Miserable 3rd Year

LadyGrey said:

Autonomy? As a third year, in the OR?

The other ob/gyn stuff sounds more problematic -- it's ridiculous, IMHO, to come out of your third year clerkship without getting to do any pelvic exams, Pap smears, or breast exams. However, I got to do a whole lot more of that during my fourth year EM rotations, so there are other places to pick up skills that you're not getting now.

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I doubt s/he means autonomy in the OR, but rather in general. I felt like I had a fairly long leash on most of my rotations. When I was on surgery, I carried the consult pager when on call, and if we got a consult, I'd take the call and talk to the attending/resident. I'd ask everything I wanted to know, tell my senior that I was going to go see this consult, and I'll page him when I'm done. Then I'd go do the consult as thoroughly as I wished. When we got traumas, I had a designated role in the trauma bay - I wasn't shadowing, I was expected to do things (cut off clothes and jewelry, foley, fem stick, rectal). I rounded on my own patients in the morning by myself (someone came by after), and they'd let us do things like remove sutures, staples, etc., and we could help with bigger things like chest tubes.

I thought it was a good mix of supervision and autonomy, and I had a really good time.


As for the OP, yes, it does sound like you're having a terrible experience. I've heard a number of people from many different schools say that their OB/GYN rotation was pretty rough, but from your description of your experiences and your classmates' experiences, it's pretty reasonable for you to expect more from your school.

Mr. Freeze said:

And I dunno, but as an aside asking unsolicited questions can be real iffy, particularly if you haven't already read a little on your own. When I was on surg, if you asked a question of certain residents with anyone who outranked that resident (s), you bought yourself an automatic 3-pg report on said topic to be presented before p.m. rounds the next day. If it was legit, no, they wouldn't do that stuff, but if you asked something that should be part of your reading already, get thee to UpToDate...

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If you want to avoid that sort of thing, it definitely helps if you put a conditional spin on it. Rather than asking what the indications are for operating on a small bowel obstruction (you might as well tell them you're looking for reading assignments), ask something specific, like "What was it about this patient that we decided to do X instead of Y?"

I learn well by asking questions though, and while I do read, I also like it when I'm with people who are willing to just explain. I'm on a rotation right now that's great for that sort of thing, and I feel like I'm learning a lot when they are happy to explain.

ILoveLampS said:

I know this may sound like a big bi*** fest, but I really want to know if students from other institutions are having such a miserable third year? If so, does your institution permit you lots of flexibility in scheduling rotations/going out of state, because ours does not. We feel like we have learned essentially NOTHING this entire year, and that if we voice any displeasure, the admin/site coordinator will crush us (they are very vindictive). If any of you have had a similar experience, did it require a lot of extra work to make up for it fourth year and internship year? Did it affect your performance on Step II?

Thanks for your input!

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First of all, my third year experience was outstanding and nothing like you describe. We had lectures, clinical sessions and loads of teaching which was nice. That was my experience.

Why was my experience outstanding? It was because those that came before me took the initiative to point out problem clerkship locations and offer suggestions. We did the same if there were any problems too. In short, if we encountered things that were counter to our learning, we were able to point these out to our clerkship directors and deans. They were very responsive when approached professionally and respectfully. I definitely think that this made a difference.

The next point is that if you have tons of time "standing around" then take stuff with you (stuff your pockets) and do some board study/shelf exam study. If your questions are not answered, the keep asking them. If you are doing third year rotations, then you should have some classes/lectures. If you don't, then you need to let your clerkship director know because lectures and presentations are the main way of learning outside of experience during third year. If you medical school is accredited, they have to meet certain standards. You may have to hold them to these standards because the things that you state above are not standard.

Lastly, if your residents are not teaching, your attendings and clerkship directors need to know. If your attending preceptors are not teaching, your clerkship director needs to know. If your clerkship director is not listening to your needs, you dean needs to know. They need specifics in black and white. You need to stand as a group united as it sounds like no one is getting the educational experience that they need. After all, you are paying for the privilege of this coursework and you need to ensure that it is quality for you. When you start paying back those loans, you need to have gotten your money's worth. It's up to you to ensure this.

They can't "crush" the entire class or even half of the class. The LCME would "crush" them. Get a copy of the LCME regulations and specifically point out where your school is not providing what you need.