4th year rotations recommendation

[Duon89]

In the process of contemplating end of my 4th year. (Currently 4th year)

done 2 neuro. so far.
and I have 2 more elevtive spots open.

I was thinking of doing
heme/onc and nephro...but spots were filled.
thinking now neuroradiology and/or peds neuro.
or
outpatient neuro
or
neuro -ICU..
or more inpatient neuro (stroke/consult/general)

what do you recommend

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[typhoonegator]

Neuroradiology could be useful. I wouldn't do peds neuro unless that's what you want to go into. Honestly with 2 previous neuro rotations, you might want to branch out a bit. I'm sure an outpatient neuro elective would be cushy, which is something you might like at this stage of the game. NeuroICU would be fun if that is what you like, but don't do it just because. I'd think about doing an ID, cardiology, or MICU rotation, something to help you round out your general medical education. Rheum maybe too.

 

[kchan99]

I did few neurology related fourth year electives. Not counting sub-Is and neuro away rotations, for the most part, I did electives in areas that were not related to neurology because I would not have exposure to these areas:

-Behavioral Neurology: saw many patients with FTD; attending had an interest in FTD
-Dermatology: learned to describe skin lesions and eruptions (helpful when seeing patients with "rash" and "weakness" for dermatomyositis r/o)
-Forensic Pathology: my only exposure to trauma cases; I did not see much trauma during residency.
-Nephrology: helpful for internship year, but not helpful for neurology

 

[deathmerchant]

I would strongly recommend doing something like Endocrine and ID- those are the things that will help u most during ur neuro residency. Doing some kind of ICU rotation wouldnt be a bad idea either since a lot of Stroke and Neuro patients are ICU level nowadays and u are primary on them. Palliative and/or pain management is another good option- ull deal with these situations daily.

 

[TUGM]

4th year, I advise these rotations, if possible:
1) Cardiology - the brain and heart are intimately intertwined
2) Infectious Disease - important for learning how to manage systemic AND CNS infections
3) Neuroradiology - self-explanatory
4) ICU - can be either neuroICU, MICU, or SICU, for reasons explained by others above

Also if you have time to take some cushy rotations, you should throw those in your 4th year, especially towards the end because senioritis is a real disease.

 

[kchan99]

4th year, I advise these rotations, if possible:
1) Cardiology - the brain and heart are intimately intertwined
2) Infectious Disease - important for learning how to manage systemic AND CNS infections
3) Neuroradiology - self-explanatory
4) ICU - can be either neuroICU, MICU, or SICU, for reasons explained by others above

Also if you have time to take some cushy rotations, you should throw those in your 4th year, especially towards the end because senioritis is a real disease.

I had Cards, ID, Neurorads, and MICU during PGY1. I'm not sure how much I would have gained, if anything, if I had these rotations as a med student. Ophthalmology with some neuro-ophthalmology exposure in a busy academic department would also be a good 4th year elective.

 

[Crayola227]

Opthalmology sounds like the best advice I've seen in here so far

You don't get a good med school.ed on that one usually, most docs are pretty clueless on eyeballs, and they definitely matter in neuro, IMHO

When I did my neuro rotation I was lucky to spend lots of time with a neuro-optho, doc was a genius, easily some of the coolest stuff

 

[Crayola227]

That and just take some easy fun stuff

ED wouldn't be bad, you don't get much first hand exposure to it otherwise, I think it's a hoot down there (for a rotation), usually you half the month off, might be last time you suture

Something to think about if you need a flex rotation for your interviews

 

[Duon89]

Wow that's a lot of good advice.

Yeah, currently signed up for : MICU, Ophthalmology,
Mandatory: ED, IM-subI
done: cardio, gi during 3rd year

ID, neurorad look like recurring theme here.

And other options are Nephro, Rheum, endo, and derm.

Kinda surprised no one mentioned heme/onc.

But thanks again for the advice.

 

[typhoonegator]

Nothing wrong with heme/onc, but most heme/onc rotations are strongly biased towards liquid tumor diagnosis and treatment. That's fine, but it is very proprietary to the field and the regimens can change a lot through time. If you wanted to get a coagulation-disorders experience for some future stroke career or something, you'd have to try to plan that out ahead of time.

 

[kchan99]

Nothing wrong with heme/onc, but most heme/onc rotations are strongly biased towards liquid tumor diagnosis and treatment. That's fine, but it is very proprietary to the field and the regimens can change a lot through time. If you wanted to get a coagulation-disorders experience for some future stroke career or something, you'd have to try to plan that out ahead of time.

Vascular Medicine would be a good rotation to learn about coagulopathies associated with stroke.

 

[Hank Rearden]

I assume you both mean doing a Hematology as opposed to an Oncology rotation. This would probably entail doing Hematology clinic as they're aren't too many inpt hematology consults. There's no such thing as "Vascular Medicine" at any hospital I've trained at.

 

[typhoonegator]

I assume you both mean doing a Hematology as opposed to an Oncology rotation. This would probably entail doing Hematology clinic as they're aren't too many inpt hematology consults. There's no such thing as "Vascular Medicine" at any hospital I've trained at.

These multidisciplinary vascular medicine services have kind of become a hot item recently, at least in some places. Mostly cardiologists, vascular surgeons, and IR folks, running an inpatient consult service that can help you figure out when to put in an IVC filter, stent something vs. anticoagulate vs. other, when to worry about that shaggy aorta, etc. From what I see of our service, it's much more procedural and less nuanced than diagnosing subtle clotting disorders, though. I always though it seemed more like a good way to divide up the procedure pie and keep everyone happy working alongside each other.

 

[kchan99]

At the hospital where I did my residency, vascular medicine was strictly run by vascular medicine with input from cardiology. Vascular surgery and IR were not involved at all so vascular medicine consults were strictly involved with coagulopathies and diseases affecting vessels, such as FMD, EDS, Loeys-Dietz, etc.

 

[typhoonegator]

At the hospital where I did my residency, vascular medicine was strictly run by vascular medicine with input from cardiology. Vascular surgery and IR were not involved at all so vascular medicine consults were strictly involved with coagulopathies and diseases affecting vessels, such as FMD, EDS, Loeys-Dietz, etc.

That's pretty unusual, from my experience, although if that service existed it would have been a great training experience.

 

[trevithick]

Here are some of my recommendations:
CARDIOLOGY!!!! Every neurologist (and probably most IM people too) should take inpatient cards, it was one of the most useful months of all of med school. I read the case files prior to starting and followed it up with reading the charts in the AHA guidelines for afib, chf, stemi/nstemi, and some valvular disease. Ultra useful. Managing CHF, anticoagulation, and afib in patients with hx of CAD is very relevant. I followed it up with some time on stroke and I felt extraordinarily pepared. Cardiology, if you take it seriously, will make stroke (which will be a third of your residency) and a good chunk of intern year much easier.(or thats the hope anyway)

Stroke-as mentioned above

EMU-prepared by reading a primer on EEG, came out with a basic understanding of EEG aand epilepsy med management, again will make that chunk of residency that much less intimidating
neurorads-was a cush course, got a little out of it, but not that much (again partly my fault for not pushing myself to read extensively beforehand/touh of senioritis)

Whatever neuro subspecialty clinics youre interested in, as you can start to get exposure to subfields you may want to pursue. This will allow you to be more targeted with your electives in residency, especially sine some programs limit electives in the first year.

ID-didnt take it, butI can see how it would be useful for neuro and life in general, so +/-
Neuroicu-my rotation wasnt superuseful (partly my fault-wasnt sure where to go for for reading resources, didnt prepare material beforehand,so I didnt read as much as on others, also had a bit of senioritis), but I think it would be good for feeling comfortable with elevated ICPs and ICH. CCU or MedICU may also be good options for leaning about sick patients
Emergency Medicine-As above, learn how to acutely manage STEMI/NSTEMI, stroke and acute seizure/status. Also really useful because EM docs have quite a different view of TPA and stroke management and its good to be exposed to that body of literature. Also good to practice LPs. Also a chance to get more comfortable with simple suturing (a good life skill, though youll prob never use it again)

Endo-havent taken it but now considering it. A chance to be super proficient with t2dm and aitd actually might be a good idea as well as getting used to the neurologic presentations of dka, hhgs and myxedema coma.

Nephro-didnt take it, maybe it would be useful, since people shy away from kidney diseases, so +/-
Ophtho-didnt take it, but maybe it would be helpful?? +/-


Of note I think fourth year is a chance to start acquiring skills that will be helpful for intern year and residency in a low pressure low stress environment. Not a big proponent of being super well rounded in things that have a negligible utility unless Im just being self indulgent with my own curiosity. My attitude is the more I know about neuro and medicine as I go into those fields, the less stress I will be under, the more time I will have to be able to grasp the nuance of patient management and read more broadly about the field rather then just the basic-what are the ten treatment algorithms I need to know to survive this block.

On the flip side, I also think its ok to slack a little in some of the less stressful courses, as this is your chance for a bit of a breather and you dont want to totally burn out. But if you use this as a chance for a low stress learning opportunity, residency and intern year may be less stressful for you (thats the hope, I will see in a year how that pans out)

 

[wildfan1]

Taking into consideration the very helpful info above and in other threads (Radiology vs. MICU rotation to prepare for intern year/neuro residency?), could I get some advice on options for my Jan, Feb, March, and April of M4 year (I didn't wanna start a new thread):

Background: already have Neurology rotation and Radiology rotation scheduled in summer/Fall (with a lot of time in Neuroradiology on my Rads rotation), along with ambulatory stuff, 2 vacation months, and an easy rotation september. So my fall is set, looking for advice for rotations to take Jan-April - I WILL be taking Medicine Sub-I one of these months, I WILL need another "acting internship", and i don't care the order (my school doesn't offer a Neurology Sub-i or Acting internship, just elective).

Goals are:
1) get high yield experiences that I'll need as a Neurology resident that I won't get much of in residency
2) get exposure to stuff I could do as electives in Neurology, so I can determine if I love or hate it AND have more info earlier on so I'm more prepared to set up residency schedule to get experiences early enough to decide fellowship options
3) no fluff (have enough fluff in fall, and I like rotations better than home, seriously)

Options (order doesn't matter):
Month #1: Medicine Sub-I (will be taking)

Month #2: (pick 1, listed in order of my interest level)
- Neurosurgery Acting Internship (will try and see some epilepsy surg and NIR, as well as cases requiring intraoperative neurophysiologic monitoring)
- Inpatient Cardiology Acting Internship
- Child Neurology Acting Internship

Month #3 and 4 (pick 2 of following, very loosely ranked by my interest level):
- Cardiology elective (if didn't do Inpatient Cardiology Acting Internship)
- Sleep medicine (to rule in/out interest)
- NICU (but residencies I'm looking at have >3mo NICU already and early enough to help me know if I like it or not)
- Ophthalmology (with some neuro-ophtho)
- Brain Injury medicine
- multi disciplinary mgmt of vascular disease (before picking I'd ask rotation coordinator if I could do most of my experience in stroke/NIR related areas)
- Infectious Disease (I suck at ID, which is why I want to take this to suck a bit less...)
- Emergency Med (but I already have a lot of experience in EM)
- Peds Neurology (if didn't do Child Neuro Acting Internship)
- Away Neurology rotation in January (prob not, hard with family sched)

Thanks in advance for your help! I wish I had one more month available, but I want to keep 2 months free for interviews and want a chill September for my application...