Rotation issues...

[Neuromonster]

So, I have encountered a little bit of a conundrum. I'm currently a third year in a small medical school somewhere in the US. Due to reasons beyond my understanding, we do not have a third year clerkship in neurology. I do think there is a one month elective that can be completed during fourth year, yet i somehow suspect it doesn't offer the same level of experience/exposure that a clerkship would. Given the circumstances, i suppose that doing an away in neuro next year would be the way to go; however, due to severe financial constraints, I'm not really sure if that is actually gonna happen or not. Lastly, as far as LORs from neurologists are concerned, i think i would be able to obtain only one of things go well. How much of a hindrance do you guys think this particular situation would be if i want to go into neuro? I mean, i wouldn't really be able to look at a PD in the eyes and say that i have explored the field.

By the way, as far as my stats go I'm pretty average (decent grades, decent clerkship grades too, step I in the low 230's, no publications). I guess the only "stand out" attribute i have is speaking Spanish fluently.....

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[splik]

Quite apart from anything else you would be doing yourself an enormous disservice if you don't do a neurology rotation before you apply. How can you know you want to do neurology if you don't try it out and see whether you like it? You might think it is perfect for you on paper, and excited by the intellectual nature of neuroscience and all the weird and wonderful diagnoses, but find in reality you hate that most patients have at least one symptoms that cannot be neurologically explained, the level of psychopathology and character disorder in the patient population demoralizing, and the lack of effective treatments for many conditions frustrating. Or you may love the challenges and relish the possibilities of emerging therapeutics. Either way, you can't know until you do a rotation in it. Just as important, you need to learn how to do a thorough neurological examination and quite frankly, if you don't do a neurology rotation you won't learn this. Most non-neurologists are terrible at doing neurological examinations, and if you don't have the opportunity to deal with patients whose primary problems are neurological (i.e. doing a neurology rotation) you won't get the level of exposure, or the supervision from people who are seasoned at performing and interpreting the most useful and least well done systems examination in clinical medicine.

 

[Neuromonster]

Well, my interest in the field arises from spotty inpatient and outpatient exposure to it during my other clerkships. Out of everything i have done so far, those brief neuro moments have been what i've enjoyed the most. I completely understand your point though.

 

[typhoonegator]

Yeah, you gotta try before you buy. I was completely convinced I was going into neurosurgery before I tried it out. Turns out I thought the OR was boring.

Plus, it would be a hard sell for residency programs to accept you without any experience in neurology. Not because they want you to know more clinical neurology before you start, but because they don't want to accept you and then find out halfway though your PGY2 year that you're bored and hate the specialty and want to transfer to radiology or something.

 

[danielmd06]

Absolutely agree with the above.

With a 230 on your Step 1, you are competitive for many things in medicine. You should do yourself the service of giving a fair confirmatory or exclusionary rotation in areas you are potentially interested in before making the leap of faith.

 

[agapemed]

Im in a similar situation. Im a M4 and my school also did not offer a neurology rotation until right now, February of my final year. I had always been interested in neuroscience and psychiatry and had tried desperately to do an away elective in neurology. The problem was that no program would take me for that elective without doing first a rotation at my own school. So I ended up applying into psych and I was really excited/happy about it since I interviewed at some really amazing programs.

And Im currently in the match, waiting to hear where I will go. At the same time. . im doing my neurology clerkship, and of course. . .I love it. I am now in the position where I feel stuck. I can see myself doing a double residency and going into neuro after I finish my psych but it seems like a long road. Its unfortunate but what can you do.

 

[Neuromonster]

All right, let's assume that i somehow find a way to do a neuro away. Based on my current 4th year outline i wouldn't be able to start one until early september at best, which means i wouldn't have the LORs from it until sometime in October. Is that too late as far as residency applications are concerned? (I'm sure this question has been asked to death, so my apologies in advance.....but it'd be nice to see a neuro oriented answer).

 

[Mattchiavelli]

Most non-neurologists are terrible at doing neurological examinations, and if you don't have the opportunity to deal with patients whose primary problems are neurological (i.e. doing a neurology rotation) you won't get the level of exposure, or the supervision from people who are seasoned at performing and interpreting the most useful and least well done systems examination in clinical medicine.

You flatter, yet sadly it's true. The fact that I can better characterize abnormal movements of a patient compared to IM interns in my program makes me feel much better about my inferior ability to hear and characterize some of the gallops, kicks, and snaps of the abnormal heart compared to my colleagues. I agree 100% that you need to rotate before you interview because it comes up quite often as a question, "how have you explored this field as a career path".

There is a point in that doing a neurological exam on some of your fellow young, able bodied classmates is great for practicing techniques and getting a routine down. It will be very poor however with patients that have neurological issues because sometimes they are immobile or can't stand from a chair or in a coma etc. and you don't learn how to tailor your exam.

Im in a similar situation. Im a M4 and my school also did not offer a neurology rotation until right now, February of my final year. I had always been interested in neuroscience and psychiatry and had tried desperately to do an away elective in neurology. The problem was that no program would take me for that elective without doing first a rotation at my own school. So I ended up applying into psych and I was really excited/happy about it since I interviewed at some really amazing programs.

And Im currently in the match, waiting to hear where I will go. At the same time. . im doing my neurology clerkship, and of course. . .I love it. I am now in the position where I feel stuck. I can see myself doing a double residency and going into neuro after I finish my psych but it seems like a long road. Its unfortunate but what can you do.

Good luck- there is a lot of overlap between geriatric psychiatry and behavioral neurology if that is one of your interests. The match is legally binding though, I hope wherever you go is ok with you leaving. You should let them know as soon as you are sure and make it a point that you do not want to leave the program you matched to up the proverbial creek with coverage so your psych program doesn't dislike you. There are also multiple fields where you might be happy. Maybe you will perform the most eloquent AIMS exam out of your cohort.

All right, let's assume that i somehow find a way to do a neuro away. Based on my current 4th year outline i wouldn't be able to start one until early september at best, which means i wouldn't have the LORs from it until sometime in October. Is that too late as far as residency applications are concerned? (I'm sure this question has been asked to death, so my apologies in advance.....but it'd be nice to see a neuro oriented answer).

Let whoever is managing this clerkship know when you go in that you want a letter out of it because you are interested in the field and ask what staffmember it would be best to let know this, they usually know who is receptive to writing letters and mentoring and who is a real pain to deal with. Although could you do it earlier? do you have required clerkships that can't be adjusted before september?

 

[Neuromonster]

Not really. The reason why i wanted to delay it that much is because i want to do that short 4th year elective @ my home school before doing an away. I would hate going for an away to look absolutely clueless.