in need of advice

As a current intern, I'd second everything Kent said....doing a few weeks of cards consults or a cardiology sub-i in addition to general inpatient medicine and ER would be very useful. ICU would be fantastic as well. I'd also recommend an EKG reading elective if your school offers one. As far as pedatrics, a PICU rotation wouldn't be a bad idea. It isn't that we'll be taking care of PICU patients as community FPs, but that it's good to get more comfortable with WHAT really sick kids look like, who gets transferred to the unit, and what some issues involved in their care might be.

Here is a good article no what is important to learn in 4th.

http://www.stfm.org/fmhub/fm2004/February/William118.pdf

Kent hit it. I would front load those hospital months he's talking about up front and get them out of your way so that by 2nd half of 4th year, you can finish off your ambulatory requirements (like for derm) and chill out. It's definitely a plus to see some critically ill patients (ER or ICU) so that you develop an intuition as to when to move to a higher level of care. You never know if you'll be the lucky one who takes call on July 1st.

lowbudget said:

Kent hit it. I would front load those hospital months he's talking about up front and get them out of your way so that by 2nd half of 4th year, you can finish off your ambulatory requirements (like for derm) and chill out. It's definitely a plus to see some critically ill patients (ER or ICU) so that you develop an intuition as to when to move to a higher level of care. You never know if you'll be the lucky one who takes call on July 1st.

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Even better, MICU call your first day! I was glad it wasn't me that first day, but I felt sorry for my fellow interns who started in the ICU. All of a sudden covering post-op surgical patients on the floor made me think I got the better rotation to begin with (not like they didn't end up having their issues, but still...)!

I might even take KentW.'s advice a step further and recommend trying (if possible) to do inpatient rotations at hospital where you are applying for internship in anticipation that you might match there. You will feel much more comfortable interning someplace that you spent time as a student and you will be a familiar face for the nurses, which definitley helps. Make sure you take at least one or two electives in an ambulatory setting where the intensity is turned down a notch too. You should enjoy your fourth year.

I noticed you are interested in FP, but my humble advice is to approach alot of rotations in 4th year as preparation for internship and recognize that it may not reflect what FP residency or practicing FP may be like. I do recommend Critical Care rotation, this is the part of the hospital that will test you most as an Intern.

drlongwood said:

I am getting ready for my fourth year electives and I dont know which ones to do ( all I know is that I want to do them in california). I want to make my fourth year productive. I would like to take electives that would prepare me for residency, so i dont look like i am in space. hopefully i will get an interview during the elective also. please make them FP relevant. all imput is greatly welcome.


thank you

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We had 8 rotations as a 4th year. One was required: Neurology. Then we had to do a subinternship in either internal medicine or pediatrics. I think either/or is fine (I did pediatrics to get the pediatrician's ideas on in-patient peds). Then we had to choose two of four clerkships: family medicine, OB/Gyn, psych, or peds. I would highly recommend not doing psych (you'll get plenty in residency in your clinics), and if you know you aren't interested in OB, then that made the decision easy (I did OB/Gyn and peds). I might even shy away from a family medicine month, since you'll get plenty in residency.

Then we had 4 other electives to choose whatever we wanted:

First and foremost, I would do ER, as it gives you a good view as to how patients are worked up (before you get the call on a patient as a resident). Most every patient you take care of in the hospital came through the ER first.

Ones I'd highly recommend: ICU, Cardiology, Pulmonology (i.e. you really should do at least one of these). All of these are heavily weighted to critical care medicine, and will give you a much better general picture of patients you'll be taking care of in the hospital.

Then others to consider: Allergy/Immunology, Dermatology, an away rotation at wherever you might be interested in, gastroenterology, and maybe even surgery if you're interested in doing a lot of procedures or C-sections.

If you want it to be a productive year (i.e. not slack off until March), then don't do a research or reading elective. My other 4th year rotations were: a month split between ICU and Allergy/Immunology, an away rotation at a family medicine program I was interested in (and subsequently ended up not ranking), ER, and a reading elective (I slacked). I wish I'd have done instead of the reading elective month a month split between 2 weeks dermatology and 2 weeks cardiology. Hope all that helps.