Clerkship order

[CirclingtheDrain]

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[Redpancreas]

The textbook answer and what you should go by is no. There are an infinite combinations of pros/cons to track order especially as someone who could go in liking everything. In reality, there will be some differences but they’re unpredictable and thus difficult to account for. Since you mention an initial interest in surgery, let’s use that as an example. Let’s say you start with surgery first. On one hand, you get newly promoted and thus inexperienced staff. On the other hand, newly promoted residents are more sympathetic to mistakes and are more willing to teach. In terms of knowledge for the shelf exam, you may feel that your knowledge base is weak because Surgery tests conditions seen on Pediatrics (malrotation of gut), Internal Medicine (pulmonary embolism), OB/GYN (uterine prolapse), Neurology (stroke), and Psychiatry (delirium tremens). That being said, Step 2/shelves are still 50% recognition and Pathophysiology which you are just fresh off of.

Overall, for every strength you think a track provides you with, there’s a weakness. Just go in thinking positive.

 

[NickNaylor]

The long/short of it is that no particular schedule is likely to make a huge difference.

It may be easier to work on a service toward the end of the year as, at the beginning of the year, new residents are likely scrambling around with their heads cut off trying to adjust to their new roles, whether that be an intern adjusting to the role as a resident or a now-senior resident adjusting to a leadership role. These aren’t things you can control, however, and I wouldn’t worry about it too much in terms of trying to schedule your rotation.

I do think there’s some value of doing IM first because the stuff you learn about and see in IM will have tentacles in every other field you rotate on. But I don’t think the advantage of doing IM first is so great as to really advocate for trying to do IM as your first rotation.

I would try and avoid doing whatever field you’re interested in first so that you’re not going through the experience of adjusting to the clinical world with residents/attendings that you will ultimately rely on for evaluations. It will already be stressful enough; you don’t want to have to worry about what exactly you’re supposed to be doing as a medical student generally in addition to doing the work of that specific rotation.

Ultimately, I don’t think it matters all that much one way or another. Don’t stress too much about it - it’ll be fine either way. Most resident/attendings that I’ve worked with will adjust their expectations based on how much time you’ve spent on the wards.

 

[sammiesings]

Intuitively I would think it would be best to rotate through a specialty you're hoping to apply for towards the middle of your year: not completely ignorant but not burnt out. Does that sound about right?

 

[Osteoth]

The long/short of it is that no particular schedule is likely to make a huge difference.

It may be easier to work on a service toward the end of the year as, at the beginning of the year, new residents are likely scrambling around with their heads cut off trying to adjust to their new roles, whether that be an intern adjusting to the role as a resident or a now-senior resident adjusting to a leadership role. These aren’t things you can control, however, and I wouldn’t worry about it too much in terms of trying to schedule your rotation.

I do think there’s some value of doing IM first because the stuff you learn about and see in IM will have tentacles in every other field you rotate on. But I don’t think the advantage of doing IM first is so great as to really advocate for trying to do IM as your first rotation.

I would try and avoid doing whatever field you’re interested in first so that you’re not going through the experience of adjusting to the clinical world with residents/attendings that you will ultimately rely on for evaluations. It will already be stressful enough; you don’t want to have to worry about what exactly you’re supposed to be doing as a medical student generally in addition to doing the work of that specific rotation.

Ultimately, I don’t think it matters all that much one way or another. Don’t stress too much about it - it’ll be fine either way. Most resident/attendings that I’ve worked with will adjust their expectations based on how much time you’ve spent on the wards.

Seconded. Do IM then Surgery, since from what I've been told IM helps you throughout 3rd year and if you find you have an interest in a surgical subspecialty if you do it later in the year you won't have a chance to network + do research before VSAS comes out in February of your 3rd year.

 

[J ROD]

I would do IM, Surgery first. With IM first, Surgery second. IM gives you a broad base for all shelves. I did OB/GYN last and they were fine with me not caring about it since I knew what I was doing. I got to miss out on some of the hell when asked if I wanted to do certain things. Plus, Psych is a nice easy one to have near the end. If you can ideally Surgery would be third.

 

[Doctor-S]

Do you want a front-heavy track or a back-heavy track?

Some general thoughts:

More of your attention and time will be required in specialties that require a lot of work with inpatients (IM, Peds, OB/Gyn, Surgery).

Since internal medicine provides you with a basic framework upon which to expand your medical knowledge, it is useful to complete your IM rotation early (and before surgery). Since you're interested in surgery, you might consider OB/Gyn before general surgery. In OB/Gyn you'll become more familiar with basic surgical skills (e.g., suturing, knot-tying). Expect weekends and long hours in general surgery. Most of the time, Psych is less time-intensive. You don't want to burn-out (think Step 2 exam) - so keep that in mind when submitting your clerkship track preferences.

Residents are busy 365 days/year. Help them ... so they can help you.

 

[soccerman93]

I want to do a surgical field, and regret that I had Surgery before IM for shelf exam purposes (I did well on Medicine but average on Surgery). Additionally, since it was early in the year we had to work with new interns, who didn't always feel comfortable teaching/coaching the med students. As others have said, I think IM followed by Surgery would be fine, you'll still have plenty of time to explore surgery and its specialties.

 

[operaman]

Just to add to the confusion, I’ll add that I went into third year 99% set on a surgical sub. My approach was to do surgery first, IM second, and specialty electives third. I had no trouble with any of the shelves.

My thought in doing this was to finalize my career plans early. I was afraid that if I did surgery later and hated it, I would have little time to find another path.

While there is some overlap regarding basically medical management, I found the surgery shelf to be nothing like a medicine shelf. I hear this myth repeated often, but it isn’t true. Sure both will ask about electrolytes, but the surgery shelf won’t ask about DKA and the medicine shelf probably won’t get into paradoxical aciduria. Surgery may ask about CAD with management of a periop MI, but it won’t ask you about longer term medical management of it. As noted above, a big chunk will come from your preclinical knowledge base.

 

[operaman]

Just to add to the confusion, I’ll add that I went into third year 99% set on a surgical sub. My approach was to do surgery first, IM second, and specialty electives third. I had no trouble with any of the shelves.

My thought in doing this was to finalize my career plans early. I was afraid that if I did surgery later and hated it, I would have little time to find another path.

While there is some overlap regarding basically medical management, I found the surgery shelf to be nothing like a medicine shelf. I hear this myth repeated often, but it isn’t true. Sure both will ask about electrolytes, but the surgery shelf won’t ask about DKA and the medicine shelf probably won’t get into paradoxical aciduria. Surgery may ask about CAD with management of a periop MI, but it won’t ask you about longer term medical management of it. As noted above, a big chunk will come from your preclinical knowledge base.

 

[doyouhaveaflag]

I agonized a lot about getting the “right” clerkship order when putting my preferences into the lottery late 2nd year. Now that 3rd year is behind me I think it actually matters very little. There are pros and cons to all orders. For example, IM first sets you up a bit better for other shelf exams but IM last means it’s freshest in your mind for step 2.

The only way in which I think it becomes extremely important is if you have any inkling you want to do a surgical aubspecialty. If you do that too late in the year, you won’t really know if you need to set up aways in time.

I was really happy I did surgery in Nov-Dec because I actually changed my mind from gen surg to a surgical sub and I then had enough time to set up aways and get some specialty specific research in.

 

[Menander's Bust]

Ultimately as others were saying, it makes no difference. I’m doing obgyn, peds, surgery, family, psych, IM and I think that’s the best, at least for me. It’s typically recommended not to do your preferred specialty first, but I did and it was fine (just get good advice and work hard since it will be your first rotation). If I had to do it over I would have switched peds and obgyn, but that wasn’t an option for me. You'll have plenty of electives to make connections also.