3rd year VS. 4th year

[medstudam]

Can anyone enlighten me on the differences between 3rd and 4th year(not SubI) in terms of responsibilities and what attendings/residents expect from the two, as in a Family Medicine rotation? Thank you.

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[electra]

I found the difference to be that in the 4th year, you should be getting batter at pulling out the ddx and indicating 1. how you are going to determine where the patient's xyz is coming from and 2. what you are going to do about it.

For example, say you have a patient in with dyspnea...is this CHF, pneumonia, a PE, etc. This sounds like a simplistic example, but this will happen. Or a patient with "CHF" who really has cor pulmonale...can't just try and diurese this patient. How will you decide? Or your patient whose in house 5 days and still has SBP of 150. What are you doing to optimize this patient?

Get used to admitting people, the whole ball game. Do the intake history, the first PE, write the admit orders, do the pharm yourself and have someone check it. Look at the xray and try to interpret it, same with the EKG. Start thinking yourself about what's going to kill this patient first and how you won't let that happen. Carry the intern pager and answer the page. Discuss with your intern or resident or attending how you would approach the situation. (this is given that the page is not a code/emergency. don't discuss that until it's over.)

A great sub I is either CCU/ICU, because you really get to learn how the patient is examined system by system.

just my .02.

electra

Can anyone enlighten me on the differences between 3rd and 4th year(not SubI) in terms of responsibilities and what attendings/residents expect from the two, as in a Family Medicine rotation? Thank you.

 

[AF_PedsBoy]

In my Sub-I for peds at least, you pretty much do everything from the initial interview to the discharge - the only people writing notes on the chart was me, the chief who just cosigned my notes, and the attending. Basically if you don't write the order, it doesn't get done. While this is kinda cool, it quickly becomes very frustrating as you shuttle back and forth from the floor to wherever the chief is and then sit and wait on the secretaries to eventually enter it... Also you have to have real plans now, instead of the vague BS you could write as a 3rd year (or at least what *I* was writing lol).

 

[SammyK]

For me, I found 4th year could be all over the map compared to 3rd year. My 3rd year consisted of what I felt was a great experience in that I was given as much responsibility as I could handle. In talking to other classmates at different places, my experience was equivalent on all my IM rotations to a 4th year Sub-I in terms of what they expected of you and what my duties were on the service. As a 4th year, I bounced around to about 8 other hospitals and found an extremely wide variety of what the expectations were from residents and attendings and with what I was allowed to do regardless of its complexity. I had a great ICU rotation where I got tons of great experience working up ddx, planning a course of treatment, etc. I definitely would recommend an ICU/CCU for 4th year. However, on my 4th year FP rotation (where I was thinking I would get the chance to function fairly independantly) I basically shadowed the residents and attendings just because that is how they do things there. In my opinion, 4th year can either be a blessing or a curse in that environment: a blessing in that at the end you are near the burnout stage and are sick of wearing your ridiculous short white coat, or a curse in that if you have to be there from 9-5 you might as well have something to do to make the day go by quicker and practice the skills you will need to have in a few short months rather than try to remain enthusiastically interested after the resident does his 4th well child visit of the day without allowing you to participate or interact because "it just takes time and you already know how to do this". Oh well. Either way it is done.