vs Monsel's please?

 

[asmallchild]

@asmallchild would you mind teaching me about when you personally would use electrodessication vs AlCl vs Monsel's please?

For hemostasis with a biopsy, in general, I like to use electrodessication (lowest possible setting that can get the job done). It can cause more tissue damage if done improperly but I do find it better for hemostasis.

If I'm working in an area where cosmesis is extremely important and bleeding isn't too heavy, AlCl is fine.

I very rarely use Monsel's because it can stain the skin but a couple of my former old-school attendings swear by it. In my limited use, it seems to do a better job of hemostasis as compared to AlCl and I haven't had any issues with tattooing. (Admittedly, I've used it a lot less than the other two above)

I've met some people who use TCA for hemostasis. I don't have enough experience with it to comment on that one way or the other unfortunately.

Finally, I know one attending who swears by pressure. You should probably run far away if an attending or resident routinely has you hold pressure on biopsy sites as their primary form of hemostasis

 

[Dral]

I pretty much only use AlChlor for superficial shaves. Sometimes Hyfrecator for deeper ones.

Punches just get pressure and a stitch or two. Could use AlChlor or Hyfrecator if bleeding a lot.

Hyfrecator can come in handy for lip, scalp, nose, or genital area...or when biopsying a friable tissue.

So yah, no set in stone methods tbh. Tissue bleeds, you go in prepared and stop it how you can. I once had an attending Bx a friable mass on the side of someone's head. They were rushed in clinic and asked me to stop bleeding. Tried AlChlor, stitch, monsels, Hyfrecator...nothing worked. Finally I just injected another cc or so of lido/epi to the area and held pressure. That worked.