3rd Year Rotations order

[DMBFan]

I have to submit my preference form and was wondering what order i should do my 3rd year rotations?

In other words, what should I AVOID doing first? And what would be a good way to ease into the clinical setting?

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[Doctor Bagel]

I'm curious about this one, too. I've heard there's really no magical schedule, but I don't know.

 

[RxnMan]

From my investigation, and what my administrators have told me, there is no magic order. However, from everything I've read, NBME shelf exams are all based in internal medicine. Supposedly a large component of the surgery shelf is internal medicine. So I want to have that as early as possible.

 

[LadyWolverine]

I just got my 3rd year schedule today, and I'M SO JAZZED! I was given my top choice schedule (FM-Neuro-Psych/Med/Surg/Peds-OB) - honestly, I have no idea if it even matters, but we have a very limited choice (there are only 4 blocks we can mess around with).
Anyway, what I've heard from all the 3rd and 4th years is that you should do medicine close to the beginning, because it will help with all of the other rotations. I have also heard that you should do neuro before psych, if possible.
I opted for FM first, because they really focus on physical exam and presenting skills - I figured that these are skills that I should try to perfect early on, and I assumed that FM would be a lower-stress rotation than surgery or IM (I am thinking seriously about IM, so I didn't want to do it last).
Also, you shouldn't do anything you think you might be interested in dead last, because you will likely have to come up with your 4th-year schedule before your 3rd-year rotations are complete. That said, I'm sure it's not impossible to switch things around for 4th year, if you decide that your last rotation is what you want to do for the rest of your life
Disclaimer: I can't vouch for the validity of these statements, though, so don't quote me!

 

[Doctor Bagel]

I'm getting my "random number" the Friday after this one, so I'll know where I stand in making my selection then. I think FM might be a good starting place, too. I really don't want to start with IM just because I might want to do it, so I don't want to suck. I feel the same way about psych.

Any thoughts about starting with surgery if you definitely don't want to do it? It might be nice to get it out of the way.

 

[LadyWolverine]

The folks in my class who seem pretty sure that they *don't* want to do surgery opted to have it either first (to get it out of the way), or dead last (because everything else was open to consideration, they wanted to do these rotations before scheduling 3rd year, and thus left surgery for the slot AFTER that scheduling was done). Does that make sense? It wasn't very articulate. Sorry.

If I KNEW that I didn't want to do surgery, but there was NOTHING ELSE I had completely ruled out, I would want to do it last, so that I would have experienced all of my other rotations before having to bust out a 4th-year schedule.

Also, FWIW, I have heard from many residency programs/directors/faculty/etc that surgery is one of the two "key" rotations that are looked at in your application (along with medicine - some people have said that Peds is also very important), so it is important to do well in both of these areas.

 

[smq123]

I have to submit my preference form and was wondering what order i should do my 3rd year rotations?

In other words, what should I AVOID doing first? And what would be a good way to ease into the clinical setting?

It kind of depends on what you think you want to go into. It also depends on what your school's requirements are for third year.

There's no such thing as a perfect schedule. Each schedule has its advantages and disadvantages.

 

[lord_jeebus]

I think I could make a persuasive case for any possible order.

From a pure shelf exam perspective, it might be nice not to do Medicine last.

I started with OB/Gyn first, which was great because I went in without any preconceived notions of what 3rd year is supposed to be like. Afterwards, simple details on every rotation like respect from residents/attendings, being allowed to touch patients and do things, and not getting peed on came as pleasant surpises.

 

[71263]

Most importantly, I would say avoid doing anything that you might be interested in first or last. You dont want to do it too early, when youre new and adjusting to the whole M3 hospital life. You dont want to do it too late, otherwise it will get in the way of planning out 4th year electives, SubIs, etc during which you will get important letters.

As more of a personal preference, I would say try to get the harder stuff done first. I will finish with Internal medicine, which sucks (still better than ending on Surgery or OB). Nonetheless, it is a blessing in disguise, as I plan on taking step 2 early, and having this stuff fresh in my head will (hopefully) help me DESTROY the thing.

 

[SocialistMD]

The hardest shelf exam is probably FM. Many of the people in my class who had FM first struggled with the exam.
My suggestion is to do what you think you want to do in the middle of the year. By then you know the hospital, you generally know how things run and your knowledge base is pretty good. You are also not burnt out, which will happen towards the end of the year and will affect your performance. Other than that, there really isn't a magical formula and no matter what order you do things you will do as well as your effort allows.

 

[Ashers]

When making my schedule, the major things I wanted in a track were
-Get psych/neuro and OB/gyn out of the way
-Get my elective in a month where it'd be easier to get (more spots available)
-Have Thanksgiving off (therefore, better chance with not the Big 3 or OB/gyn)
-Surgery not last

My school does it so you have the Big 3 in the 1st 6 months or 2nd 6 months. The Big 3 are Surgery, Peds Medicine. I got my top track choice after a trade, and I'm almost done with surgery. I've got peds then medicine.

The one downside to my track was that the truncated clerkship for Christmas break was anesthesia. That's one of the easier months, and I also really enjoyed it.

I also wanted surgery in Jan/Feb because I figured if there's no sun out anyway, I wouldn't miss it if I'm in the hospital all the time.

This means though, I have to take the medicine shelf last. The only shelf exams we have are Psych, OB/gyn, Peds and Medicine.

 

[UCLAstudent]

I purposely tapered my schedule to make it go from hardest to easiest --- surgery, Ob/Gyn, pediatrics, internal medicine, neuro, psych, family practice, ambulatory. It worked out this way because I knew ahead of time that surgery and Ob/Gyn were not options for me. I'm on internal medicine right now and am finding that it's nice having a few rotations under my belt. I want to go into radiology, so internal medicine will probably be the most relevant evaluation for when I apply.

 

[PeepshowJohnny]

My general advice (other than not doing what you're interested in first or last) would be:

1) Family Medicine late as possible, because it touches on many different specialties (although the shelf TENDS to stay general medicine focused, you can almost skip over peds and ob/gyn questions and still pass)

2) If you're not interested in Peds, don't do it in the winter. At our institution, Peds teams during the summer were carrying single digit patient numbers. During winter, never under double digits.

3) Medicine before surgery as the surgery shelf is basicaly a medicine shelf in disguise.

 

[nontradappl]

Ob first since it has a little bit of everything (clinics, surgery, L&D). Since IM is so important, I would not do it first. Many people are not familiar with the shelf exam format and would be better served to have 1 or 2 under their belt before taking IM shelf. I had IM in my 4th month. Thought my first shelf (OB) was impossible and IM shelf taken later seemed straightforward, ended up doing well. So I would try to do something else first before medicine but have medicine still in first half (before holidays).

As for rest, ob before surg, medicine before surg, medicine/ob/peds before family. If you can, save room at end of 3rd year for early elective in specialty you're interested in.

That being said, you really have no control over schedule and honestly will do just fine with any schedule. Everyone is in the same boat and at same advantages/disadvantages if schedule is not ideal.

 

[ineedsleep]

The whole don’t do what you are interested in first or last is important. I started off easy with family because I had just finished the boards the week before and knew jumping into surgery would be too painful. My goal was EM, but my school doesn’t have a third year rotation for it and my advisor told me to wait till forth year to do my rotation (I was pretty certain even before third year that was where I wanted to go-so I was lucky) because I needed all the third year stuff to look good for EM. My big advice would be don’t save something really hard (like surgery) for last because it is painful to know you still have surgery waiting. Also my school tends to set and easier and a harder rotation up together so from surgery you go to neuro, Ob and Psych were a pair, and Peds came with Family. It was nice to have easier electives in-between hard ones, so you don’t burn yourself out in one long rush of the hard ones. That's what worked for me.

 

[getunconcsious]

Your ideal schedule will depend on what you think you want to go into, and also your personal preferences. Some people want to start with something easy after step 1 and to ease their way in. Some people want to start with something terrible (like I did) and just get it out of the way. Some will insist on taking medicine first (highly overrated, medicine does NOT magically translate to the other services like you think it does).

I'll break it down a bit by specialty. This, of course, assumes that you have *some* idea of a likely specialty/specialties going in.

If you're generic and Medicine is what you think you want to do, then ditch the conventional advice and DO NOT take it first! Try to take Pediatrics beforehand so that you get used to writing the long form H&P's and SOAPs. For the ambulatory side of medicine, it may help to have Family Medicine before IM.

If Surgery is your interest, then congrats you're a masochist! No seriously, you will need to take two rotations before surgery: Ob/Gyn in order to learn how to scrub in (sort of) and tie knots, and medicine because the surgery shelf is so hard and has so much medicine on it.

If you like the kiddos and are thinking Pediatrics then you should probably consider taking medicine and family medicine beforehand so that you will be somewhat familiar with both the inpatient and outpatient side of things. Peds is basically medicine for kids but without past medical history/surgical history most of the time and with some developmental/birth stuff. If you've taken IM you should at least be familiar with the format. Also, you should consider taking peds in winter since this is when the census will be the highest and you'll have the most time to shine.

If you're a man hating she-devil interested in Obstetrics & Gynecology, then I don't know what to tell you. Just kidding! I guess I would say take surgery beforehand to learn scrubbing in and knots and crap like that. Consider taking Family beforehand as well to get some exposure to prenatal care and well-woman/minor Gyn issues.

If you feel like a nut and Psychiatry is your prime directive, then it probably doesn't matter as much what order you take your rotations in. Neurology might be mildly useful, and family medicine will expose you to some of the outpatient psych stuff. But psych is so different that really none of the others is like it, so just don't take it first or last.

If for some God-awful reason you want to see the incurable and Neurology is your interest, I would say that medicine and psych would be good to have first, but medicine probably overlaps more than psych does. As long as you're familiar with hospital basics and note-writing, that's about all you can do.

If you're a jack-of-all-trades and Family Medicine is what you think you like best, then I might consider taking it next-to-last or even last. You'll see a little of everything on this rotation, and on the shelf which is notoriously difficult! Basically the more exposure to other specialties going in the better, especially ambulatory care clerkships in peds, medicine, or OB/Gyn.

I was interested in psych and pedi going in, and I wanted to take something really bad first. Our school breaks up medicine into a fall semester block and a spring semester block so that was impossible to avoid. My schedule ended up being: OB-Psych-Medicine-FP-Neuro for fall and Peds-Medicine-Surg for spring. This gave me Jan and Feb as my peds months, which I wanted. The only thing I'd change is to have taken psych later. August and September are still pretty early on and my skills weren't great. Also OB/Gyn was pretty useless in terms of helping me prepare at all for psych. Oh another note: As someone has said if you do NOT want to do pediatrics, put it first or last. The census will be VERY low and thus it will be pretty easy. Peds is by far the most 'seasonal' of the rotations.

Good luck to the MS2's! It makes me happy to realize that soon enough someone will be coming in to take my place in the land of unending misery and torment that is third year

 

[MrBurns10]

I liked having surgery first. We don't get a choice, but I wouldn't have done it differently. After waking up between 4 and 430 am and feeling dumb for 8 weeks, everything else just doesn't seem so bad...

 

[diosa428]

My schedule was FM/Psych, IM, Surg, Ob/gyn and Peds. FM/Psych was a nice way to ease into the year, and I wasn't so concerned with what I got on FM b/c I am def not doing it, so I didn't feel under tons of stress to do well. Although I'd agree that, testing wise, FM is very broad, in the clinic it is not. You see DM, HTN, Asthma, moles, warts, URIs, maybe some PAP smears, etc. I've finished medicine and am almost done with surgery and having the two big ones out of the way is definitely going to be nice. However, here Ob/gyn is a pretty easy rotation and Peds isn't that bad (only 3 weeks inpatient) so I ended up with an easier start and an easier finish. I liked it overall.

 

[MeowMix]

We got to choose only 1 rotation in 1 slot, and that was it. It really doesn't matter too much, except that it's nice to do either Medicine or Surgery early on so that you can sort yourself into the medical vs. surgical side for residency planning.

Things to consider:
- if you do your first rotation in June/July at a location with new interns, no one will give up their procedures/deliveries/whatever so that you can do them. Boring! I chose my first rotation (june/july) at a community hospital with no residents. Tons of surgery as first assist. Also nice to have those surgical skills before the ob rotation.
- if you have any choice, try to alternate rotations with heavy pre-rounding or long hours (surgery, ob, medicine, inpt peds) with 9-5 (psych, neuro, ambulatory anything). Back to back medicine/surgery/ob is a recipe for exhaustion.
- medicine first is nice because they teach you how to do your H&P and present pts. I wish I had had that early on.
- peds in the winter is a good way to actually see interesting stuff
- FM last is a nice way to integrate everything before Step 2
- don't worry too much about residency; you'll do a subI in your chosen specialty anyway, so it's not a disaster if you do the rotation early in the year

 

[riverie]

I started with OB/Gyn first, which was great because I went in without any preconceived notions of what 3rd year is supposed to be like. Afterwards, simple details on every rotation like respect from residents/attendings, being allowed to touch patients and do things, and not getting peed on came as pleasant surpises.

 

[jocg27]

I liked having surgery first. We don't get a choice, but I wouldn't have done it differently. After waking up between 4 and 430 am and feeling dumb for 8 weeks, everything else just doesn't seem so bad...

AGREE wholeheartedly with the nontraditional, underappreciated advice to take surgery first.

I think this is a great way to go if you want no part of surgery whatsoever, and a perfectly reasonable way to go if you are actually interested in surgery. Here's why-- (sorry this turned longer than I expected)

For the first group, its just so nice to have surgery over and done with early. It's a much nicer rotation to have behind you than looming up in front of you. And, as alluded to by MrBurns and Jeebus, having rotations like this first is nice because you still don't know any better about what other rotations are actually like, and it's still early enough that you are able to remain enthusiastic no matter what (unless you are just generally an unenthusiastic person). Then, once you leave, your schedule will not seem quite so bad again for the rest of the year, and you get to smirk superiorly at people on your next rotation complaining about how bad the peds schedule is because they just came off family, or something.

Now probably the more controversial side of this, is that honestly I think taking surgery first might[/I] also be reasonable if you're interested in surgery. Anyone who says you need to take ob-gyn before surgery to learn to tie knots is being silly. You'd have to run into a one in a million first class a-hole to hold your lack of suturing ability against you during the first month of 3rd year. There are plenty of, uh, strong personalities for sure, but in my experience they were all at least aware that in the two weeks since step 1, we had not yet become surgery residents. In no way are you graded on technique on a surgery clerkship...No students have good technique...interns don't have good technique...that's why, as they say, it's a 5 year program. I'm not even convinced that answering pimping questions right matters all that much -- I usually turned bright red, mumbled something, and got them almost universally wrong. And it's fine, because I'm convinced they were generally asked just to mess with our heads, and we worried much more about them than any attendings thought about them -- they all seemed to instantly forget about it. I am convinced that the evaluation part of your grade in surgery is almost entirely enthusiasm, interest, improving over the course of the rotation, and never ever complaining. And honestly, its easier to stand out for your enthusiasm when you're at the beginning with 3 people who plan to do peds than if you take it in January and your team consists of 4 people whose enthusiasm flows over with such exuberance that they are stumbling all over each other all day every day trying to show the world how interested and excited they are. As for the shelf, yes the shelf is a ton of medicine, and yes no matter what you will walk out feeling violated in some way...but no, it's not like you need to break out your Harrison's. You can do just fine...Here's the thing no one says when they say "THE SURGERY SHELF WAS ALL MEDICINE!!!!! THERE'S NO SURGERY!!!:" any of the books we'd be using are kind of "all medicine," too...It's not like Case Files:Surgery is all about types of suture and hardcore anatomy and surgical approaches. It's about medical management of surgical patients, which is what the test's about.

I took surgery first and didn't expect to like it much at all. I didn't know how the hospital worked, I didn't know how to study for or take a shelf, I certainly didn't know how to suture. I liked it way more than I expected, and learned a lot. My evals, shelf grade, and course grade were awesome. Of course, I am n=1, am I the exception? Iunno, I only know my own story of course...But my point is don't be terrified of surgery first -- you can do it and be perfectly fine, whatever your interest in surgery itself.

 

[Kubed]

If you can, do your electives at the end of the year. That way you'll have had some exposure/experience and you'll be able to use the electives as an opportunity to try out a specialty you might want to go into.

 

[Ypo.]

I'm curious about this one, too. I've heard there's really no magical schedule, but I don't know.

That is a bunch of bullcrap. I was told that as well, but looking back on it now, here is what my IDEAL schedule would be.

FM-->IM-->OB/Gyn-->Pediatrics-->Surgery-->Psych

Family medicine first because you will hate it and die of boredom and it's a good one to ease into followed by internal medicine. Alternatively you can switch them around. IM is really important; gives you a good overall foundation and experience in the hospital; you will learn a lot, but don't expect to honor it if you take it first unless you are really on the ball. Family is great because you get light peds, light OB, light medicine, so it prepares you for all of the above.

Next I would do OB (prepares you for surgery), followed by peds. To me this makes sense as you are following the natural progression of pregnancy to birth to childcare.

After that you can do surgery and you will be as prepared as you will ever be for it.You'll know your way around the OR, and you'll know how to avoid pissing people off as well as knowing how to make yourself look good.

Finish up with Psych (haven't had psych yet but I've heard the shelf is IM-intensive) because it's a very light schedule and you can start studying for step 2 during it.

 

[fakin' the funk]

In other words, what should I AVOID doing first? And what would be a good way to ease into the clinical setting?

To me, this is simple:

If you don't care about getting potentially getting LORs from any rotations, then it doesn't matter what order.

If you do care about getting LORs from any specific rotation(s), just don't do that rotation as your very first one. Easy!

 

[njbmd]

Order makes no difference in your clinical rotations other than avoiding peds during the peak of school physical season unless you just love doing all of those H & Ps. Residents and attending know that students are "green" when they start out and sophisticated when they end third year. We take that into consideration in terms of our evaluation.

A student can be inexperienced and still earn an excellent evaluation from me if they learn and progress on the rotation. I shudder to think what my first progress note looked like as a medical student but by the end of the first week, I had totally adjusted to what I needed to do for that rotation.

Order doesn't matter unless you are specifically trying to avoid something like school physical or peak trauma months (summer). In terms of evaluations, order makes little difference. I remember a person in my class who wanted to go into surgery. Since we didn't have a choice of rotation order, he got surgery first. He aced the rotation and ended up in a surgical residency. His last rotation was Internal Medicine which he hated and it turned out to be his lowest grade.

 

[jetxiu]

I think FM is a good starting place because it's lower-stress and you can get idea for every next rotation.

2th i prefer IM and then Peds.

 

[Ypo.]

Residents and some attendings know that students are "green" when they start out and sophisticated when they end third year. We take that into consideration in terms of our evaluation.

Had to fix that. Overall it's true of course.


In reflecting, I think whether or not there is a good "order" of rotations depends on the person and the site.

Best advice is to ask your upper classmen what the rotations are like at your location. Some of them will be good, and some of them will be bad. Having a heads up about which attendings and residents are good to work with and which are bad, knowing how to ace the rotation, or (if you know you don't want to go into said specialty) knowing how to do the minimum and still get decent evaluations...INVALUABLE.

Know yourself, your interests. I didn't want a bunch of hardcore rotations in a row. My schedule ended up like this; peds-->IM-->family-->OB-->psych-->surgery. I really liked it, with the exception that I wish I had done peds after OB and switched psych with surgery, so that I could have psych last.

 

[bmcgilligan]

We didn't get to pick. I had surgery first. I think it was actually a good thing. I felt most of the nbme was step 1 regurgitated with a bit of trauma thrown in. I studied for it like mad, and it paid off. Since your nbme grade will be compared with all other students who take that shelf at the same general time, if you study like crazy you have a serious advantage. No one else knows what they are doing either.

 

[jocg27]

We didn't get to pick. I had surgery first. I think it was actually a good thing. I felt most of the nbme was step 1 regurgitated with a bit of trauma thrown in. I studied for it like mad, and it paid off. Since your nbme grade will be compared with all other students who take that shelf at the same general time, if you study like crazy you have a serious advantage. No one else knows what they are doing either.

is it? anyone know for certain that this is true? I've never really known for sure and have never really gotten a straight answer...

Everyone seems to interpret these scores very differently; it seems very mysterious as to what they actually mean.

 

[GoBuckeyes913]

However, from everything I've read, NBME shelf exams are all based in internal medicine. Supposedly a large component of the surgery shelf is internal medicine.

From someone who has taken all the shelf exams..... the most important advice I can give is to make sure you take medicine BEFORE surgery. 40% of my surgery shelf was IM. Psych- know your drugs, FP- not as easy as it sounds, but mostly IM and peds. OB- everyone is bleeding. IM- all you need to read is Case Files: Internal medicine. I highly suggest investing in that book (the series is great for all the other shelf exams in other subjects as well).
hope this helps

 

[domer621]

I have to submit my preference form and was wondering what order i should do my 3rd year rotations?

What are you interested in going into?

Also, everyone has their own strategies on rotation schedules.

I personally think Peds > FM > IM > winter break > surgery > psych > ob/gyn would be the best schedule. That's assuming you don't want to go into Peds.

FM preps you for IM; IM preps you for surgery; psych gives you a break between surgery and ob/gyn.

 

[SoCuteMD]

Yeah, but IM and surgery back to back is pretty brutal, even with a winter break in there.

 

[domer621]

Yeah, but IM and surgery back to back is pretty brutal, even with a winter break in there.

The shelf-smashing power you get from having IM right before surgery makes it worth it, though.

 

[ambulancedriver]

how about someone who is either going into internal medicine or peds?

i'm conflicted, because the ideal schedule to me seems like obgyn & peds in the 1st quarter, medicine in 2nd, psych & FM in 3rd, and surgery in 4th.

the drawback is that peds would fall in late Aug./all of September, so pt. loads will be low and you may not get a good sense of what it's like during peak season (winter). plus, it would only be your 2nd rotation, so may not do so well.

the other possible one i'm considering is psych & FM in 1st, medicine 2nd, peds & ob/gyn in 3rd, and surgery in 4th. this puts peds in january/early feb, but makes FM tough since you haven't had the other rotations (and do FM or psych prepare you well to rock IM?).

at our school, ob/gyn+peds and FM+psych are always in the same quarter (6 weeks each), medicine and surgery are occupy whole quarters (12 weeks).

any advice appreciated

 

[Mental Gymnast]

AmbulanceDriver,

Disclaimer: There is no correct answer as I am sure everyone on this post knows. This is purely my subjective and personal opinion:

If I were you, I would do OB/Gyn + Peds, Medicine, Surgery, Psych+FM. Here is my justification.

1)Ob/gyn is a great rotation to start off with before peds. It's the perfect progression to do pregnant women, childbirth, and then newborns, children, and adolescents. Also, some people would say do FM before peds, but I actually think OB/gyn is a better rotation to do before peds because it throws you right into the hospital, you learn how to write soap notes and HPI's, you learn how to present on inpatient rounds. This will be really useful for inpatient peds. You will not get any of that experience on FM. I think it prepares you for inpatient peds, inpatient medicine, and surgery.

2) Don't worry about the order of peds. Many people would argue that peds is a "seasonal" rotation, ie you get twice the patient load in the winter. I think that does not matter. If you do it in the fall or summer and have less patients, that might be good because you will have more one one one time with attendings, more time for teaching, more time for the attendings and residents to get to know you and appreciate your work rather than be burdened by seeing all 25 patients AND teaching your arse how to do a pulmonary exam on a screaming toddler.

3) If you are interested in medicine, it is great to do peds before medicine. It is essentially medicine in a different population. You think about organ systems and differentials in the same way, you write the same format for notes, you present on rounds in the same way. It's good preparation. You'll shine on medicine by the time you do it in the winter.

4) Doing surgery right after medicine is SO worth it, and I agree with domer 621. You forget this medicine junk so fast, and if you do medicine right before surgery you will SHINE on the surgical floor and on the surgical shelf. Delay surgery til the end and you will have forgotten your medicine and be super burned out to be waking up at 4 AM to go to rounds. Let there be no doubt, I would NOT save surgery til last, it is one energy-demanding rotation. Plus if you have a winter vacation in between medicine and surgery then you can't ask for more.

5) I agree with peepshowjohnny, that FM should be delayed until late. Do it after you have done peds, medicine, and ob/gyn and you will be far ahead of your classmates. Starting off with family is a PAIN in the crotch when you are sitting there during your shelf trying to figure out what meds to give a woman with amennorhea or the immunization schedule for kids if you haven't done gyn or peds.

Just my $0.02

 

[-Goose-]

Any more suggestions for a someone interested in surgery?

Right now, here is what I'm thinking:

Ob/Gyn --> Peds --> Medicine --> Surgery --> Neuro/Psych --> Home ortho --> away --> FM --> away

Any thoughts? I am somewhat concerned that I might be doing surgery too late (January/February).

 

[ambulancedriver]

OP and others: this thread (and others linked from it) has a lot of different opinions that may help: http://forums.studentdoctor.net/showthread.php?t=189692

Just my $0.02

insightful and thorough response any others with thoughts on this? (it wasn't addressed in the link I posted, so that is why I ask)

 

[153445]

There is a lot of good advice on here, especially if you know what you want to do. Coming into 3rd year though, I was confused about whether I wanted to do surgery or consider non-surgical specialties too.

Conclusion from my experience: start with OB/Gyn if you don't know what you want to do.

I agree with Ashers that OB/Gyn really throws you into an intense hospital environment, and everything afterwards may seem relatively pleasant and benign. Gyn surgeries and C/S are not really comparable to other subspecialty surgeries, but you at least get a taste of the OR and can then decide if you like to cut or not. You also get to experience emergent situations and decide if you like that type of stress. There is even an outpatient clinic component, and you can decide from there if clinic is something you would enjoy. My favorite part of OB/Gyn was actually doing the H&P's in triage and then playing with the ultrasound machine, so from that I knew that I am not going into surgery (even though I came into med school thinking I would).

Unfortunately, I am stuck doing surgery last, and I would not recommend that. I am already burned out, and I haven't even finished my medicine rotation. I am definitely not looking forward to 15 hour days.

As for when to do peds, the winter season is not necessarily bad in terms of patient load, depending on your attending. Mine discharges patients very quickly, so our list rarely exceeded 10 on any given day. Right now, in fact, our patient list consists of 2 kids. As long as you wash your hands like you have OCD and avoid getting spat on or directly coughed on by the kiddies, you won't get sick.

 

[vtucci]

I love my rotation schedule.

We started with family (ambulatory- consisting of family med, outpt peds, out pt medicine, out pt gyn, geriatrics and adolescent medicine) and then went to internal med-peds (inpatient with one afternoon of outpatient med) and then did OB/Gyn and then Emergency Medicine. I am on surgery now and will end with neuropsych.

 

[vtucci]

Also, I have seen responses mentioning family as the hardest shelf? I don't know if we have been taking the same exams but family was the easiest so far and medicine the worst.

 

[docjolly]

at my school, we do not have an option (at least anymore) as to what our MSIII schedule will be..however, i had a great schedule because i had all of my more difficult rotations first:

Internal Medicine
Surgery
Obstetrics/Gynecology

Having IM first truly made a difference in my other rotations because it laid the foundation of my understanding for everything else (for the most part). Also, having all of the more difficult rotations out of the way will make the rest of my junior year (when I need time to begin prepping for away rotations, and thinking about Step II) much, much easier and more enjoyable...

Having an easier rotation (like many of my friends had) put them under a great deal of pressure because many felt unprepared when they got into the more challenging rotations. I encourage you to try one of the more difficult rotations first.

just my two-cents

 

[beponychick]

Also, I have seen responses mentioning family as the hardest shelf? I don't know if we have been taking the same exams but family was the easiest so far and medicine the worst.

Hey,

Is there anything you did specifically to prepare for the FM shelf? I actually have it scheduled first and Im really worried because everyone says that shelf is a killer!

 

[vtucci]

I also like the case files series. I used Case Files Family, Blueprints Peds, Case Files Peds, Blueprints Ob/Gyn (Gyn only chapters), Swanson's family practice.

Very heavy on preventive med on our administration of the exam. Know your immunizations for peds.

 

[Doctor Bagel]

Also, I have seen responses mentioning family as the hardest shelf? I don't know if we have been taking the same exams but family was the easiest so far and medicine the worst.

Hmm, so maybe FM first wouldn't be horrible. I'm pretty sure I don't want to do FM, surgery, peds or ob/gyn, so I guess any of those first would work. And I should try to do IM and psych (two I probably want to do) somewhere around the middle of the year, so I know stuff and am still motivated. Now I'm just hoping I don't get the lowest random number, which means I'll be stuck with surgery and IM back to back at the end of the year.

 

[vtucci]

how about someone who is either going into internal medicine or peds?

i'm conflicted, because the ideal schedule to me seems like obgyn & peds in the 1st quarter, medicine in 2nd, psych & FM in 3rd, and surgery in 4th.

the drawback is that peds would fall in late Aug./all of September, so pt. loads will be low and you may not get a good sense of what it's like during peak season (winter). plus, it would only be your 2nd rotation, so may not do so well.

the other possible one i'm considering is psych & FM in 1st, medicine 2nd, peds & ob/gyn in 3rd, and surgery in 4th. this puts peds in january/early feb, but makes FM tough since you haven't had the other rotations (and do FM or psych prepare you well to rock IM?).


at our school, ob/gyn+peds and FM+psych are always in the same quarter (6 weeks each), medicine and surgery are occupy whole quarters (12 weeks).

any advice appreciated

You are kidding about the low patient load in peds in late August right? You will get a ton of well-child checks and once the kiddies go back to school and are there for a few weeks, you will see the first wave of illness in Sept. I was constantly busy during my peds outpatient and inpatient months.

 

[smq123]

how about someone who is either going into internal medicine or peds?

i'm conflicted, because the ideal schedule to me seems like obgyn & peds in the 1st quarter, medicine in 2nd, psych & FM in 3rd, and surgery in 4th.

I don't know if that's the "ideal" schedule - you'll die on surgery if it's last. You'll be so burnt out as it is.

the drawback is that peds would fall in late Aug./all of September, so pt. loads will be low and you may not get a good sense of what it's like during peak season (winter). plus, it would only be your 2nd rotation, so may not do so well.

I did extremely well on my 2nd rotation. It's not impossible to totally rock your 2nd rotation. If you ask around, and prepare to work hard, you might very well honor your 2nd rotation.

the other possible one i'm considering is psych & FM in 1st, medicine 2nd, peds & ob/gyn in 3rd, and surgery in 4th. this puts peds in january/early feb, but makes FM tough since you haven't had the other rotations (and do FM or psych prepare you well to rock IM?).

Can't speak to FM, but psych doesn't prepare you for anything except psych. It doesn't prepare you to do well on IM, since the "medicine" that you need to know on psych is fairly minimal.

It DOES prepare you to write extremely long progress notes and to keep track of very long medication lists. Otherwise, I didn't feel like psych prepared me for anything that came after it.