advice on getting honors in IM rotation?

[viostorm]

I'm second year interested in IM. We are going to have to pick our preference for the order we do our 3rd year rotations soon.

Any idea when I should request (1st? last?) IM if I want best shot at honors?

What rotations should I try and do first to prepare me for IM?

We only have 8 weeks for medicine at my school.

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[Big Ben]

This depends some on how your med school is set up. If your main goal is to ace IM and a large percentage of your grade comes from the shelf exams (most schools take these standarized tests for major rotations), you'll definetly do better taking IM at the end of the year. A lot of what you learn as a 3rd year does overlap and rotations such pediatrics and surgery will help you know things for you IM rotation.

That being said, internal medicine will probably end up giving you more points on other shelves (i.e. surgery, peds) than vice versa. I think for people who don't want to go into medicine, it's the best rotation to start with because it will help you the rest of the year. You'd be surprise how much of the surgery shelf will be pure medicine type questions rather than what you probably thing of as "surgery".

If your school doesn't delegate much of your rotation grade to the shelf, schedule IM last. You'll be polished for presentations and have a solid knowledge base. Additionally, some students who don't want to go into IM will be wearing down and it's a little easier to stand out later in the year.

IMHO, if you're set on medicine, getting surgery out of the way first is sometimes nice. It tends to be the most brutal third year rotation. Otherwise, take something first you're night interested in that gets you exposed to the hospital. You'll spend the majority of your first two months learning how a hospital works and general basics.

 

[mcindoe]

interesting perspective from Big Ben, and I don't think there's anything wrong with his advice. I have a much different opinion, though, but it's just another perspective to help you decide. let me preface this by stating that there were no shelf exams at my school, so that never factored into my clerkship schedule planning.

i'm a big advocate for doing your med clerkships early in your 3rd year. maybe do a rotation or two first to get familiar with life on the wards, but then jump right into your med rotations. my reasons:

-you're more excited and eager (and perhaps a bit nervous) early on, and you're really motivated to go above and beyond to impress your attendings because you've got the energy and drive that i certainly didn't towards the end of the year

-you've probably just taken step 1 before starting 3rd year, so all that stuff you've learned for the test is still fresh in your head and you'll be well-prepared if you're pimped on rounds about the physiology or mechanisms of disease pertaining to your patients

-if you make mistakes or don't know something, you'll be given the benefit of the doubt by the residents and attending if you do it early because they know you're new to the wards and will be much more understanding than they are towards students who've been on the wards for a while. if you do your med rotations late in the year the expectations of you will be higher

-remember that as you start your 3rd year, the interns will be starting too, and you won't be the only one who's new and unfamiliar with the system... and also not the only one who's nervous on your team!

-i started to get tired towards the end of the year, and i just didn't have the same enthusiasm as i did when i started. i can't imagine i would have performed as well in my med rotations if i did them late in the year

-you'll learn a LOT on your med rotations, especially the basics of patient care, which will help you with every rotation you do that comes after. plus you learn early on how to be efficient, and that will help you especially on your surgery rotations.

just some things to consider...either way i'm sure you'll do fine if you're really motivated to do well in your med rotations.

 

[EndlessSong]

My personal opinion is that you should try to do it early in the year, but not first. We didn't have any say in the order of our rotations, but I randomly got IM second, which I thought was great (I'm a 4th year now, matching in Med/Peds). Having it relatively early is good, because it really does prepare you for other rotations. Your attendings/residents will be more forgiving of what you don't know early on, PLUS if you actually do your reading and go the extra mile it's a little easier to stand out as excellent when everyone else is a bit new as well.

I think I wouldn't do it first though, because there is a lot you need to learn just about how a team works, how to present, how to get your work done, etc. If I could design the perfect schedule for you I think I would do peds first and IM second. Peds teams generally run very similarly to IM teams, so even though the actual medicine is different, you will have your general patient management and presentation skills down pat by the time you get to medicine.

Just a caveat to this - overall, I wouldn't stress too too much about the order of your schedule. There are true pros and cons to every possible permutation, and the reality is if you work hard and do your reading, you'll do awesome.

 

[viostorm]

My personal opinion is that you should try to do it early in the year, but not first. We didn't have any say in the order of our rotations, but I randomly got IM second, which I thought was great (I'm a 4th year now, matching in Med/Peds). Having it relatively early is good, because it really does prepare you for other rotations. Your attendings/residents will be more forgiving of what you don't know early on, PLUS if you actually do your reading and go the extra mile it's a little easier to stand out as excellent when everyone else is a bit new as well.

I think I wouldn't do it first though, because there is a lot you need to learn just about how a team works, how to present, how to get your work done, etc. If I could design the perfect schedule for you I think I would do peds first and IM second. Peds teams generally run very similarly to IM teams, so even though the actual medicine is different, you will have your general patient management and presentation skills down pat by the time you get to medicine.

Just a caveat to this - overall, I wouldn't stress too too much about the order of your schedule. There are true pros and cons to every possible permutation, and the reality is if you work hard and do your reading, you'll do awesome.

Thanks for everyone's advice. I think I'll try and split the difference of your guys recommendations.

Right now my current thinking is: Peds, Family, Surg, IM, Psych, OB.

 

[smid]

i did IM last--a mistake, I think. I also was not planning to do IM until the end of third year, so my planning was not centered around it. At my school, there is an exam, bu the grade is determined by "clinical performance"--basically if your attendings like you. you just need to do well on the exam as well to get honors, but it's not sufficient. Anyway, I agree that doing a lot of other rotations first will prepare you for medicine, but doing med very first will make the expectations lower (I wish that's what I had done...I didn't get honors)
also, having surgery right before medicine will be tough because it's back to back hard rotations. maybe put family in between or psych...
good luck! and enjoy third year if you can

 

[EspiritDeCorps]

In terms of scheduling, I think it depends altogether on your personality. My friend, for example, did phenomenal in her first rotation and became known by all the big heads in the dept she was going into. They basically told her they had a residency spot waiting for her after that. Me, on the other hand, had a rocky start. However, by the end of the year, I felt comfortable doing almost everything. So again, do some introspection to determine if you need some more clinical experience first and how much or if you think you'll hit the ground running.

In terms of getting honors in IM, my advice would be (whenever you do it), the most important thing is to work hard!!! Be thorough, read on your patients, practice your presentations (presentations are sometimes all that attendings see or hear of most med students). Think about your differential diagnosis and what favors a certain diagnosis and what puts other dx's lower on the differential. Try to be the primary Dr. for your patients. Earn respect from your intern, residents to be in this role by working hard and thinking hard about the assessment/plan. Be proactive. Also, working together as a team is key and the housestaff likely has a decent say in whether you get honors from the clinical side. The academic side of getting honors...well, I'm not going to go in depth, but try to think of diseases in terms of patient's sx's, physical exam findings, vitals, labs, differential dx's, treatments, and risk factors, which is the step of clinical medicine. It takes time, but work at it and it will come easier. Good luck!

 

[viostorm]

In terms of scheduling, I think it depends altogether on your personality. My friend, for example, did phenomenal in her first rotation and became known by all the big heads in the dept she was going into. They basically told her they had a residency spot waiting for her after that. Me, on the other hand, had a rocky start. However, by the end of the year, I felt comfortable doing almost everything. So again, do some introspection to determine if you need some more clinical experience first and how much or if you think you'll hit the ground running.

In terms of getting honors in IM, my advice would be (whenever you do it), the most important thing is to work hard!!! Be thorough, read on your patients, practice your presentations (presentations are sometimes all that attendings see or hear of most med students). Think about your differential diagnosis and what favors a certain diagnosis and what puts other dx's lower on the differential. Try to be the primary Dr. for your patients. Earn respect from your intern, residents to be in this role by working hard and thinking hard about the assessment/plan. Be proactive. Also, working together as a team is key and the housestaff likely has a decent say in whether you get honors from the clinical side. The academic side of getting honors...well, I'm not going to go in depth, but try to think of diseases in terms of patient's sx's, physical exam findings, vitals, labs, differential dx's, treatments, and risk factors, which is the step of clinical medicine. It takes time, but work at it and it will come easier. Good luck!

Thx for the advice! That is really helpful

 

[reallyanon]

I would do at least one hard rotation (peds/surgery) before medicine so that you understand how to present patients and hopefully get stuff done in the hospital. The other piece of advice has to do with presentations. Don't be boring. really long really drawn out presentations aren't necessary or appreciated (usually). also I found that stating "The plan for the day for this patient is..." or "what I'd like to do for Mrs. Jones today is" rather than "so what do you guys think about x/y/z problem/abnormal lab value..." or even worse just stopping with a deer in the headlights look without presenting a plan is really important. This is the time to commit and make mistakes especially when they don't really matter as your plan will just get corrected. granted, it is nice to nail it but really just taking ownership is one of the most important things you can do as a medical student.

 

[Rocky2007]

I would not do medicine 1st. I wouldn't do it too late in the year either because you'll start to get burned out and sick of med school...which may lead to a bad attitude (as it did w/ me). I did medicine 2nd - after surgery - and felt that it worked out well for me.

Also - do not be a gunner, do not stab other students in the back, do not be annoying. you can get honors without doing any of the above mentioned things. Work hard, have a positive attitude, and read, read, read and you'll do well.