3rd Year Clerkship Order

[mymembernames]

Hi All,

I was wondering if I can get some advice about scheduling third year.

What order is ideal in terms of scheduling 4th year / aways, Step 2, doing well on the shelfs, LORs and the specialty you are interested in going into?

Is there a strategy one should keep in mind when scheduling or does it not matter? TIA!

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[Taddy Mason]

Hi All,

I was wondering if I can get some advice about scheduling third year.

What order is ideal in terms of scheduling 4th year / aways, Step 2, doing well on the shelfs, LORs and the specialty you are interested in going into?

Is there a strategy one should keep in mind when scheduling or does it not matter? TIA!

Its highly dependent on how your school structures 3rd and 4th year, your specialty interest(s) and career goals, and your personal strengths and weakness regarding self-directed studying, clinical assessment skills, etc. The best advice regarding your questions is going to come from those in the classes above you and very recent graduates from your school who went into the field(s) you're considering.

 

[sazerac]

The last time I saw this question asked on SDN, the collective wisdom was that IM adds a small but measurable boost to all remaining shelf exams taken after IM. It only added like a point or two, but that is often the difference between High Pass and Honors.

Some folks say take IM clerkship last so you will be in tip-top shape studying for Step 2 CK, but being in tip-top shape for all 3rd year clerkships >> a slightly reduced effort studying for a 4th year exam that often isn't even necessary to score an interview.

 

[Psai]

IM early. surgery later. fm last (hard shelf in the beginning of the year but cake at the end). Step 2 is about the entire year, why bother with im last lol

 

[Tenk]

IM is great first. Surgery is great around Christmas so you get a break. Save psych for when you want a break from the grind. Throw OB and peds in there someplace. Family is good later.

 

[Taddy Mason]

IM early. surgery later. fm last (hard shelf in the beginning of the year but cake at the end). Step 2 is about the entire year, why bother with im last lol

IM is great first. Surgery is great around Christmas so you get a break. Save psych for when you want a break from the grind. Throw OB and peds in there someplace. Family is good later.

I would not do IM early if you're considering going into it (but definitely do it before surg - surg shelf is pretty much a weird IM shelf), however doing FM later is probably the one solid piece of advice that is going to be consistent between schools.

 

[Jabbed]

IM before surgery. Whatever you're interested in, make sure that you can rotate through it before picking your fourth year schedule.

n=1, but I thought family was super doable early on (took it as my first shelf). The curve was also fairly generous at that point.

 

[DocWinter]

I 2nd doing IM before surgery. The surgery shelf was an IM/ER mix.

I view ObGYN, peds and Psych as stand alone shelfs. Ideally take one to start the year and get a feel.

Family has OB and peds, so ideally take those 1st.

Internal would be my 2nd and 3rd rotations if i could do it over again. Probably family last.

 

[WheezyBaby]

Whatever you think you want to go into, don't do it last. Otherwise, it's not really worth stressing about

 

[operaman]

As the resident contrarian, I would argue it makes no difference at all. The only time it might matter is if your school spreads clerkships across both Third and fourth year, AND you will need to take step 2 before ERAS goes out as well as do a sub I or two. If your school does clerkships in second or third year only, then order makes absolutely no difference.

My personal approach was to do surgery and medicine first and back to back. Then I put all my electives back to back in my chosen field. My reasoning was to make sure I knew what I wanted to do early in the year. Had I despised surgery, I would have had time to change my supspecialty electives. If I'd hated everything, I'd still have time to explore other fields. Thankfully it worked out fine, but I would not want to be someone who finds out in June that they really don't like XYZ field after all.

 

[Chillbo Baggins]

As above, it depends on your school's set up and your interests.

I did FM first to set a foundation, then surgery, then peds. Yes, surgery is hard without doing IM first, but very doable as long as you know beforehand there will be a lot of medicine questions.

I have IM last for Step 2, and I don't regret that choice.

 

[earf]

I think you should do very specialty specific shelves first, such as psych, neuro, and ob/gyn, maybe even peds. Do your specialty you're considering the most in Jan-Feb. Do internal medicine as close to Step 2 as possible so you don't have to study twice. I don't think you necessarily need to do surgery after IM. Everything is related to IM: psych manifestations of IM issues (hypercalcemia, thyroid issues, etc.), neuro manifestations of IM issues (afib causing stroke), etc.

In the end, no it doesn't matter. There's pros and cons to having something first or last with any schedule.

 

[Sea Otter]

My Step 2 CK had a bunch of OB/GYN on it (I've talked to others who did as well) so taking that towards the end of the year might be a good idea so the content is fresh.

 

[byaaaaaaah23]

My Step 2 CK had a bunch of OB/GYN on it (I've talked to others who did as well) so taking that towards the end of the year might be a good idea so the content is fresh.

I did OB as my 2nd to last clerkship and still had to relearn it all for step 2. IMO, don't take Step 2 into account at all when you make your schedule as you will have to relearn almost everything anyway. Pick the optimal schedule for doing well on shelves (IM before surgery and FM towards the end if possible, as stated above) and to set yourself up for whatever you're going into.

 

[Levo]

Internal medicine is the prototypical clinical rotation. It gives you a chance to work out all of the basic "rotation skills" before you have to apply them to future rotations. If you're not interested in IM, it would be very beneficial to do IM first, IMO. If you ARE interested in IM, I would suggest doing it second. It's early enough that you'll still get a chance to apply the learning to many other rotations, but by making it your second rotation, you're much less likely to do something embarrassing because you don't understand how medical teams function. Everything else could go in any order.

 

[Redpancreas]

Hi All,

I was wondering if I can get some advice about scheduling third year.

What order is ideal in terms of scheduling 4th year / aways, Step 2, doing well on the shelfs, LORs and the specialty you are interested in going into?

Is there a strategy one should keep in mind when scheduling or does it not matter? TIA!

My opinion is the following as a third year can be broken down into these tips ranked by the one's I feel the most strongly about:

1.) Don't do what you want to do first. Books --> Wards is a transition that takes more than a year and you still won't know everything by the end of it. Whether it's navigating the EMR, adjusting to H&P+Presentation and other stuff it'll take time. While there is some level of leniency in that most residents get that July 1st is a special day, most residents/attendings (especially surgeons) have the ability to not give a damn after a week or two and expect you to pick up everything from what I gather from my friends who started first with surgery.

2.) Choose what you want to do after Christmas break. It'd be nice to enter what you want to go into after coming off the longest break you've had in a year. It will also give you plenty of time to get acclimated.

3.) Don't do what you want to do last...because what if you don't like it or idk...the thought just makes me uncomfortable.

4.) If you're interested in one of the cores like surgery/IM (so not OB/GYN, Neuro, Pediatrics or Emergency) I would suggest starting off with the core you're not interested in. For example, if you want Medicine, start surgery first, vice versa. The reason for this is that you're well rested and enthusiastic so you'll do alright/well in the core you're less interested in but is still important, you will get a tough rotation out of the way, and third, it will allow you to have a rotation where you are expected to do a lot and learn about your settings. I personally want to do IM but I unfortunately learnt more stuff about the hospital on the first week of IM when I had it in January then I did for the entire duration of OB/GYN, Neuro, and Psych that I had before (I delayed Step 1 2 months and booted surgery to the end).

5.) If you want OB/GYN or Neuro, consider doing IM last. This will be beneficial for Step 2 CK.

 

[Redpancreas]

As the resident contrarian, I would argue it makes no difference at all. The only time it might matter is if your school spreads clerkships across both Third and fourth year, AND you will need to take step 2 before ERAS goes out as well as do a sub I or two. If your school does clerkships in second or third year only, then order makes absolutely no difference.

My personal approach was to do surgery and medicine first and back to back. Then I put all my electives back to back in my chosen field. My reasoning was to make sure I knew what I wanted to do early in the year. Had I despised surgery, I would have had time to change my supspecialty electives. If I'd hated everything, I'd still have time to explore other fields. Thankfully it worked out fine, but I would not want to be someone who finds out in June that they really don't like XYZ field after all.

Your school had a track that allowed you to have those B2B? Or did you individually schedule each rotation? That would be one hell of a lottery.

 

[operaman]

Your school had a track that allowed you to have those B2B? Or did you individually schedule each rotation? That would be one hell of a lottery.

We had a lottery but it was pretty easy to game it mathematically. My only preferences were IM and Surg first and I didn't care what order. Then I wanted field specific electives immediately following. The lotto algorithm gave out rotations based on trying to evenly maximize sheer number of preferences among the class. As I only had 3 that didn't really conflict with anyone else's, I got exactly what I wanted.