Should I do psych or medicine rotations first?

[deleted314290]

I have the choice of starting my 1st year medicine half or psychiatry half first. I was thinking about doing medicine last so when I finished I would just hopefully take step 3 and be done with it. I wouldn't have the luxury of being thrown in the fire with everyone else if I started with medicine though. Any thoughts are appreciated, thank you.

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[WolverineDoc13]

The residents at my program also can choose which six months they do first, but from what I hear, so many residents select doing medicine first (to get it out of the way) that many don't get their first choice.

I'm not saying that should influence your decision, but that's an interesting observation. I'm hoping to to medicine first, as I'm not the strongest in IM and would rather be thrown into the pit with everyone else--- especially since we have to do ICU, which is not just intense/challenging but also depressing.

Good luck with whatever you decide!

 

[Doctor Bagel]

Most people want to start with medicine because they want to get it out of the way. Also, as WolverdineDoc mentioned, the expectations are a little lower at the start of the year for all residents, which can make doing off service rotations a bit less intimidating. We split our rotations up into 3 months blocks (3 months on versus off service), so I did a medicine month in October and in April. The month in April felt way more painful than the month in October, and I was definitely more noticeably behind the other intern who had been doing medicine all year in the April month. Still fine, but I'd vote for doing it earlier. Taking step 3 a few months out from the off service stuff shouldn't be a problem. Just don't wait a year or more.

 

[MacDonaldTriad]

I hear a lot of people suggest not taking step 3 until after doing medicine because in theory that is where you will learn the most medicine. I really don’t think this is very true. Residents are very busy on medicine and there is some learning, but it probably doesn’t help step 3 scores all that much as compared to studying. Residents have more study time on psych.

 

[notdeadyet]

I hear a lot of people suggest not taking step 3 until after doing medicine because in theory that is where you will learn the most medicine. I really don’t think this is very true. Residents are very busy on medicine and there is some learning, but it probably doesn’t help step 3 scores all that much as compared to studying. Residents have more study time on psych.

Disagree with this. I found that fitting in the relatively minor amount of time most people fit in for Step 3 study wasn't a problem. I also found that actually doing rotations like Medicine and (more so) Emergency Medicine were very helpful for the multiple choice and especially the simulated encounters.

At the end of the day, OP, you'll be fine either way. Very, very few residents fail Step 3, and those that do tend to fail due to language defecits or weirdness (death in the family, etc.). Your score doesn't matter. So choose what schedule appeals to you, but it won't matter a whole lot either way.

 

[deleted314290]

Interesting discussion, thank you for the replies. I might see if I can do medicine first while I still have the energy and excitement to plow through it.

 

[Dogdaysofsummer]

I would say do medicine first. Having more medicine behind you will help you manage or at least triage the trillion medical things that will come up on the unit and it will also help you while doing consults if you do them 1st year. Good luck!

 

[wolfvgang22]

Don't sweat it either way.
I was also given a choice to do medicine or psych rotations first by my program director. I chose medicine, got psych first anyway. It didn't matter much. I had some pretty good learning experience with medicine in medical school rotations, so I did just fine on call and in the psychiatry rotation. Most senior residents, some helpful nurses, and most attendings were very kind and helpful in teaching, which is the point of residency. Only one or two people were jerks, as most remembered being in the same spot themselves. If I didn't know what to do, I asked somebody what they usually do. I usually found I knew a whole lot more than I thought I did about medicine, and just needed to put the knowledge into practice within the policies of my hospital.
I don't think doing medicine last mattered one way or another for step 3. Studying USMLE World prior to the exam is what mattered for me. Nobody in our program did Step 3 until PGY2 anyway, we were all too tired from doing call in PGY1.

 

[masterofmonkeys]

You really should have learned all the medicine you need for step 3 by the time you graduated med school. Retention is an issue, but still. Besides, you know what they say, two months, two weeks, two number 2 pencils...

 

[shan564]

We have 3-month blocks and I did psych first. It was nice to start in friendly territory, and I was able to feel more comfortable in my first few weeks as I got the hang of things in the American system. But then when I went to medicine, I was the last experienced intern on the floor, since they'd all done 4 months of medicine (and they were already coming from a higher baseline, since they actually like medicine and our IM program is highly competitive). So I was in a constant daze of self-perceived relative incompetence for the first 3 weeks or so. That was compounded by the fact that my senior resident was well-known for his enjoyment of the sport of pooping on interns.

If I'd gone to IM first, my relative inexperience would have been much less prominent, since all of the interns would have been as fresh as I was.

 

[rkaz]

If I'd gone to IM first, my relative inexperience would have been much less prominent, since all of the interns would have been as fresh as I was.

I was actually thinking about this issue myself today. Initially I was thinking that it would be nice to have IM first, so I don't look ignorant compared to other IM interns if I start my medicine rotations several months after them. However, I was conversely thinking that it might be better for patient care not to have so many ignorant people on medicine teams at one time. Even though you do have people supervising the interns, I still figure that it would be better for patient outcomes to have people in various states of experience on a team rather than a bunch of newbies all there together. That's my inexperienced MS4 opinion... although I know I won't be too thrilled some months down the line when I am in the same position and know less than the other IM interns.

 

[WolverineDoc13]

I was actually thinking about this issue myself today. Initially I was thinking that it would be nice to have IM first, so I don't look ignorant compared to other IM interns if I start my medicine rotations several months after them. However, I was conversely thinking that it might be better for patient care not to have so many ignorant people on medicine teams at one time. Even though you do have people supervising the interns, I still figure that it would be better for patient outcomes to have people in various states of experience on a team rather than a bunch of newbies all there together. That's my inexperienced MS4 opinion... although I know I won't be too thrilled some months down the line when I am in the same position and know less than the other IM interns.

That's such an altruistic viewpoint, rkaz! I never thought of it that way. I admire that (and I'm frankly embarrassed I didn't think of it that way myself-- I was just thinking of what option makes me look less dumb! Haha!).

 

[SteinUmStein]

I was actually thinking about this issue myself today. Initially I was thinking that it would be nice to have IM first, so I don't look ignorant compared to other IM interns if I start my medicine rotations several months after them. However, I was conversely thinking that it might be better for patient care not to have so many ignorant people on medicine teams at one time. Even though you do have people supervising the interns, I still figure that it would be better for patient outcomes to have people in various states of experience on a team rather than a bunch of newbies all there together. That's my inexperienced MS4 opinion... although I know I won't be too thrilled some months down the line when I am in the same position and know less than the other IM interns.

Regardless of experience or competence, any senior would want an intern who thinks like this on their team. You'll be fine!

 

[wolfvgang22]

You really should have learned all the medicine you need for step 3 by the time you graduated med school. Retention is an issue, but still. Besides, you know what they say, two months, two weeks, two number 2 pencils...

Well, sort of I guess. Step 2 and 3 are easier than step 1, but you can't use a pencil. I'm pretty good at tests (one of the few things I am "really good" at), and I still had to study for a month for step 2 and 2 weeks for step 3. 2 an 3 seemed about the same difficulty to me.
The psychiatry board exam was easier for me, I still studied hard for about a week for that after nearly 4 years of residency.

 

[Doctor Bagel]

You really should have learned all the medicine you need for step 3 by the time you graduated med school. Retention is an issue, but still. Besides, you know what they say, two months, two weeks, two number 2 pencils...

Maybe #2 pencil in that your score doesn't matter, but I found Step 3 to be somewhat challenging and certainly wouldn't recommend blowing it off. It's super easy for people who repeat this type of material in their rotations constantly, which isn't us. I took it at the start of my PGY2 year and had already forgotten a good deal of ob/gyn, surgery and peds stuff. For the op's issue, I don't think a few month gap between medicine months with make a big difference, but I still think psych residents should study for Step 3.

 

[Doctor Bagel]

We have 3-month blocks and I did psych first. It was nice to start in friendly territory, and I was able to feel more comfortable in my first few weeks as I got the hang of things in the American system. But then when I went to medicine, I was the last experienced intern on the floor, since they'd all done 4 months of medicine (and they were already coming from a higher baseline, since they actually like medicine and our IM program is highly competitive). So I was in a constant daze of self-perceived relative incompetence for the first 3 weeks or so. That was compounded by the fact that my senior resident was well-known for his enjoyment of the sport of pooping on interns.

If I'd gone to IM first, my relative inexperience would have been much less prominent, since all of the interns would have been as fresh as I was.

Boo to your senior resident for making life hard for interns. We're lucky in that the IM department is very friendly here, so people seem to be pretty nice and understanding. However, my senior my second month of medicine (in April of intern year) was super anxious, so that made life hard. Good lesson in how contagious anxiety can be, though.