Hi spidermonkey11,
Congrats on being accepted at Einstein
I'll cut and paste each question followed by my response below.
"How is the third year structured? How are the rotations structured in general? What is your role on the wards? Do you have a clear role Do you get your "hands dirty" alot, or is it alot of shadowing?"
3rd year has required rotations in Internal Medicine (11wks), Radiology (2wks), OB/GYN (6wks), Psychiatry (6wks), Surgery (8wks), Family Medicine (4wks), Geriatrics (2 wks), Peds (7wks). The order you take them depends on a lottery. Einstein has 8+ hospitals students can rotate through. At the end of your second year, you put your preferences on a form and a computer sorts everything out and gives you the best schedule it can. There are 1 wk blocks of vacation spread throughout the year. I think there were about 4 total.You spend the majority of the time seeing patients and working in the hospitals. Depending on the rotation, you may have lectures or conferences scheduled during the day at the hospital where faculty will show you how to do things or see patients with you or give you a lecture. On other rotations, there are dedicated days where you spend in the classroom & the rest of the time is devoted entirely to hospital work. Your role in the wards is not always well defined, which I found to be a good thing. On the rotations where I am weak on the subject or want to learn more, I can be more aggressive and ask to do more work; on the rotations where I'm not as interested in or where I feel I am strong enough on the subject, I can hold back a little and have a easier time. This is much better than a rigidly defined role where you cant change anything. Depending on which hospital you rotate through, your role may be different depending on that hospital's clinical director. For example, I rotated through Montefiore hospital (a big name in surgery) where I got to scrub in on cases of any subspecialty I wanted; we had dog labs where we did surgerys on dogs; we had suture lessons teaching us how to suture; we even had a laperoscopic lab with a tech who taught us how to do simple stuff with laperoscopy. At another hospital, their surgery dept was not as big and surgery was not it's "thing," the students scrubbed in on general surgery cases and didn't get to do much else (eg no cardiothoracic surgery, no ent surgery, no ortho surgery, no dog lab, no laperoscopic lab, etc). So students basically pick what they prefer. If you really like procedures, you can pick hospitals like the one I did where they let you do a lot. If you don't like it, you can pick the smaller hospitals and spend more time on the books. Up to you and your style of learning. Einstein students dont do much shadowing. Even in the first year, there is a course on how to take a medical history. The preceptor usually gives you some guidelines and you go straight out on your own to practice on real patients, taking their medical history. By 3rd year, you do a lot of the work yourself. You are assigned patients who you are responsible for rounding on in the morning, writing their progress notes, putting in their orders (cosigned by the residents of course), presenting to the attending, etc... I felt I was really well trained at Einstein because they give us so much autonomy. I'm a big procedure person, so even on rotations like internal medicine, I asked the residents to show me & let me put in nasogastric tubes, foleys, paracentesis, lumbar punctures, etc....If you're not as hands on, you can also be more passive and just follow the residents around. No one will force you to do anything you don't want. So some of the girls didn't like the body fluids...so some of them will decline if a resident asks them if they want to put in a foley (catheter in the urethra), etc... But overall, this school rocks with procedures & patient care training.
"Where do 3rd year evaluations come from? For every rotation do you have an attending directly responsible for evaluating you, or a preceptor?, etc."
There is an attending in charge of every rotation at every site you are at, at Einstein. Your ultimate grade & narrative report is written by the attending, NOT a resident. However, because students will spend a lot of time with residents, all rotation directors get evaluation forms and feedback from the residents you work with. In some rotations, you hand out eval forms only to the residents you want evaluating you. On other rotations, the attending will have a meeting with the "team" of residents you worked with and ask them what they think of your performance. But overall, the evals are fair and there is an attending overseeing every eval each student gets.
"How are medical students protected from scut work?"
Haha, I wish I knew about scut work when I started med school. During many of the rotations, the attendings / rotation directors tell you & tell the residents that you are here to learn & not to do excess menial tasks (their way of calling scut). However, like at EVERY single hospital of EVERY med school, there are residents ranging from excellent to scums. Most residents at Einstein are pretty good about not scutting the med student out unless they want the work to practice skills. I had one intern tell me when I was in 3rd year that she hated people scutting her at her med school so she wont scut me at all. She kept her word & I loved her! Then there are the scums who blow off what the attending tells them and makes the med students look up labs for them all morning or something like that. However you'll see that at every hospital, I guarantee it. The thing that's important is for you to not let them push you around. You can help them out to a certain extent if patient load is crazy, but if they start telling you to do stuff you don't feel is right, tell them no. I've done it plenty of times and never got in trouble. Just tell them politely you have another patient to see, tell them you are busy with something else, or tell them you'll help them later if you have time....if you do that a few times, they get the picture you're not a pushover and stop scutting you out. Worse comes to worse, you can file a complaint with the rotation director, but it has never come to that.
"About how many hours are you in lecture/lab a week? I'm not lookin for a specific number, but in general do you feel that you spent too much time in lectures/labs or did it feel just right?"
During the first 2 yrs, most of your time is in lectures & labs. Usually the mornings are dedicated to lectures (8am-12pm) The afternoons depends on the subject. Sometimes you go to lab in the afternoon doing really cool & fun stuff (1pm-4/5ish) Other times you go to conferences to discuss what you learned in the morning (also 1-4/5ish). Labs and conferences are generally a good idea to go to and usually are required (attendence taken, but you can probably have someone sign you in). Lectures are completely optional. I went to every single lecture in my first year. But got lazy second year and studied almost completely at home. By the end of my second year, I don't remember going to any morning lectures at all. Basically, it's your choice if you want to go to lecture, but labs & conferences are required.
"is the schedule flexible enough to switch around the order of some of your clinical rotations in years 3 and 4? I ask this b/c on another forum I read that it's good to have done your rotation already in the specialty you wish to match into. Going in I have a strong interest in neurology, and I see that you don't get to that until the fourth year, and it could work out that i would be interviewing for that specialty without having had the rotation experience first."
Schedule is very flexible in both years. Even after you turn in your form with your preferred order of clinical rotations at your preferred hospitals, if you hear from your other classmates a certain place is better or doing a certain rotation first is better, you just walk over to the registrar's office and ask for your preference sheet, change it, and resubmit it. You can do this as many times as you like. The only condition is you have to do it one month before the rotation starts because the preferences are entered into the computer every month, one month before your actual rotation. As for the overall order of your rotations, if you don't like what the computer gave you and someone else with a better schedule likes yours, you two can trade. Fourth year is rediculously flexible. You have 4 required months & 7 electives that you can do anywhere, anytime, at any hospital you want. Thats what I call flexibility
Don't worry not getting to the rotation in the specialty you are applying to. I didn't do my emergency medicine rotations until the beginning of 4th year! And I still got my letter of recs in on time & did well. When you're close to the time of residency application you will find out the schedule of when things are due. Then you'll realize you actually have more time than you think. Some people try to cram an 2 wk elective in their 3rd year, but most do it their 4th year, and we match very well every year so it's not a problem.
Hope this helps. Feel free to ask anything else that's on your mind.
Good luck & congrats again,
~ribs.