Clerkships with greatest learning curve

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Anastomoses is still in her pre-clinical years. Yes, you will (most likely) see combative or at least agitated patients. It happens, one of the skills is to realize when you can calm them down and when you need to just walk away.

Also, for the discussion between need for OB/peds vs no need for OB/peds, I think some exposure to it is fine, but you definitely don't need 8 weeks of OB/GYN. Even 6 weeks was a bit much. The thing is, 3rd year rotations are generally less competitive than non-3rd year rotations (besides subspecialties in IM/surgery/GYN). I think that is one of the factors in why the system hasn't changed.

I don't argue that we don't need OB/GYN or Peds exposure. I DO argue that EVERY medical school should have mandatory Rads and EM blocks, and that neuro shouldn't be a required. And there should be more electives (in 3rd year) so say someone is procedure based, they can do critical care vs anesthesia vs surgical subspecialty rotations to figure out which one they would like.

At my medical school, we do the following
12 weeks IM (8 weeks IP + 4 weeks of OP)
12 weeks surgery (3 weeks general, 3 weeks trauma/acute care, 3 weeks elective, 3 weeks cardiac/thoracic/vascular)
6 weeks peds (2 IP, 2 OP, 2 NICU)
6 weeks OB/GYN (1 L&D, 1 L&D NF, 2 Gyn OP, 2 Gyn IP/Gyn Onc)
6 weeks psych (5 IP, 1 OP)
6 weeks family (6 OP)

This leads to 10 weeks of OP primary care. All sorts of F-that come to my mind.

Here's what I would LIKE as the breakdown
IM - 8 weeks, ALL IP. 8 weeks.
Surgery - Honestly this is probably the best one. No real complaints about how they break this one up. If I was going to make it 8 weeks though, I'd say something like 2 General + 3 sub-specialty (including cardiac/thoracic/vascular if that's your thing) + 2 trauma/acute care). 8 weeks.
Peds - Get rid of NICU. As a 3rd year (at least at my hospital) the attendings don't let you touch anything, and you end up doing newborn exams in the nursery for 2 weeks. Waste of time. 4 weeks.
Psych - 3IP + 1 OP - 4 weeks.
OB/GYN - Clinic - 1 week. Gyn or GynOnc - 1 week. L&D + NF - 2 weeks.
Family Med - 4 weeks OP.

That has saved 4 + 4 + 2 + 2 + 2 + 2 = 16 weeks. Guess what? That's 4 4-week electives during 3rd year.

4th year rotations are allowed to be 4 weeks long. Why is that so taboo for 3rd year students?
 
Anastomoses is still in her pre-clinical years. Yes, you will (most likely) see combative or at least agitated patients. It happens, one of the skills is to realize when you can calm them down and when you need to just walk away.

Also, for the discussion between need for OB/peds vs no need for OB/peds, I think some exposure to it is fine, but you definitely don't need 8 weeks of OB/GYN. Even 6 weeks was a bit much. The thing is, 3rd year rotations are generally less competitive than non-3rd year rotations (besides subspecialties in IM/surgery/GYN). I think that is one of the factors in why the system hasn't changed.

I don't argue that we don't need OB/GYN or Peds exposure. I DO argue that EVERY medical school should have mandatory Rads and EM blocks, and that neuro shouldn't be a required. And there should be more electives (in 3rd year) so say someone is procedure based, they can do critical care vs anesthesia vs surgical subspecialty rotations to figure out which one they would like.

At my medical school, we do the following
12 weeks IM (8 weeks IP + 4 weeks of OP)
12 weeks surgery (3 weeks general, 3 weeks trauma/acute care, 3 weeks elective, 3 weeks cardiac/thoracic/vascular)
6 weeks peds (2 IP, 2 OP, 2 NICU)
6 weeks OB/GYN (1 L&D, 1 L&D NF, 2 Gyn OP, 2 Gyn IP/Gyn Onc)
6 weeks psych (5 IP, 1 OP)
6 weeks family (6 OP)


This leads to 10 weeks of OP primary care. All sorts of F-that come to my mind.

Here's what I would LIKE as the breakdown
IM - 8 weeks, ALL IP. 8 weeks.
Surgery - Honestly this is probably the best one. No real complaints about how they break this one up. If I was going to make it 8 weeks though, I'd say something like 2 General + 3 sub-specialty (including cardiac/thoracic/vascular if that's your thing) + 2 trauma/acute care). 8 weeks.
Peds - Get rid of NICU. As a 3rd year (at least at my hospital) the attendings don't let you touch anything, and you end up doing newborn exams in the nursery for 2 weeks. Waste of time. 4 weeks.
Psych - 3IP + 1 OP - 4 weeks.
OB/GYN - Clinic - 1 week. Gyn or GynOnc - 1 week. L&D + NF - 2 weeks.
Family Med - 4 weeks OP.

That has saved 4 + 4 + 2 + 2 + 2 + 2 = 16 weeks. Guess what? That's 4 4-week electives during 3rd year.

4th year rotations are allowed to be 4 weeks long. Why is that so taboo for 3rd year students?

Wait, your school doesn't require neuro? Damn you're lucky. I thought neuro was an LCME requirement, but I guess we've all been duped.
 
Surgery, to me. I knew close to nada about surgical procedures and perioperative care and, maybe most disorientingly, OR protocol from years 1 and 2, and that was what we spent all day doing. In terms of tested material less so...you can know what looks like appendicitis or cholecystitis or peptic user from preclinical stuff.

We did 5 weeks gen surg, 5 weeks subspecialty (mine was ophtho clinic, more or less a joke), 5 weeks OBGYN. Seemed fair enough.

Combative patients...I've had a few...but then again, too few to mention. Being as you have time as a medical student you can defuse them with empathy (they may need it but they don't have to like it) and lightheartedness or a sincere effort to understand their (possibly manic or delusional) POV. I recommend it, worth the effort, great learning exercise, and connecting means greater chance at useful info and treatment compliance.
 
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As a pediatrician, I dont feel that it is necessary for people going into other fields to take a clerkship in peds to be a competent physician.

The one non-peds clinical exposure that I wish I had more of is OB/GYN. There's a lot of stuff they do at the end of pregnancy that affects us as pediatricians that is helpful for us to know and understand their thinking.

I will say, however, that no matter what you jaded med students say, treating kids absolutely ROCKS! Even when they throw up on you or pee on you. :laugh:

My first patient today was a 2 year old girl who I'd never seen before. She immediately jumped into my arms and we spent a couple of minutes flying around the room on one of those stool chairs that has rollers on it. Her smile and laugh were infectious.

Seriously, kids are everything that is good and right about the world.
 
Kids are awesome 😀

I do agree that there should be more electives in med school. That way, your education can:
1) Tailor to your interests and/or get more exposure to your chosen field.
2) Expose you to fields you'll never see again in residency.

Surgery being 12 weeks IMO is way too much. After 6 weeks, I was done. The time after that to the last day was the worst time as a 3rd year. Literally did not want to go to work anymore, and had to hold in all my frustrations. As someone who is normally optimistic and "perky", this was the only time in med school that I felt sad.

I would have liked to see more OP Psych. I can understand why it's very difficult to do from a med student standpoint(patient's don't want strangers to listen to their private convos), however, there are some psychiatric illnesses don't present in the psych ward.

I think neuro should stay a requirement. 4 weeks of that doesn't hurt. Rads AND EM should be taken by every medical student. Rads with the dual perks of being super easy, and a good chance to learn a little about it. You won't be adept at reading all your images in 4 weeks, but you'll take some pearls away from it. EM is also a great rotation to do prior to Step 2 CS!
 
Wait, your school doesn't require neuro? Damn you're lucky. I thought neuro was an LCME requirement, but I guess we've all been duped.

4 week block mandatory during 4th year along with a 4 week mandatory medicine sub-I. I forgot about it since I haven't taken it yet. Not looking forward to it.

So maybe throw that 4 weeks of Neuro into 3rd year as well in exchange for one elective block.
 
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