Anyways, I've seen a few things mentioned on SDN and elsewhere about 3rd year/hospital culture recently. It seems like depression/hating life is "not uncommon" for 3rd years at some hospitals/rotations. I don't have any experience in teaching hospitals so I have no personal experience seeing these kinds of attitudes portrayed. Can anyone here (CCLCMer maybe?) comment on the quality of 3rd year rotations at University, the Clinic & other places? A few questions to perhaps help:
bucks, you are asking good questions, and it's very smart of you to be thinking about clinical stuff at your stage in the game. I mean no disrespect, but I am working 12-16 hour days, and I'm just not up to the task of writing a whole book right now, which is about how long it would take me to answer your questions. So, how about if I answer one question for now and we can do the rest another time.
What kinds of things do you do as a 3rd/4th year?
At all American med schools, you will spend your third year doing the core rotations. (For CCLCM, third year rotations can be done during the fourth year of the program if you do your research year between your second and third years of med school.) Mandatory core rotations at all schools include pediatrics, OB/gyn, internal medicine, surgery, and psychiatry at minimum. Some schools also have mandatory third year rotations in neurology, family medicine, geriatrics, and/or emergency medicine. (Case requires all four of these.) Rotations last anywhere from four to eight weeks at most schools. Case's rotations run from four to six weeks. They are organized into three "cores," which are groups of rotations that must be taken together in a block. The cores are different now than when I took them, but one core is psych and neuro for eight weeks. I think that OB/gyn and peds are still together, as are surgery and medicine. Family med was with surgery/IM when I went through, but it has now been moved into the same core block with OB/gyn and peds. There are also two "advanced cores," which are geriatrics and EM. These are standalone rotations that each last for four weeks.
What you do depends very much on the rotation. Some rotations tend to be more hands-on than others, and it also depends on the team you're on, the hospital you're at, whether it's inpatient or outpatient, and even your gender sometimes. (A lot of male students don't get to do nearly as much on OB/gyn as the female students do because the patients aren't always willing to allow a guy in the room.) In general, outpatient rotations run on an 8-5 kind of schedule. You go to clinic each day, see patients, present them to the attending, and write notes. Your evenings and weekends are typically free. (No call.) These tend to be easier rotations.
Inpatient rotations tend to run closer to the 80 hour workweek limit for IM, peds, OB/gyn, and surgery. (Technically, the 80 hour workweek rule only applies to residents, but Case and CCF also apply it to medical students.) I found neuro and psych to be a bit easier, with neuro around 60 hours/week and psych more like 40. On inpatient rotations, you are generally assigned a few patients to follow. Usually two or three at a time is the norm for an MS3. You go in early, round on your patients, write notes, and then round again with the team. On surgery, rounds are very quick and you're in the OR by 7:30 or so. On IM, you will probably round all morning (and if you get an especially sadistic attending, into the afternoon as well). Peds is pretty similar to IM schedule-wise. Gyn is pretty similar to surgery. OB goes by 12 hour shifts, and it's kind of a medicine-surgery hybrid since you assist with C-sections along with vaginal deliveries. On IM, we took Q4 (every four days) call with the team. We had to do Q4 30 hour call, which sucked hard, but I don't know if the current MS3s have to since the residency work hour rules changed again this year. Surgery also had overnight call, but just 24 hours and Q7 (once a week). Peds, neuro, and psych had short call, where you went home like at 10 or 11 PM. A lot of the residents would send us home even earlier than that for those three specialties.
On Friday mornings, we always have didactics just for the medical students. This is true no matter which site a student is rotating at. Also, most departments have their own conferences that you will attend while you're rotating through that specialty. My experience was that the more "cerebral" specialties like IM and neuro had a lot more conferences than the surgical specialties. There are also shelf exams at the end of each block. These are multiple choice tests with questions in the style of Step 2CK of the USMLE. Each specialty has its own shelf. For UP students, the shelfs are required, and the scores count toward their rotation grade. For CCLCM students, the shelfs are optional, and even if we take them, they don't count toward our grades. But a lot of us take them anyway, because they're good practice for Step 2.
Fourth year, there is a lot more variety among medical schools. At Case, we are required to do two "acting internships." One of these must be in IM, peds, or surgery, even if you are not going into one of those specialties. The other can be in any clinical specialty (so, not path or rads). AIs last four weeks each and are the most intense rotations of all, since the purpose of them is for you to attempt to function like an intern. You carry more patients than you did as a third year, and you do more advanced things like help dispo the patients (figure out what needs to be done before you can get them out of the hospital, when they can go, etc.). One AI must be done at one of the Case hospital affiliates, while the other can be done as an away rotation at another institution. You can also do extra AIs if you want, and some students do.
The rest of the year is elective time (and of course residency apps and interviews). Case has a required "area of concentration," which is pretty loosely defined as a plan of rotations (both clinical and nonclinical) that are related to one another. You create a plan during your third year, but it is very flexible, and most people, including me, change them over time. Most electives are relatively cush, with short hours and no call. Again, duties vary depending on what you're doing.
If you are a UP student, you will also be doing a research block for four months. Since the UP finishes their second year in March, some of them do their research then. Others start on rotations in March of second year and then do research later after finishing some or all of their rotations.
That's about all I can think of right now. Hope it helps give you a general idea. Like I said, a lot of what we do is similar to what other schools do, because all LCME-accredited schools are required to provide a similar set of third year rotations, and a certain number of elective weeks. For a more day-to-day view, you can read the last eight months or so of my blog. I got most of the way through my third year, so it will give you an idea of what those rotations are like.
You guys must be awesome.
I suppose you could ask them to compose a letter together, and sign off on it together? I think that would be a great way to minimize the redundancy (which the readers on CCLCM's end who probably appreciate), and furthermore, there would be two sets of eyes reviewing what is produced. I suspect it could be an excellent LOR, if done right. 😀
