Ask a 4th year!

[MDbound2013]

Hey guys,

the "ask a first year anything" thread gave me the idea for this. I'm using an anon username at the moment but I'm a very long-time member of the site. I was extremely active as a premed and stayed pretty active during my first year or so of med school- then it took over a bit. Anyway, I'm in residency application land so I'm staying as incognito as I can.
Because I was very active in the site, I understand you guys have a ton of questions, and upperclassmen are pretty hard to come across, so I want to pay it forward now that I have a little bit of time. I promise I'll try my best to answer whatever questions I get and to take them seriously- I do think it's too early for you guys to worry about the stuff I worry about, but I also know you worry about it anyway (I did).
Fire away!

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[An MD Hopeful]

Hey guys,

the "ask a first year anything" thread gave me the idea for this. I'm using an anon username at the moment but I'm a very long-time member of the site. I was extremely active as a premed and stayed pretty active during my first year or so of med school- then it took over a bit. Anyway, I'm in residency application land so I'm staying as incognito as I can.
Because I was very active in the site, I understand you guys have a ton of questions, and upperclassmen are pretty hard to come across, so I want to pay it forward now that I have a little bit of time. I promise I'll try my best to answer whatever questions I get and to take them seriously- I do think it's too early for you guys to worry about the stuff I worry about, but I also know you worry about it anyway (I did).
Fire away!

Thanks for doing this!

In the clinical rotations, do med students end up spending most of their time with the residents and/or fellows, or is it possible to get a significant amount of interaction with the attendings? Also, who ends up deciding the med students' clinical rotation grades: the residents or the attendings?

 

[MDbound2013]

Thanks for doing this!

In the clinical rotations, do med students end up spending most of their time with the residents and/or fellows, or is it possible to get a significant amount of interaction with the attendings? Also, who ends up deciding the med students' clinical rotation grades: the residents or the attendings?

So this depends largely on the rotation, in my experience- other hospitals may work differently. The vast majority of the time, you're around residents (not usually fellows actually, unless you seek them out). In internal medicine/ psych/ neurology/ peds/ obgyn I really only saw attendings during rounds. However, your grade generally depends largely on evaluations, and depending on the director of your clerkship (aka rotation), this may often be weighed more heavily in favor of the attendings. So, even though you spend 95% of your time with the residents, a lot of the time your grade is largely based on the evaluation given to you by the attending who only spent that 5% of time with you. That's why that's the time you really have to shine- answer questions correctly, present efficiently, be up on the literature for whatever your patients have if they ask you to be...etc. Resident time can be a little more chill for that reason, and more focused on your own learning. Not that resident input doesn't matter- it absolutely does. Their evaluations certainly count too, and a bad resident evaluation can sink your grade and if it makes it into your Dean's letter (which ends up on your application to residency), that's just no bueno. But usually residents remember what it's like to be in your place a lot more, they're less likely to ask you questions, and just want you to help out the team in whatever capacity you can.
I didn't mention surgery cause it's a little different, since you're in the OR with an attending a lot of your day (and a resident as well usually) so you do have more attending interaction- however, whether this is quality time is debatable and entirely dependent on whether your attending wants to chit-chat or not.
Once you get to fourth year, you're treated as what they call a "sub-i" or sub-intern, which is basically one step below an intern. In many instances that means that you do all the work of an intern but basically your notes can't be billed on and you can't prescribe. In that case however you may find yourself working one on one with an attending, not other residents. This is definitely helpful when you're looking for letters of recommendation.
Hope this answers your questions!

 

[An MD Hopeful]

So this depends largely on the rotation, in my experience- other hospitals may work differently. The vast majority of the time, you're around residents (not usually fellows actually, unless you seek them out). In internal medicine/ psych/ neurology/ peds/ obgyn I really only saw attendings during rounds. However, your grade generally depends largely on evaluations, and depending on the director of your clerkship (aka rotation), this may often be weighed more heavily in favor of the attendings. So, even though you spend 95% of your time with the residents, a lot of the time your grade is largely based on the evaluation given to you by the attending who only spent that 5% of time with you. That's why that's the time you really have to shine- answer questions correctly, present efficiently, be up on the literature for whatever your patients have if they ask you to be...etc. Resident time can be a little more chill for that reason, and more focused on your own learning. Not that resident input doesn't matter- it absolutely does. Their evaluations certainly count too, and a bad resident evaluation can sink your grade and if it makes it into your Dean's letter (which ends up on your application to residency), that's just no bueno. But usually residents remember what it's like to be in your place a lot more, they're less likely to ask you questions, and just want you to help out the team in whatever capacity you can.
I didn't mention surgery cause it's a little different, since you're in the OR with an attending a lot of your day (and a resident as well usually) so you do have more attending interaction- however, whether this is quality time is debatable and entirely dependent on whether your attending wants to chit-chat or not.
Once you get to fourth year, you're treated as what they call a "sub-i" or sub-intern, which is basically one step below an intern. In many instances that means that you do all the work of an intern but basically your notes can't be billed on and you can't prescribe. In that case however you may find yourself working one on one with an attending, not other residents. This is definitely helpful when you're looking for letters of recommendation.
Hope this answers your questions!

Thanks, this helps a lot!

You mentioned that in the fourth year, you work a lot with attendings, which helps with LORs. But doesn't the residency application process start in the beginning of the 4th year? Do 4th years still have enough time to interact with those attendings to get solid LORs by the time of the application process?

That also brings me to my next question. Other than the Dean's Letter, what other LORs are we required to get for residency apps? Do you get letters from the professors from the first two years or from the attendings of clinical rotations or both? Which ones count more?

Also, do med students get the chance to help with writing case reviews?

Thanks again for doing this!

 

[wholeheartedly]

Given what you know now as opposed to what you thought as a pre-med, what do you think the most important things are to look for in a medical school?

ie a lot of pre-meds are gung ho about early patient interaction, but med students often say that it's useless until you actually know some medicine.

 

[The Beyonder]

Hey guys,

the "ask a first year anything" thread gave me the idea for this. I'm using an anon username at the moment but I'm a very long-time member of the site. I was extremely active as a premed and stayed pretty active during my first year or so of med school- then it took over a bit. Anyway, I'm in residency application land so I'm staying as incognito as I can.
Because I was very active in the site, I understand you guys have a ton of questions, and upperclassmen are pretty hard to come across, so I want to pay it forward now that I have a little bit of time. I promise I'll try my best to answer whatever questions I get and to take them seriously- I do think it's too early for you guys to worry about the stuff I worry about, but I also know you worry about it anyway (I did).
Fire away!

What are the most important factors when choosing between med schools? What should we do in MS1 that will help us get a leg up on the step? In clinical years, what is the difference between honoring vs just passing?

 

[a2014]

So this depends largely on the rotation, in my experience- other hospitals may work differently. The vast majority of the time, you're around residents (not usually fellows actually, unless you seek them out). In internal medicine/ psych/ neurology/ peds/ obgyn I really only saw attendings during rounds. However, your grade generally depends largely on evaluations, and depending on the director of your clerkship (aka rotation), this may often be weighed more heavily in favor of the attendings. So, even though you spend 95% of your time with the residents, a lot of the time your grade is largely based on the evaluation given to you by the attending who only spent that 5% of time with you. That's why that's the time you really have to shine- answer questions correctly, present efficiently, be up on the literature for whatever your patients have if they ask you to be...etc. Resident time can be a little more chill for that reason, and more focused on your own learning. Not that resident input doesn't matter- it absolutely does. Their evaluations certainly count too, and a bad resident evaluation can sink your grade and if it makes it into your Dean's letter (which ends up on your application to residency), that's just no bueno. But usually residents remember what it's like to be in your place a lot more, they're less likely to ask you questions, and just want you to help out the team in whatever capacity you can.
I didn't mention surgery cause it's a little different, since you're in the OR with an attending a lot of your day (and a resident as well usually) so you do have more attending interaction- however, whether this is quality time is debatable and entirely dependent on whether your attending wants to chit-chat or not.
Once you get to fourth year, you're treated as what they call a "sub-i" or sub-intern, which is basically one step below an intern. In many instances that means that you do all the work of an intern but basically your notes can't be billed on and you can't prescribe. In that case however you may find yourself working one on one with an attending, not other residents. This is definitely helpful when you're looking for letters of recommendation.
Hope this answers your questions!

3rd year med student here (finished with clinical rotations), also a longstanding user on a throw away account for this thread.

I agree with everything he just said here. How much time you get with attendings is going to be completely dependent on your school and how the specific rotation in scheduled. Most of the time you'll see your attendings during morning rounds, and that's your time to shine. These can last anywhere from 20 minutes (surgery) to 7 hours (peds cards). Outside of that, most rotations will have some sort of preceptor groups set up, and that will be face time with an attending, but not necessarily the same attending that is on your service. Either way, it's teaching time, and their input usually factors into your grade.

The rest of the time is resident time, and as MDB2014 said, it's less intense and matters less to your grade. They're not going to pimp you all the time, and if you have a good team they'll sit you down and teach you stuff once in a while. That being said, you need to do your work, and you need to be reliable. Nothing will tank your grade faster than someone checking off the "unreliable" box when filling out your eval. In my experience, we got very little time with fellows. They're usually there to become experts in a niche field, so they're usually dedicated to the OR or a specialty consult service and teaching med students usually isn't on their list of clinical duties.

 

[NickNaylor]

3rd year med student here (finished with clinical rotations), also a longstanding user on a throw away account for this thread.

I agree with everything he just said here. How much time you get with attendings is going to be completely dependent on your school and how the specific rotation in scheduled. Most of the time you'll see your attendings during morning rounds, and that's your time to shine. These can last anywhere from 20 minutes (surgery) to 7 hours (peds cards). Outside of that, most rotations will have some sort of preceptor groups set up, and that will be face time with an attending, but not necessarily the same attending that is on your service. Either way, it's teaching time, and their input usually factors into your grade.

The rest of the time is resident time, and as MDB2014 said, it's less intense and matters less to your grade. They're not going to pimp you all the time, and if you have a good team they'll sit you down and teach you stuff once in a while. That being said, you need to do your work, and you need to be reliable. Nothing will tank your grade faster than someone checking off the "unreliable" box when filling out your eval. In my experience, we got very little time with fellows. They're usually there to become experts in a niche field, so they're usually dedicated to the OR or a specialty consult service and teaching med students usually isn't on their list of clinical duties.

The prospect of seven hours of rounds is saddening.

 

[a2014]

What are the most important factors when choosing between med schools? What should we do in MS1 that will help us get a leg up on the step? In clinical years, what is the difference between honoring vs just passing?

The most important thing depends on what you want to go in to and what your goals are. I think the structure and quality of 3rd year rotations is huge, as it can make the year really suck if you have a lot of bad rotations. Make sure the school will be able to give you exposure to the fields that you're interested in. For example, if you're considering trauma, you should make sure that either a) your hospital is level 1 trauma center or b) they have collaborations with other schools to give you a trauma elective in your 4th year. Same goes for most other specialties. If you're considering something competitive, you should look into how well your school matches people into those residencies. For example, if you want to go into neurosurgery (which for some reason most MS1s do), you going to kill your chances prematurely if you go to a DO school in the middle of Nebraska (no offense to Nebraska).

For step 1, the biggest factor is going to be personal motivation and time to study. Pass-fail preclinical will help, because you won't be burdened by spending an inordinate amount of time learning things that just aren't clinically- or step-1 relevant. Some schools are now putting step-1 off until after clinical year, and from what I've heard their board scores have improved because of it.

Clinical grades are determined by a ton of factors. For the most part, being dependable and playing well with others are the pre-reqs for getting honors. After that, it depends on how well your team likes you, how you do on rounds / preceptor groups, and how you do on the exams. Some rotations weigh the shelf (and other exams) more than others. Find out ahead of time what matters for each rotation. Also, don't sabotage your classmates for any reason whatsoever. It will make your classmates hate you, and it will make your clinical year much worse than it has to be.

 

[a2014]

The prospect of seven hours of rounds is saddening.

That rotation was an outlier. Morning rounds went from 8-noon, then there was a break for lunch/noon lecture, and then they usually resumed after lunch to finish up. We were usually interrupted by transplant rounds early in the afternoon, which took a few more hours. Honestly, I don't remember doing anything else on that rotation except for rounds.

Most rotations will have rounds closer to 2-3 hours.

 

[a2014]

Given what you know now as opposed to what you thought as a pre-med, what do you think the most important things are to look for in a medical school?

ie a lot of pre-meds are gung ho about early patient interaction, but med students often say that it's useless until you actually know some medicine.

We had some early patient contact. I don't think it was the worst thing in the world, but I'm not entirely sure how helpful it was. It probably smoothened the transition from pre-clinical to clinical a bit, as we had all interacted with real- and fake patients at least a bit. I wouldn't choose a school because of it.

 

[NickNaylor]

That rotation was an outlier. Morning rounds went from 8-noon, then there was a break for lunch/noon lecture, and then they usually resumed after lunch to finish up. We were usually interrupted by transplant rounds early in the afternoon, which took a few more hours. Honestly, I don't remember doing anything else on that rotation except for rounds.

Most rotations will have rounds closer to 2-3 hours.

What on earth are these clinicians doing? It sounds like work is basically rounds plus clinical work if necessary.

 

[NickNaylor]

Given what you know now as opposed to what you thought as a pre-med, what do you think the most important things are to look for in a medical school?

ie a lot of pre-meds are gung ho about early patient interaction, but med students often say that it's useless until you actually know some medicine.

"Early patient contact" is a joke. The only real value of it from my perspective is getting used to being in a room with a stranger and asking them what are potentially personal questions. The first few times you do a "patient" encounter are pretty awkward unless you've had clinical experience before. In terms of practicing what questions to ask, getting to a diagnosis based on complaints, etc., though, that can't happen until you have a solid base of knowledge first, which usually isn't until sometime through second year. Even then you still won't be able to do it that well.

 

[wholeheartedly]

"Early patient contact" is a joke. The only real value of it from my perspective is getting used to being in a room with a stranger and asking them what are potentially personal questions. The first few times you do a "patient" encounter are pretty awkward unless you've had clinical experience before. In terms of practicing what questions to ask, getting to a diagnosis based on complaints, etc., though, that can't happen until you have a solid base of knowledge first, which usually isn't until sometime through second year. Even then you still won't be able to do it that well.

so the patient encounter thing was just a specific example to illustrate my general question. any other examples of things that seem great to premeds but not as high value to a graduating med student and what else is high value aside from what a2014 mentioned?

 

[The Beyonder]

The most important thing depends on what you want to go in to and what your goals are. I think the structure and quality of 3rd year rotations is huge, as it can make the year really suck if you have a lot of bad rotations. Make sure the school will be able to give you exposure to the fields that you're interested in. For example, if you're considering trauma, you should make sure that either a) your hospital is level 1 trauma center or b) they have collaborations with other schools to give you a trauma elective in your 4th year. Same goes for most other specialties. If you're considering something competitive, you should look into how well your school matches people into those residencies. For example, if you want to go into neurosurgery (which for some reason most MS1s do), you going to kill your chances prematurely if you go to a DO school in the middle of Nebraska (no offense to Nebraska).

For step 1, the biggest factor is going to be personal motivation and time to study. Pass-fail preclinical will help, because you won't be burdened by spending an inordinate amount of time learning things that just aren't clinically- or step-1 relevant. Some schools are now putting step-1 off until after clinical year, and from what I've heard their board scores have improved because of it.

Clinical grades are determined by a ton of factors. For the most part, being dependable and playing well with others are the pre-reqs for getting honors. After that, it depends on how well your team likes you, how you do on rounds / preceptor groups, and how you do on the exams. Some rotations weigh the shelf (and other exams) more than others. Find out ahead of time what matters for each rotation. Also, don't sabotage your classmates for any reason whatsoever. It will make your classmates hate you, and it will make your clinical year much worse than it has to be.

Thanks, but what is a good or bad structure for third year. How do you find out as a Pre-med which rotations are going to be bad? Thanks again.

 

[Geebeejay]

Few questions here:

1. Do you believe that residency programs take into account the setting at which you attended medical school? For example, if you aspire to do your residency at an inner city hospital, will your chances of matching into such a residency be comprimised if you attended a medical school in the middle of nowhere? in the suburbs? in a "college town"?

2. Which rotation did you do first (3rd year)? Which one do you wish you did first?

3. Do you think the hospital setting makes a big difference for your rotations? For instance, if you are forced to do a particular rotation at some small, "affiliated" rural hospital, would you feel short-changed compared to someone who did the same rotation at the university hospital?
To advance the question, would it be smart to take into account how frequently a medical school "ships you out" to affiliated hospitals when choosing between schools?

 

[daymann]

How did you choose your specialty? Did you make your decision after a good 3rd year rotation experience? Did you come in with an idea of what you wanted to do? Did the decision require more research?

 

[NickNaylor]

so the patient encounter thing was just a specific example to illustrate my general question. any other examples of things that seem great to premeds but not as high value to a graduating med student and what else is high value aside from what a2014 mentioned?

I can't remember anything now, but there's a great (and old) post by a then-MS4 that addresses this exact topic. I can't seem to find it but it's reposted often so hopefully someone can come by and share it.

 

[a2014]

Few questions here:

1. Do you believe that residency programs take into account the setting at which you attended medical school? For example, if you aspire to do your residency at an inner city hospital, will your chances of matching into such a residency be comprimised if you attended a medical school in the middle of nowhere? in the suburbs? in a "college town"?

2. Which rotation did you do first (3rd year)? Which one do you wish you did first?

3. Do you think the hospital setting makes a big difference for your rotations? For instance, if you are forced to do a particular rotation at some small, "affiliated" rural hospital, would you feel short-changed compared to someone who did the same rotation at the university hospital?
To advance the question, would it be smart to take into account how frequently a medical school "ships you out" to affiliated hospitals when choosing between schools?

1. Yes, I think residencies take it into account. How much is going to depend on the field and the specific program. A lot of fields of medicine are actually quite small, and people know each other. Word of mouth and behind-the-scenes string pulling definitely occur. I don't think geographic location necessarily matters as much, with the caveat that you tend to make contacts in your specific area.

2. I did OB/Gyn first, and thought it was a great rotation to start on. It's a good mixture of medicine and surgery, and I was never interested in going into the field so I didn't feel bad about it being a "learning experience". I'd recommend it. Though others may disagree with me, I think it's a good idea to have your internal medicine rotation early in the year. Two reasons: it's hard, so you get it out of the way. Secondly because you'll learn a ton on that rotation that will apply to all of your other rotations. People tend to think that if they put it off until the end that they'll be more prepared for it, but my class' experience with that didn't really hold true.

3. Hospital experience definitely matters. I did a few rotations at affiliated sites, and overall the teaching was not as good as it was at my home site. Most schools are going to have to "ship you out" for at least one or two rotations, but if you have to do most of your core rotations away it's probably a bad sign. You should ask how away core rotations work, how many the average student has to do, and what the process is for selecting them. Our school gave every student two choices for preferences for the year that we were pretty much promised to get. It made it so that if, for example, you were interested in surgery, you could make sure that you did your surgery rotation here.

Thanks, but what is a good or bad structure for third year. How do you find out as a Pre-med which rotations are going to be bad? Thanks again.

There's the rub, it isn't exactly straightforward for premeds to find out how the rotations are structured. Even during interviews, it's not guaranteed that the interviewer will known the details of how rotations are scheduled. Post in school-specific discussions, and try to seek out any upperclassmen when interviewing or going for a second look.

 

[MDbound2013]

Thanks, this helps a lot!

You mentioned that in the fourth year, you work a lot with attendings, which helps with LORs. But doesn't the residency application process start in the beginning of the 4th year? Do 4th years still have enough time to interact with those attendings to get solid LORs by the time of the application process?

That also brings me to my next question. Other than the Dean's Letter, what other LORs are we required to get for residency apps? Do you get letters from the professors from the first two years or from the attendings of clinical rotations or both? Which ones count more?

Also, do med students get the chance to help with writing case reviews?

Thanks again for doing this!

Ok, so re: your last question (case reviews) the short answer is yes. I've seen it happen and I've been offered the chance to do it a couple of times.

Your other questions: Applications are generally due in early September. Like in med school, the earlier the better though I'd argue it's not quite as stringent because letter writers are often late, USMLE transcripts take a while, dean's letters come in later...so you have a little more wiggle room before you're "late". Either way, some schools start their fourth year early- say April or something- in order to allow enough time for you to get letters as a sub-i and not have to rely on 3rd year letters (as I said, it's just harder to get to know attendings well enough to get a good letter at that point- not that it's not done, I did have a 3rd year letter, but often those tend to be a bit more vague). Other schools, mine included, starts 4th year in July, which is the more traditional route. This way you have July and August to get a letter, and I also had a couple of September attendings send one although I suspect most places didn't get to read them because they came in mid-October and I was knee-deep in the interview process at that point. I will say too that it depends on the specialty. This may be too detailed for you guys to worry about at this point, but some specialties start interviewing later than others- for example, plastics, ortho and derm don't really start until mid-November/ December while others start in early October. So if you go into plastics for example, where you need a couple of away rotations in order to apply, you have a little more time to get your letters together.
As for letters: this also depends on the specialty. Generally you want 1-2 (preferably 2) in the specialty of your choice, one from a relative bigwig like the clerkship director, the program director or the chairman of the department. That's sort of the official nod from the department at your school that you're being recommended for that specialty, and I believe this usually includes some sort of language comparing you to all other applicants from that school. The other can be another attending you worked with. As for extra letters (usually most people will have either 3 or 4), these can come from away rotations or from other specialties. You can have your research mentor, your academic advisor, or whomever write you one- but make sure your other letters cover your clinical abilities enough so that having one letter that doesn't talk about your clinical skills at all is ok. Otherwise, use the same judgment you'd use for med school admissions. If you worked with a research person for 3 years, it's probably a bit weird not to have a word from him/her. If you're going into a surgical subspecialty, maybe you want to have a letter from general surgery as well. That kind of thing.

Given what you know now as opposed to what you thought as a pre-med, what do you think the most important things are to look for in a medical school?

ie a lot of pre-meds are gung ho about early patient interaction, but med students often say that it's useless until you actually know some medicine.

I do think early patient interaction is basically useless, and honestly often just straight up awkward cause you don't know what you're looking at, listening to, or doing. Attendings don't exactly know how to tailor their teaching to your level most of the time, so they expect you to just absorb, but I don't find that very useful from a learning standpoint. There is no difference between shadowing as a premed and shadowing as a med student.
That being said, I looked for it too when I was applying and I do think that if I'd had no patient interaction whatsoever until third year, I would have felt a little cheated. I think it's your job as the student to ask questions of the attending about technique- everything from history taking to physical exam maneuvers- so they know how to help you. I had a truly terrible shadowing experience in my first year doing ophthalmology because the attending ignored me the whole time and I didn't understand a word and couldn't see what he was seeing. I learned nothing. I would have benefitted far more from doing something like surgery, which is more anatomical, or something basic like general internal medicine, where I could learn something from scratch.

Honestly I'm not sure exactly what I'd look for, but one thing that I realized this year is how fortunate I was to be at my school. I didn't really enjoy most of first and second year, and third year was really hard, but I didn't realize quite how good my hospital is until I started traveling and seeing other ones. Unfortunately the main thing I'm lucky for, I sort of stumbled into- the specialty I'm going into is extremely strong here, arguably top 3-5 in the country. I didn't know this was what I'd do, so I didn't plan for it, but it was extremely fortunate for me because every interview I go to, someone mentions my chairman and is impressed by the fact that his name is on my letter. That kind of thing is just huge. As I said, you can't really plan for that- however, I'd caution you against spending too much time worrying about the details of curricula among different schools because it really doesn't make much of a difference in the end. Your pre-clinical grades are basically irrelevant, and most of your Step 1 score will depend on you and how much time you have to study for it. Focus on the reputation of the hospital- is it well-regarded? Are the 3rd and 4th years happy, treated well on the wards, and taught a lot? If you can find upperclassmen on your interview day, those are the people to talk to. We may not know about the fancy new curriculum, but we can tell you about what really matters when you're applying for a job.

 

[MDbound2013]

Awesome new questions! I'll be back in a couple of hours to answer more.

 

[iforget2]

Yay thanks for doing this!

I'm sure you have classmates that have a spouse or perhaps living with a significant other. How do you think this has affected his/her social life with other classmates as well as his/her academic life (as in do you think the spouse/SO will negatively impact his/her studying)?

 

[MDbound2013]

Few questions here:

1. Do you believe that residency programs take into account the setting at which you attended medical school? For example, if you aspire to do your residency at an inner city hospital, will your chances of matching into such a residency be comprimised if you attended a medical school in the middle of nowhere? in the suburbs? in a "college town"?

2. Which rotation did you do first (3rd year)? Which one do you wish you did first?

3. Do you think the hospital setting makes a big difference for your rotations? For instance, if you are forced to do a particular rotation at some small, "affiliated" rural hospital, would you feel short-changed compared to someone who did the same rotation at the university hospital?
To advance the question, would it be smart to take into account how frequently a medical school "ships you out" to affiliated hospitals when choosing between schools?

1. Not necessarily in the way you're asking. I think your school matters a lot more than SDN would like to admit, although to what extent is specialty dependent. So if your school has an amazing ortho program with a super well-known ortho attending, you may have an easier time getting ortho later on. In terms of "ivory tower" vs inner city...honestly I haven't seen that too much. I think if you go to an inner city, county program you may have a little bit more trouble getting into a big fancy academic program, but that has more to do with the name of your school than its location. If you go to a place affiliated with a big inner city hospital that still has a good name out there, it shouldn't make too big a difference. Also, don't discount the importance of away rotations. If you go to school in like, rural Iowa somewhere but really want a trauma-heavy residency in Detroit, you can always do a rotation there.

2. My first one was Ob/gyn. For us it was a lottery system so I actually didn't get my first choice, which was medicine. I wanted medicine cause I thought it'd give me the best base for everything that came after, and it's arguably the hardest shelf (at least the one with the most info). The question of how to schedule your third year is ridiculously complicated though and you can argue for and against every single combination, so it probably doesn't matter that much. I did think having ob/gyn before surgery was helpful in that I was already pretty comfortable in the OR, had some good techniques down etc. But again, I don't think it really matters all that much.

3. That's a tough question for me, cause my school doesn't "ship us out" at all. I will say that I chose to do a rotation at a community hospital on purpose because the relative lack of residents there allowed students to have more attending time and to spend more time doing stuff and less time watching residents write notes. Community and rural hospitals can certainly be more hands-on than academic hospitals (where 5 different residency programs all have to get very good at the same procedure, so the med student never gets to try it). That being said, I'm glad I had the option of staying academic for the whole year, I wouldn't have liked being told to go somewhere I didn't want to go.

How did you choose your specialty? Did you make your decision after a good 3rd year rotation experience? Did you come in with an idea of what you wanted to do? Did the decision require more research?

I came in with an idea of what I wanted to do, and I turned out to be wrong.
Picking your specialty is sort of a strange beast. Some people really have an epiphany at some point and mid-anatomy already knows what they're going to do. Some people are never 100% sure, they just pick what makes the most sense because they have to pick something (you'd be surprised how often this happens). For me it was somewhere in the middle. I had a hunch based on my personality that I'd like something alone these lines, then I spent 3rd year crossing everything else off the list. Took my specialty rotation and I realized I was happy, and that this is what makes the most sense for who I am.
That being said, there are other things I could do and still be reasonably happy. It's not always a "do or die" decision, and that's a good thing.

Yay thanks for doing this!

I'm sure you have classmates that have a spouse or perhaps living with a significant other. How do you think this has affected his/her social life with other classmates as well as his/her academic life (as in do you think the spouse/SO will negatively impact his/her studying)?

I think this really depends on the classmate and the SO. I think if they were the kinds of SO's that affected their studying, they broke up with them pretty quickly. That may be harsh, but it's true. This is a tough road for everyone, partner included, and it's important for everyone to have reasonable expectations. Needy people who require constant attention don't usually survive very long because school has to come first, or they have to change their attitude.
As for social life: some SO's are better than others at fitting in with the class, and some students prioritize that more. I do know some married people who literally never do any class related things, never go out etc. That's fine for them. I also have a couple of married friends who bring their wives along to everything, and their wives get along with everyone as well. They never have to choose between the class and their SO, and that's awesome. I will say, we're a tough group to break into. We have nothing to talk about other than medicine, which makes coming into our group pretty tricky. So if your gf actually puts in the effort, give her some serious credit because it's not easy.

 

[sinombre]

I can't remember anything now, but there's a great (and old) post by a then-MS4 that addresses this exact topic. I can't seem to find it but it's reposted often so hopefully someone can come by and share it.

I'm pretty sure this is the one you're referring to:

http://forums.studentdoctor.net/showthread.php?t=104541

I found it pretty interesting... definitely worth reading to anyone who hasn't already read it.

 

[pv515]

Question concerning curriculums.

Do you think having an earlier clinical rotation year, like at Duke or Vanderbilt, would have helped you do better on the step 1 exam or been beneficial to you on later rotations?

 

[a2014]

Question concerning curriculums.

Do you think having an earlier clinical rotation year, like at Duke or Vanderbilt, would have helped you do better on the step 1 exam or been beneficial to you on later rotations?

I'm not sure about benefiting you on "later rotations", but it definitely helps for the step 1. It required students to go back and relearn a lot of basic science that they put out of their heads during their clinical rotations, but that stuff comes back quickly. Averages I've heard for schools with post-clinical year step 1 dates have been pretty spectacular.

One thing that is discounted that I think really helps with the early clinical year is that it makes 4th year 4-6 months longer. That gives you plenty of time to do elective rotations in the case that you finish your core rotations and still don't know what to do.

 

[ErrantWhatever]

There's the rub, it isn't exactly straightforward for premeds to find out how the rotations are structured. Even during interviews, it's not guaranteed that the interviewer will known the details of how rotations are scheduled. Post in school-specific discussions, and try to seek out any upperclassmen when interviewing or going for a second look.

Just wanted to back up this unfortunate reality. My bro's med school treated all rotations (including 4th year) as a weighted lottery (think similar to the match process--you could identify preferred rotations but weren't promised anything). He definitely did not get every rotation he wanted to experience before choosing a specialty. It was such a frustration that he straight up did not recommend the school when it came time to apply. This is another thing that makes it difficult talking to M1 and M2's all day at a lot of schools--they just don't really know this stuff.

 

[sinombre]

Just wanted to back up this unfortunate reality. My bro's med school treated all rotations (including 4th year) as a weighted lottery (think similar to the match process--you could identify preferred rotations but weren't promised anything). He definitely did not get every rotation he wanted to experience before choosing a specialty. It was such a frustration that he straight up did not recommend the school when it came time to apply. This is another thing that makes it difficult talking to M1 and M2's all day at a lot of schools--they just don't really know this stuff.

Would you mind posting the name of the school?

 

[a2014]

Just wanted to back up this unfortunate reality. My bro's med school treated all rotations (including 4th year) as a weighted lottery (think similar to the match process--you could identify preferred rotations but weren't promised anything). He definitely did not get every rotation he wanted to experience before choosing a specialty. It was such a frustration that he straight up did not recommend the school when it came time to apply. This is another thing that makes it difficult talking to M1 and M2's all day at a lot of schools--they just don't really know this stuff.

Yep, and even the stuff they "know", they often don't really understand. I would never trust an M1 or M2 here to give advice on clinical rotations, simply because they haven't been there yet. I probably would have given bad advice myself at that stage simply because I didn't really know what was good.

 

[dally1025]

Question concerning curriculums.

Do you think having an earlier clinical rotation year, like at Duke or Vanderbilt, would have helped you do better on the step 1 exam or been beneficial to you on later rotations?

We start 3rd year early at my school and I am glad we started early. It doesn't really matter for step 1/2. The advantage is that you get to start 4th year a bit earlier giving you more time to do electives and away rotations which is important if you're having trouble deciding or want to do something outside the typical 3rd year rotations.

 

[Frazier]

Would you mind posting the name of the school?

Kind of humorous how they build it up just to leave you in the dark, huh?

 

[mvenus929]

In the clinical rotations, do med students end up spending most of their time with the residents and/or fellows, or is it possible to get a significant amount of interaction with the attendings? Also, who ends up deciding the med students' clinical rotation grades: the residents or the attendings?

I know this has already been addressed, but I wanted to answer it again, because it really does matter. My school has a variety of structured rotations. Outpatient medicine and Family Medicine are both one-on-one with a preceptor, so your entire clinical grade is made up of one evaluation (it gets weighted with the shelf exam grades and a few other miscellaneous grades at our school). Inpatient medicine and peds, on the other hand, has you working with the residents the majority of the time. That doesn't mean that their input doesn't matter as much as the attending's, though, because sometimes the attendings will ask the residents for feedback regarding your performance, and will incorporate that into their own evaluation. Here, both residents and attendings contribute to the clinical grade, though obviously the attending's evaluation matters more.

Other than the Dean's Letter, what other LORs are we required to get for residency apps? Do you get letters from the professors from the first two years or from the attendings of clinical rotations or both? Which ones count more?

Also, do med students get the chance to help with writing case reviews?

Generally, you're required to have a letter from the chairman of the department of the specialty you want to go into. So I'd need to have a letter from the chairman of Pediatrics. Other than that, you get letters from various attendings who can speak to your ability to be a good physician. I worked with an EM attending primarily during my first two years (though some since third year has started as well) for my 'how to be a doctor' class, and I plan on having him write me a letter because he can speak to my development through med school.

As for case reviews, if you seek out the opportunity, you may have a shot at helping out.

Thanks, but what is a good or bad structure for third year. How do you find out as a Pre-med which rotations are going to be bad? Thanks again.

Couple things:
1) Talk to the upperclassmen. They'll be your best source of information about clinical rotations. And since everyone focuses so much on the pre-clerkship curriculum, you might have to dig to get that information.

2) 'Bad' is not a good term, because the experience of clinical rotations depends on a lot of variables, not the least of which is the residents on service at the time. For instance, I'm on surgery now. We switched services last week, and the students I switched with are lamenting over how rough the service is, when we didn't think it was that bad. The difference is that the chief resident was on vacation while I was on service, and it wasn't nearly as busy.

3) There are pros and cons to each structure of clerkship. We have some away rotations at our school for the majority of the core clerkships, so you could do OB at our home institution or at a private hospital in the next town over. The advantage to the private hospital is that you work one-on-one with attendings, because there are no residents at that institution. The disadvantage is that you have to be much more proactive to see deliveries, because the attendings don't see all the patients on the labor and delivery unit.

Question concerning curriculums.

Do you think having an earlier clinical rotation year, like at Duke or Vanderbilt, would have helped you do better on the step 1 exam or been beneficial to you on later rotations?

I know people will disagree with me, but I don't like the idea of taking Step 1 after clerkships. When you take it right after second year, you often have dedicated study time, and everything is relatively fresh. Yes, taking it after third year (or the equivalent, in Duke's case) cements some concepts more, but if I were to go back and study for Step 1 now, I would have to relearn a ton of basic science concepts that just weren't addressed during clerkships.

Besides, you have to take Step 2 CK and CS after third year as well (the timing varies by school), and studying for 2 major exams, both of which are 8ish hours long, in the span of a couple months would be very anxiety provoking. Moreso because they have different focuses... Step 1 focuses more on basic science and diagnosis, while Step 2 focuses more on management and treatment, with the assumption that you have the diagnosis down.

 

[sinombre]

Kind of humorous how they build it up just to leave you in the dark, huh?

Haha... yep. Guess I'll have to do some investigative work.

 

[MDbound2013]

Question concerning curriculums.

Do you think having an earlier clinical rotation year, like at Duke or Vanderbilt, would have helped you do better on the step 1 exam or been beneficial to you on later rotations?

To be perfectly honest, I'm sort of in the camp that thinks this is a bad idea. Granted, I took Step 1 after 2nd year, and I don't know how it would have been had I not done that. However, it is hard enough to remember biochem after second year- I had no recollection of that junk after third year. It's not even the amount of time that passed, you just don't focus on basic science at all during your third year. You still have to take tests- the "shelf exams"- which are specialty specific, written by the same people who write the steps, and very similar to Step 2 questions, NOT Step 1. I have other reservations with the 1-year pre-clinical curriculum to be honest, but that's a different story. I will say that having a longer 4th year would be super beneficial, and that often times taking Step 1 after "third year" means you have a lot more time flexibility, so you can take longer to study. I'll also echo the fact that taking Step 1 and 2 both in a short period of time sounds like absolute torture. It would probably also make sense to take 2 before 1 because you remember that stuff a lot better (again, that's what tested on the shelfs) but I don't know if that can be done.
I've heard the argument that step 1 is "clinically based" so it's helpful to take it after third year. That was not my test. I did not go over genetics, the urea cycle or details of every single bug that ever existed during my third year- but that stuff was heavily represented on my test. I had no peds (unless you're talking about questions regarding crazy metabolic disorders which you're likely not to see too many of, and you won't be learning what step in the metabolic pathway is messed up anyway), no obgyn, no surgery- those would all be "wasted" rotations. So no, I dont think it helps, besides giving you more time to study for the test and making you get all 3 boards done in a matter of months (which I think is brutal). Just my opinion though.

 

[LovelyBRass]

The prospect of seven hours of rounds is saddening.

I'm not sure where all the hating on rounds comes from. This isn't throw-away time that's somehow taking you away from doing other, more important things. It's the time you actually spend with the attending physician where you can learn about differentials and management of the patients on your team. Rounds aren't just for the individual taking care of the patient; they're for the whole team to learn about every patient, and for the whole team to work together. If you look at it this way, you'll find attending rounds are the most educational time you can have third year and beyond.

 

[The Beyonder]

What is one thing you don't like about your school that we should watch out for?

 

[a2014]

I'm not sure where all the hating on rounds comes from. This isn't throw-away time that's somehow taking you away from doing other, more important things. It's the time you actually spend with the attending physician where you can learn about differentials and management of the patients on your team. Rounds aren't just for the individual taking care of the patient; they're for the whole team to learn about every patient, and for the whole team to work together. If you look at it this way, you'll find attending rounds are the most educational time you can have third year and beyond.

Yes and no. It completely depends on the team. Sometimes you'll have a busy service with an attending that doesn't particularly care about the academic aspect of things, in which case rounds can be horrible. On the other hand you can have a great time with amazing attendings that really care about teaching, in which case you'll learn a lot. I don't hate rounds, but they should have a limit. They're also not the only want to learn, and when they go on for more than 2 hours, I think they start to eat into other valuable learning experiences.

On the other hand, how much you seem to enjoy rounds seems to correlate well with whether you're a "medicine person" or a "surgery person".

 

[a2014]

To be perfectly honest, I'm sort of in the camp that thinks this is a bad idea. Granted, I took Step 1 after 2nd year, and I don't know how it would have been had I not done that. However, it is hard enough to remember biochem after second year- I had no recollection of that junk after third year. It's not even the amount of time that passed, you just don't focus on basic science at all during your third year. You still have to take tests- the "shelf exams"- which are specialty specific, written by the same people who write the steps, and very similar to Step 2 questions, NOT Step 1. I have other reservations with the 1-year pre-clinical curriculum to be honest, but that's a different story. I will say that having a longer 4th year would be super beneficial, and that often times taking Step 1 after "third year" means you have a lot more time flexibility, so you can take longer to study. I'll also echo the fact that taking Step 1 and 2 both in a short period of time sounds like absolute torture. It would probably also make sense to take 2 before 1 because you remember that stuff a lot better (again, that's what tested on the shelfs) but I don't know if that can be done.
I've heard the argument that step 1 is "clinically based" so it's helpful to take it after third year. That was not my test. I did not go over genetics, the urea cycle or details of every single bug that ever existed during my third year- but that stuff was heavily represented on my test. I had no peds (unless you're talking about questions regarding crazy metabolic disorders which you're likely not to see too many of, and you won't be learning what step in the metabolic pathway is messed up anyway), no obgyn, no surgery- those would all be "wasted" rotations. So no, I dont think it helps, besides giving you more time to study for the test and making you get all 3 boards done in a matter of months (which I think is brutal). Just my opinion though.

I'd be curious to hear why you think a shortened pre-clinical curriculum is a bad idea. Ours was 1.5 years, and I'm incredibly grateful that it wasn't any longer than that. One year might be cutting it a bit short, but I'm not sure what I would have gotten out of another 6 months of classroom.

As far as your points about the step 1 after clinical year, I agree with some of your points. Yes, you don't focus on the mechanism of disease as much in your clinical rotations, but I don't think it's fair to say that it never comes up. Some of the nitty gritty biochem stuff will go completely neglected. You'd be surprised how quickly it comes back though. Step 1 doesn't focus on management of diseases as much either, but you'd be surprised at how much knowledge of common management helps with those types of questions. If you're still not convinced, the numbers tend to agree with me. In the classes above me that used to new curriculum, step 1 scores have been on the order of a standard deviation above the national mean.

 

[MDbound2013]

I'm not sure where all the hating on rounds comes from. This isn't throw-away time that's somehow taking you away from doing other, more important things. It's the time you actually spend with the attending physician where you can learn about differentials and management of the patients on your team. Rounds aren't just for the individual taking care of the patient; they're for the whole team to learn about every patient, and for the whole team to work together. If you look at it this way, you'll find attending rounds are the most educational time you can have third year and beyond.

I guess I agree with your subtitle then, you are a "budding internist". I didn't really find rounds useful. I could pay attention when my own patients were being discussed, but could not keep it together to save my life for the other 3.5 hours. Half the time the discussion about management was either so over my head (as in the ICU) or so mind-numbingly boring (20 minutes on Lasix dosing, anyone?) that every part of my body would start to ache at the same time and my eyes would start to close. Rarely did my attendings really spend a good amount of time discussing differentials- that would actually have been fairly useful. Most of the time the diagnosis was a given, and time was spent on dispo and management minutia and complaining about why the patient had been admitted in the first place. This was not a pleasant experience for me.
Not that spending hours on end standing still in silence at the crack of dawn retracting and idly wondering if I was getting a DVT/if I'd fall asleep in the patient's body cavity was any better on surgery, mind you. This is the tough part about third year. A lot of your time is spent doing stuff that is supposed to be educational but isn't, and everyone has to do it cause the alternative is just to let you go home and read about everything on your own, and that's not really feasible either. The point is to try and draw out all the education you can, and not be shy about asking questions and occasionally demanding some attention.

What is one thing you don't like about your school that we should watch out for?

That's actually a really tough question and I've been thinking about it all day actually. The real problem is that the main thing i dislike about my school has nothing to do with my school- it's a person on the administration who I think affects the student body negatively (and honestly if you asked most of the students, they'd tell you he/she is great...because they rarely have to interact with him/her in any way that really matters). I will say that when it comes to extracurriculars, my school has a way of always having the same 3-4 people at the head of all the big clubs because the administration does those groups' faculty advising and they're privy to our grades, so they are biased as to who would be more "reliable" vs not. Unfortunately this results in a bit of a self-fulfilling prophecy, as those 5 people run the most important organizations on campus AND have the best grades, they keep running more and more things because others view them as especially reliable for running those groups in the first place, and then they're AOA (the medical honor society) later because of their impressive involvement on campus. I'd rather see the wealth spread a little bit among people who are just as passionate about extracurriculars (or more) and who maybe aren't running 4 at once.
Another issue I do have is with third year grading. Each clerkship director (the people who run the rotations) is allowed to choose how to grade students for that clerkship. This results in extremely uneven grading across the board. Some rotations count the shelf exam as 40% of the grade, some as <20%. In some, you can fail the shelf (worth 30%) and still get a high pass in the rotation, and it is essentially impossible to get a pass (but equally impossible to get honors) so that the person with the 90% on the shelf and comments like "best student I've ever had" has the same grade as the person who failed the shelf. In others, getting a P is fairly easy even if you do ok on everything, just because of one bad evaluation- again, unfair if you think about other students who failed other shelfs and still got a HP, etc...that kind of thing makes me crazy. Unfortunately third year grading is arbitrary enough without adding inconsistencies among clerkships on top of it all.

 

[Geebeejay]

Let's pretend I get accepted to your school, among others. Give me 3 reasons why I should choose your school.

 

[MDbound2013]

Let's pretend I get accepted to your school, among others. Give me 3 reasons why I should choose your school.

I'm not sure how that helps anyone given that you don't know where I go to school...

 

[mmmcdowe]

Let's pretend I get accepted to your school, among others. Give me 3 reasons why I should choose your school.

You should choose the school based on fit, finances, and location.

 

[LovelyBRass]

I guess I agree with your subtitle then, you are a "budding internist". I didn't really find rounds useful. I could pay attention when my own patients were being discussed, but could not keep it together to save my life for the other 3.5 hours. Half the time the discussion about management was either so over my head (as in the ICU) or so mind-numbingly boring (20 minutes on Lasix dosing, anyone?) that every part of my body would start to ache at the same time and my eyes would start to close. Rarely did my attendings really spend a good amount of time discussing differentials- that would actually have been fairly useful. Most of the time the diagnosis was a given, and time was spent on dispo and management minutia and complaining about why the patient had been admitted in the first place. This was not a pleasant experience for me.

Obviously this doesn't mean much for you anymore, but maybe a preclinical or premed student will find this useful...

I agree that attendings don't usually go out of their way to teach. This is why people say you get out what you put in. The attending isn't supposed to be the one to throw out differentials and tell you why they're wrong or right. YOU are supposed to hear the cases and come up with your own differentials and consider what you might do or have seen done and ask why things were handled a certain way. And yeah every other word was over my head when I did Medicine (first clerkship ftw), so what do you do? Write things down! Look them up. Rounds are where you hear those terms and learn those things your Step Up to Medicine review book doesn't teach you. I clearly disagree with you that the time is useless; you simply have to know how to use it (which no one teaches us and this frustrates me to no end).

 

[Arbor Vitae]

What do you regret doing or not doing from the last 4 years?

 

[Shinobiz11]

As a 4th year, would you say you are satisfied with your choice to pursue medicine? You always hear about the students who didn't do enough research and end up hating the field or the others who get burned out, etc. We all know you've been working hard the past 4 years, but do you feel like its been worth it? Are you excited to graduate and start "doctoring", though you know the road ahead is going to be even more difficult?

 

[LovelyBRass]

What do you regret doing or not doing from the last 4 years?

This is going to sound weird because everyone thinks P=MD is a great way to look at things, but I regret letting P=MD be my motto. I don't think I got the most out of my medical education the first 2.5 years because "grades don't matter." And while that's true, I think I became a slacker and was less motivated to push myself and learn as much as I can while I was still a student and didn't have real patient responsibilities (like when I'm a resident!). Spending the last bit of time I have left in med school trying to rectify that.

 

[Geebeejay]

I'm not sure how that helps anyone given that you don't know where I go to school...

Not the point of the question. I want to know what you think the selling points of your school are...things that having spent 4 years at your school, you think are important considerations that I may not think of. Or things that may set your school apart from some others.....I just want to know what you consider some of these qualities to be... what school it is is irrelevant. I'm not talking about "fit, location, cost" but more specific qualities.

 

[a2014]

Obviously this doesn't mean much for you anymore, but maybe a preclinical or premed student will find this useful...

I agree that attendings don't usually go out of their way to teach. This is why people say you get out what you put in. The attending isn't supposed to be the one to throw out differentials and tell you why they're wrong or right. YOU are supposed to hear the cases and come up with your own differentials and consider what you might do or have seen done and ask why things were handled a certain way. And yeah every other word was over my head when I did Medicine (first clerkship ftw), so what do you do? Write things down! Look them up. Rounds are where you hear those terms and learn those things your Step Up to Medicine review book doesn't teach you. I clearly disagree with you that the time is useless; you simply have to know how to use it (which no one teaches us and this frustrates me to no end).

While I don't think you necessarily intended it this way, this comes off as a tiny bit condescending when you're talking to other M3/M4s. I understand what the point of rounds are, and I understand the getting out of it what you put in part. I'm sure MBD2013 does as well. I don't even completely hate rounds, I just can't stand it when they drag on for ages. For some people, this just isn't an efficient learning style, and it always a productive use of time. I don't dislike rounds because I don't understand them, I dislike them because many times they can devolve into an academic circle jerk with attendings ranting about some minutiae that isn't particularly relevant or interesting.

You could use your same argument against people who say they don't like standing in the OR holding a retractor. If they had only read up on the cases, they could be involved and asking relevant questions during the case. That doesn't mean that everyone is going to like standing in the OR for an 8-hour whipple.

 

[MDbound2013]

What do you regret doing or not doing from the last 4 years?

Nothing major, really. There are certain things specific to me I guess (certain learning styles I should have picked up on earlier, etc) but I don't know how much of that is applicable to others. I wish I'd studied more in groups because I learn by teaching, and studying in a quiet room by myself probably wasn't nearly as efficient a use of my time (my mind wanders). Also, I wish I'd gone to class more. I'm a night owl so waking up early just didn't seem like an option at the time, but then third year hit and I started waking up at 4 and I realized- why did I think 7am was so totally unreasonable? I think I would have learned a little more and had more bonding opportunities with my classmates. I honestly don't regret the P=MD attitude at all. It saved me a lot of anxiety and allowed me to have more of a life, which I wouldn't exchange for anything. No, I probably won't match at the number 1 program in the country, but I don't care. Medical training happens in residency, not med school, I never expected to learn it all now.

As a 4th year, would you say you are satisfied with your choice to pursue medicine? You always hear about the students who didn't do enough research and end up hating the field or the others who get burned out, etc. We all know you've been working hard the past 4 years, but do you feel like its been worth it? Are you excited to graduate and start "doctoring", though you know the road ahead is going to be even more difficult?

I really am. I don't think I'm quite as gung-ho and starry-eyed as I was when I was premed, but I really look forward to the next step, having some responsibility etc. I mean, it was a really tough 4 years and once I leave I may have some PTSD, but I didn't go to med school to be a professional med student. You do get a little jaded I think, but I think you get a bump in excitement when you figure out what specialty you want to pursue and can finally see yourself doing that work- i think that part is really cool- so toward the end it kinda gets fun again. You just have a new goal and you get excited about it. So am I just as excited to be a generic "doctor"? Probably not. I've seen the sucky parts and they really are sucky. But I'm even more excited to be the kind of doctor I chose to be.

 

[Shinobiz11]

Cool, what are you going into?

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