Best and Worst Rotations

Best:
-internal medicine because you actually get to do "doctor-y" things and are given a lot of responsibility with your patients. You're forced to tap into all of the seemingly useless knowledge that you accumulated during years 1 and 2
-neurology absolutely fascinated me. I loved how the physical exam was so integral to diagnosis, moreso than most other specialties.

Worst:
-surgery: long hours, which make it particularly painful if you're someone who has no desire to go into surgery
-psychiatry: yeah, the hours are great, but I need something with a lot more structure. This is the one rotation where I actually felt uncomfortable going to work each day.

 

Compare the previous response to my own and you'll see that the answer completely varies between individuals.

Best:
Psychiatry- really interesting, great hours
I'm currently on my Neuroradiology elective and have enjoyed it for the last 3 days, though it's not the most exciting just watching others read films.

Worst:
Surgery- long hours, not the nicest residents, didn't like the OR

I really enjoyed Internal Medicine for the first 3 weeks...it was new, interesting, cool stuff. The rest of the rotation I couldn't wait to get done with it. The cases became repetitive and boring (COPD flares and r/o chest pains) and rounding became so painful.

 

Agree- responses will vary. I have enjoyed almost every clerkship of 3rd year.

OP will note that I even have one clerkship listed in both categories for different reasons. It is fortunate that we have a wide range of specialties that can cater to our different interests and needs.

Best:
-Emergency Medicine- interesting, diverse & undifferentiated complaints, diverse populations. PLus I love working nights and overnights.
-Trauma Surgery- amazing, complicated patients- great attending and residents. Best teaching all year by residents and attending.
-Internal medicine & Peds (we have it as a combined clerkship)- managing complex patient pathology

Worst:
-Gyn Surgery- I had some issues with 2 residents as they did not seem to believe or care that I had physical issues (needing to eat every few hours s/p gastric bypass, bad vasovagal reaction with heat and rebreathing warm air). The general surgery attendings and residents were excellent. However, on a whole, I found surgery to be not as intellectually stimulating as other disciplines and the hours were longer than other rotations.
-Internal Medicine & Peds- endless rounding, call q4-5.

 

Best:
Surgery: Actually felt useful, even as a third year. Really got to talk to patients - really felt like I had an important role in their life. (One cancer patient, who had incurable pancreatic cancer, said that her day never felt "right" unless I was the one waking her up...that seeing me was "one of the few bright spots" in her day.) Amazing residents and attendings. Really fun surgeries. Got to do procedures and learn SKILLS. Loved, loved, loved being in the OR.

OB/gyn: Loved delivering babies - one of the few things that most people never learn how to do, and will never really get to experience. Enjoyed feeling like I made a REAL, immediate impact on someone's life. Saw some crazy pathology (teratoma the size of coffee mugs). The residents let me take a lot of responsibility and start triaging patients on my own. Liked the "hands-on" nature.

Family Med: Clinic is fun. Talking to people about their lives, and feeling like you can really get a chance to play a long-term role in their healthcare was exciting. The variety was pretty amazing - first patient of the day might be here for HTN/diabetes maintenance, the next patient might have newly diagnosed hypothyroidism, third patient was hit by a car and here for followup, fourth patient is here for routine OB prenatal visit.

Worst:
Internal Med: Walk rounds are just an instrument of sheer torture. The inevitable lull after rounds end, but before night float shows up for sign out is so, so slow - but you're "not supposed to leave" before sign out. During that time, we were told to "read," but no one could explain (least of all the intern) why I couldn't just do that at home. The combination of eternal rounds plus all the drug seekers and malingerers also really, really got to me. Had more meaningful interactions with the patients on surgery than I did on medicine. Loved the medicine and the subject matter - but hated the nuts-and-bolts of that rotation.

 

Here's mine so far:

Best
Ortho -- cases were fun, residents were fun, I enjoyed waking up at 3:30 to go round. Rounds on each patient took 5 minutes. There are power tools. Patients generally left the hospital after a few days, and while they had pain, they felt better than when they did coming into the hospital. (also, no stethoscope the whole month.)

Anesthesia -- procedural stuff, physiology and drug stuff was interesting. I spent a day watching nerve blocks, no rounding. (Only bad thing was that I kept wishing I were on the other side of the drapes, and 1 day I got to scrub into a case after intubating the patient.)

Worst
Psych -- I hated waking up at 6:30 every day to go talk to people about their problems and deal with the borderline personalities. Don't get me wrong, I enjoy talking with people, but this is way different.

OB part of OB/gyn -- writing labor notes, emergent c-sections, vaginal deliveries that I only got to watch because of curmudgeony attendings. (The gyn part wasn't that bad.) I started hating life after 4 weeks out of 6 on OB/gyn. The chief resident also picks people she likes or dislikes, she didn't like me.

Internal medicine -- I've been on it since 1 May. I've never spent so much time online as I have on IM. My attending right now doesn't round on patients -- we look at Xrays. I've been turned into a phlebotomist (used to get paid to do that, ugh.) There's logorrhea on our pseudorounds, and none of my patients ever leave the hospital. I hated life after 1 day.

Neutral
Family medicine -- had it right after OB/gyn, it was a good break. The patients were REALLY frustrating though. I had a non-compliant wrist fracture. ARGH!

Surgery -- I got the worst surgery service combo available at my school with a horrid fellow and resident. Bad times. I liked being in the OR, just not the subject matter.

Peds -- my intern on inpatient peds was one of the most incompetent people I've met (an FP resident from the program that I did FP at, not the best FP place in the state). She made my life miserable. However, the patients were fun, and I saw really interesting stuff which kept me entertained. Rounding was terrible. Outpatient peds was fun, and I got really good at looking in thrashing kids' ears.

Neuro -- I was in the NICU. Saw interesting stuff (ALS, ICH). Didn't really do much though except lots of physical exams on patients snowed on propofol.

 

As I think you can see OP, you'll get a wide range of responses to this question because it's really rather personal. Everyone will respond with...

Best: "the thing I'm going to do and fields that are somewhat related."
Worst: "Things that are not the field I'm going to do."

So take things with a grain of salt, the things some people hate about a rotation will be the exact thing someone else loves about it. I remember talking to a urology resident before going to the OR for the day and she was telling me how she was pumped that we had all big cases that day. She said, "I don't mind this at all, I love spending 10hrs in the OR. And you have to do what you love. If you were, say, a medicine person you'd rather bang your head against a wall than be in the OR all day like that, but wouldn't at all mind rounding for 3 hours, which sounds like torture to me." And I thought to myself, "yup, the head banging guy, that's me. I would MUCH rather be on interesting medicine rounds than be in the OR all day."

So don't stress, you'll find your place 3rd year. And if you really want a preview of rotations maybe reading what someone love and what someone else hates about the same rotation will start to give you an idea.

And I'll add that, in general, people seem to feel that OB/GYN and Surgery are the most strenuous rotations

 

My m3 experience -

awesome: surgery, peds, psych

+/- (not particularly memorable to me one way or the other): family

yeah not so much: medicine, neuro, ob/gyn

I'm going into peds. Definitely do agree that it's a personal question and asking different people can lead to very different and at times exact opposite answers...Don't quite agree with this though:

I had a blast on surgery and psych; but I only briefly considered entering surgery, after the rotation, and really never considered psych. And, on my rotations at least, neither one necessarily had any particular overlap with peds, at least no more so than anything else.

Stay open-minded and you can definitely enjoy rotations that are not related to what you want to do.

 

Definitely agree. Staying open minded not in just "do you want to consider this as a career," but also knowing that you can gain something from each rotation despite the fact that you know you'll NEVER go into it as a career and the month or 2 in med school may be the only experience you'll ever get in it.

M3 year it seems to be more important to stay open minded, especially for grades, but M4 year as well. I'm taking stuff that I won't do as a career, eg dermatology, but I know I'm bad at skin stuff, and knowing the population now, maybe even as an orthopaedist I could ID some skin cancers or something.

 

I agree with Ashers. Staying open minded is the best way to approach 3rd year as you can be pleasantly surprised. We can learn from every rotation even the ones that we say "hell will freeze over before I do that for a living".

I think it also helps to not have any preconceived notions about a rotation (or at least any strongly positive ones). For example, I will love OB because I love babies. I was dreading OB because I had heard horror stories about the residents from my classmates. I was fortunate in the residents I worked with during OB and was pleasantly surprised with the rotation as a result-- I really enjoyed that rotation (I was not so pleasantly surprised when I ended up working with different OB residents during GYN surgery but I survived and you will too).

 

BEST:
Psychiatry- Great hours, and the patients are so fun! I mean where else are you going to talk to people who are married to God and need to "search the galaxy"? In addition, the assessments & plans are hard to mess up...it's all about figuring out which antidepressants/antipsychotics/antimanics your attending happens to prefer.

Pediatrics- I loved the babies and kiddos! So much fun! They usually only have one problem which is an acute problem, no comorbidities or anything. And pediatricians tend to be nice, fun people!

WORST
OB/Gyn--Hands down the worst rotation EVER. Malignant personalities, horrible hours, disgusting deliveries, etc. Don't be fooled, deliveries aren't fun at all. Peds gets the baby as soon as it's cleaned up and made cute. You're still stuck with mom and her vagina as your main concerns. Ugh. See "Peds" above. Babies are fun but women and vaginas not so much.

Surgery--Since I'm going into Pathology, this is actually the most relevant of the MS3 rotations for me. Unfortunately, surgical people are just not nice people at all. So they are ruining it for me. Won't let me follow specimens to the lab, etc. Not to mention the hours are totally crappy.

So not everyone says what's good/bad based on specialty. Peds and psych are pretty much irrelevant to path, but Surgery provides the bulk of slides! It's just that surgery attracts the meanest people...

 

Yeah - the only thing that you CAN do is just listen to stories. Everyone's experience on a given rotation will be so different, and it's all based on luck: who was your resident? Who was the attending? What types of patients did you happen to see during your time there? It's very individual.

That's too bad. On OB/gyn, when they dug out a teratoma the size of a grapefruit, the med students got to run it down to the path lab and watch as they prepared the frozens, and waited with the pathologist as they did the prelim report.

On surgery, when we did a sentinel node biopsy, we did the same thing. The pathologists were happy to show us what he was looking at.

 

BEST:
Internal Medicine - Intellectually stimulating, faculty have not only excellent knowledge but are very good at teaching as well. Occ. [certainly not frequent] procedures (LP, paracentesis). They don't keep us late because "students need time to read" [It's very, very rare for any attending to say that]

Peds - same as above, but the hours/scutwork were a little worse

Ortho - not as much teaching, but damn you get to do some cool stuff. tibial nail, total hips, c-spine fusion...I even got to basically do an entire hand case (simple I&D)


WORST:

Ob-gyn - by far the worst. the work is disgusting, boring, and repetitive. The patients hate you, the nurses hate you, the residents hate you, the attendings hate you. At times, you will feel like God hates you.

Family Medicine - just rehashing everything you do on other services, except at a lower level of care.

Psych - I enjoyed studying pyschiatry but disliked practicing it. You are nothing more than a glorified social worker, attempting to find housing for the legions of homeless schizophrenics/schizoaffectives. Very little to no evidence based medicine. Most of your patients do not get better; I don't mean not cured, but ZERO improvement post medical intervention. Some patients baselines are just very low.

 

BEST

Internal Medicine - Being able to manage patients from admitting them in the ED to discharge, and have a say in every aspect of their care in between. Minimal scut. And as others have said, intellectually stimulating.

Ob/Gyn - I'm very thankful that I enjoy this rotation. Attendings are nice for the most part, some are friendly, and some even like to teach. Clinic is fun because whether it's for ob or gyn, you get to do some sort of procedure on most patients, however minor. I'm looking forward to the end of gyn because there are fewer c-sections on ob than there are gyn surgeries.

Psych - I got to go to lunch every day for at least an hour, definitely a plus. Interesting patients, fun to talk to when they're able to communicate.

WORST

Surgery - My experience included retracting something that I couldn't see because there wasn't enough room at the table; working with attendings who yell at everyone in the OR and berate their residents; residents who, in the absence of attendings, say negative things about their colleagues and the attendings; mind-numbing shadowing (really!) of attendings on their clinic days; showing up at 4:45 am; and finally, rounding in between OR cases--who needs to eat during the middle of the day anyway?

Outpatient Internal Medicine - Patients with complex medical problems here for f/u would be scheduled every 15 minutes! And of course things back up in that situation. There would be patients with a dx of schizophrenia (managed by psych) living in an assisted living sort of place there for multiple medical problems, like diabetes, obesity, HTN, smoker--unable to drive, scheduled for a late afternoon appointment and inevitably misses the last van/bus back to the home where she lives, so the clinic has to pay for a taxi. Poorly organized. Patients who no-show about a third of the time and want to spend longer than 15 minutes talking about their chronic issues. One patient who showed up each week I was there, wanting to talk in painful detail about herself.

 

Best: Surgery. Sure it was long hours but the residents were so busy there was little grilling or reprimanding, unlike internal. Rounds are fast and efficient, unlike internal. Yes there is scut but it is broken up by going to the OR. I much rather be scrubbed into a surgery than trying to ingratiate myself with radiology to get that CT done. The former may get boring at times but the latter provides zero education.

Worst: Obstetrics. Worst combination of uninteresting subject matter, disgusting daily work, lack of teaching, nazi nurses, awkward situations, and bitchy residents.

 

I liked some component of each rotation, but... Best:
Psych - Actually felt good about interacting with attendings, staff, & patients on this rotation. Felt like a real person. And no white coat!

FP - a little bit of everything - more of a real-life, "attending" type experience, at least for me.

OB - not the MS3 rotation, but a 4th year elective. Great opportunity to do deliveries, 1st assist on sections and more. Loved the patients. Several attendings loved to teach. Loved the nurses, they just warm up slowly.

Worst:

IM - How, I thought, can you be a doctor and not like "MEDICINE?" I hate the endless debate over patient X's sodium level and what it may or may not mean. I mean, Na is important and all, I just don't want to spend 40 minutes talking about it. And the rounding - the endless, inescapable rounding...

Peds neuro - Hello, your child has been neurologically devastated and there's not a thing we can do about it. Very sad.

 

If I had a choice between doing internal medicine or not doing medicine at all, I'd go into real estate.

 

The problem with these kinds of comparisons is that your experience depends much, much, much more heavily on the residents and attendings you happen to work with than on the actual work itself.

I did very similar inpatient neurology rotations at two different hospitals. Hated the first one, loved the second one. It was all about the team and the environment.

Anyways. For my third year rotations in med school:

Best: Tied between psychiatry and internal medicine. I liked them because
- I got to spend a lot of time thinking through complex and interesting problems
- I was able to function very independently and actually make a real contribution to patient care.

(For both these reasons, I enjoy the subject matter of neuro as well; but I had such a malignant team on the first rotation that I really disliked the experience, and was totally unable to disentangle the people issues from the neurology issues.)

Worst: OB-Gyn. It was really the OB part that sucked, Gyn was less bad.
- Anti-intellectual environment (they're doers, not thinkers - bad match for me)
- B1tchy residents
- Small, boring differentials
- Extended periods of doing nothing on L&D, except waiting to...
- ...watch a fat lady poo

 

I've only had three rotations thus far, but I'll add my very green opinion to the list:

Best:
Pedi: I'd been exposed to adult medicine during my weekly clinical experience in the first 1.5 years, and I have to say pediatric medicine is SO much better. The information is more interesting, you'll see zebras so you'll really learn to expand your differential, I felt like I was constantly learning and being taught. Add to that the fact that kids are awesome, pedi residents are really sweet, and you get to work in a very colorful, up-beat environment and pedi kicks all other rotations' @sses.

Psych: Psych residents are quirky, fun, and easy to get along with. The material is incredibly interesting--especially where psych overlaps with neuro. Whether you love it or you hate it, you have to admit that it is NOT boring. The psych EC is especially lively. You'll see your fair share of suicide attempts, crack addicts, violent crazies high on PCP, schizophrenics, and naked manic people. There are a lot of "special" people in this world, and you'll meet 'em all on psych

Worst: SURGERY thumbdown: holy **** I hate my life right now. Hours are long, you're never that important to patient care, surgeons are jerks but also think they're God's gift to this world, **** really slides down hill and everyone is quick to remind you that you're at the bottom of that hill. To top it all off, you have to hang around and stroke the surgeons' egos or be sentenced to death by verbal hanging. I'm so sick of pretending to feel privileged to hold a big, floppy, cancerous boobie for three hours. Scrubbing in is a nightmare--especially in longer cases. Scrub nurses are Nazis about your scrub etiquette, but the surgeons could wipe their asses on the patient and no one would say anything. No moving, no touching anything, no talking depending on the surgeon, no questions, etc. Once you get used to the blood and guts, surgery itself is just not interesting. While all the surgeons are standing around being proud of themselves, you're sitting there thinking, "Yep, you sure did cut 'em good...uh huh, that was grade A cutting " Clearly I could go on and on about this, but I'll spare you all. In summery" surgery sucks (in case you missed it).