Advice for MS2's that are scheduling for third year

[AK_MD2BE]

The title pretty much says it all. Do any of you third and fourth year students have advice on scheduling the third year? Any and all good advice would be greatly appreciated. Thanks.

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[Ashers]

There have been several threads like this in the Clinical Rotations forums recently.

Basically it comes down to what you want. Easy stuff earlier or later? Better chance of having Thanksgiving off (ambulatory in November or elective where you can get it off). Each school also does scheduling incredibly differently.

 

[Law2Doc]

The title pretty much says it all. Do any of you third and fourth year students have advice on scheduling the third year? Any and all good advice would be greatly appreciated. Thanks.

IMHO, you want to put the things you are most likely to go into later in the year. You will be lousy as a third year clerk for the first couple of rotations. Embarrassingly bad. You will try hard, but still be constantly in the way, not knowing the right balance between asking too much and being too quiet. You will contaminate yourself and have to scrub out of things. You will not know how to do a decent physical exam. Your SOAP notes will not be close to what your residents want to see. And everything you do will take twice as long as your residents/attendings expect it to. But you are going to want to impress folks in your more desired rotations in order to get them to write you a glowing letter of recommendation and a favorable eval. So hold off on those until you are able to shine.

I personally would worry less about easy/hard or vacation scheduling issues. That comes into play more in 4th year when you will be nursing a healthy dose of senioritis post-match.

 

[smq123]

IMHO, you want to put the things you are most likely to go into later in the year. You will be lousy as a third year clerk for the first couple of rotations. Embarrassingly bad. You will try hard, but still be constantly in the way, not knowing the right balance between asking too much and being too quiet. You will contaminate yourself and have to scrub out of things. You will not know how to do a decent physical exam. Your SOAP notes will not be close to what your residents want to see. And everything you do will take twice as long as your residents/attendings expect it to. But you are going to want to impress folks in your more desired rotations in order to get them to write you a glowing letter of recommendation and a favorable eval. So hold off on those until you are able to shine.

I kind of disagree. (I'm sorry - I know it's confusing to get so many conflicting opinions.)

* I know that everyone recommends doing a field that interests you in December - January - February. But by January, I was so tired that I was dragging. I had done 6 weeks of OB followed up by 12 weeks of surgery, and I was totally burned out by the time I started medicine in January. (Which ended up not being a huge problem, in that I had realized that I'd rather take Step 1 again than do an internal medicine residency, but...still.)

* You don't have to suck at the beginning of third year. If you really study up on how to write a good SOAP note in the first rotation, then your following rotations will be fine. I know a few students who got Honors and Excellents on their early rotations. There's no real reason why you can't be one of them.

* I think the idea that all your previous rotations help you with your later rotations is kind of false. I got great feedback from my residents during OB and surgery on the "excellent" quality of my SOAP notes...but my SOAP notes on medicine were, evidently, not considered to be anything special.

* Finally, I'm not even totally convinced that rotation order truly matters. For starters, there is a good chance that what you start out wanting to do as a career will not be the same as what you end up deciding as a career. Lots of people in my class wanted to be surgeons - they're now doing medicine. Lots of people also wanted to do medicine - they're now doing ER or surgery. Things can change quite drastically.

 

[Law2Doc]

* You don't have to suck at the beginning of third year. If you really study up on how to write a good SOAP note in the first rotation, then your following rotations will be fine. I know a few students who got Honors and Excellents on their early rotations. There's no real reason why you can't be one of them.

EVERYBODY sucks at the beginning. Alright, not everybody, but 99% do. Most of the honors at the beginning of the year are more a function of dumb luck -- you get a really nice attending who is generous and doesn't expect much, and you do more right than wrong. You won't get honors because you know what you are doing, because few will know what they are doing at that stage. Sadly most of us learn from our mistakes, but mistakes don't go unnoticed. So sure, you can run for luck. But if you really want to be able to prove yourself, you probably ought to wait until you actually have those ninja skillz. Because you won't at the beginning.

 

[smq123]

EVERYBODY sucks at the beginning. Alright, not everybody, but 99% do. Most of the honors at the beginning of the year are more a function of dumb luck -- you get a really nice attending who is generous and doesn't expect much, and you do more right than wrong. You won't get honors because you know what you are doing, because few will know what they are doing at that stage. Sadly most of us learn from our mistakes, but mistakes don't go unnoticed. So sure, you can run for luck. But if you really want to be able to prove yourself, you probably ought to wait until you actually have those ninja skillz. Because you won't at the beginning.

I think part of it depends on what rotation you're doing first.

I have classmates who started with surgery or OB/gyn - and honored them. Yes, even though it was the first rotation, and their attendings were NOT ***** cats by any stretch of the imagination. (I mean - surgery and OB/gyn attendings are typically not the sort of attendings who are "really nice" and generously shower their med students with Honors and High Passes.) And it was definitely not just dumb luck. By working their butts off, and by modeling their intern's behavior on the floors, these people got honors.

I would argue that it's easier to honor surgery and OB/gyn if you do it earlier in the year - because those rotations, more than others, really measure your enthusiasm and willingness to work. At least for me, I was MUCH less burned out in the beginning of the year, and excited to be on rotations, so my enthusiasm was a lot more palpable.

If you're a very hard worker, and a quick learner, then you could definitely honor family med or maybe even peds if it is your first rotation. Just by showing massive improvement from your first week would probably be enough to get you a very high grade.

I agree that honoring medicine (if it's your first rotation) is very difficult, though.

 

[Law2Doc]

If you're a very hard worker, and a quick learner, then you could definitely honor family med or maybe even peds if it is your first rotation. Just by showing massive improvement from your first week would probably be enough to get you a very high grade.

I agree that honoring medicine (if it's your first rotation) is very difficult, though.

Although we don't quite see eye to eye on this topic, I do agree that things like family med and peds are probably universally reasonable starting rotations and IM probably isn't, if you can avoid it. OB and surgery clearly depend on your school, I guess, because there are definitely places where you will get seriously abused in surgery if you don't know the basics (surgeons are not known for being tactful and warm and fuzzy with their comments), while OBGYN folks in my experience seemed to appreciate effort and interest even if you were a novice. I'm sure this is all quite variable based on the program.

 

[Ashers]

IMHO, you want to put the things you are most likely to go into later in the year. You will be lousy as a third year clerk for the first couple of rotations. Embarrassingly bad. You will try hard, but still be constantly in the way, not knowing the right balance between asking too much and being too quiet. You will contaminate yourself and have to scrub out of things. You will not know how to do a decent physical exam. Your SOAP notes will not be close to what your residents want to see. And everything you do will take twice as long as your residents/attendings expect it to. But you are going to want to impress folks in your more desired rotations in order to get them to write you a glowing letter of recommendation and a favorable eval. So hold off on those until you are able to shine.

I personally would worry less about easy/hard or vacation scheduling issues. That comes into play more in 4th year when you will be nursing a healthy dose of senioritis post-match.

I basically gave a very brief summary of how I chose my track, which I got the perfect one for me.

So when I was talking about easy/hard, my school divides up rotations with the Big 3 (surg, peds, med -- 2 month of each) in the 1st 6 months or 2nd 6 months. I wanted to do the "easier" classes first (psych/neuro, OB/gyn, FP, elective, anesthesia), because I wanted to get psych and OB/gyn out of the way (1st 3 months of M3 year -- neuro was also in there) and I figured I'd hate them. I also got Thanksgiving off because my ortho rotation generally let students off for it (and I plan on doing ortho). I think doing ortho in November was perfect -- I had already been in the OR from ob/gyn, and I already had some rotations. Now that I'm on the Big 3; I'm just so burnt out and at the point of not caring (especially on surgery, I hated every day, but somehow managed to do well). There's also no way I could possibly do OB/gyn or psych now -- I'm glad I did that when I still had enthusiasm for being in the hospital.