doing medicine last?

[Nestle]

hey - What do you all think about doing a medicine rotation at the very end of 3rd year? Did any of you do that and feel it was really bad or good idea? Especially for someone who is undecided about what field they would like to go into. Would all the attendings just have really high expectations and make it really hard?

Thanks.

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[docB]

The order of your third year rotations is not that important. The attendings know that you don't have that much choice. They will expect you to know the basics by then but they will still expect to teach you about their field.
Now the order of fourth year rotations is important.

 

[doepug]

I think it's a bad idea to do medicine last...

1) Medicine will help you in other clerkships. It really will.

2) Many, many specialties require an internal medicine residency. You should take medicine early enough to plan your career accordingly. What if you want to be a cardiologist, only to find at the end of year 3 that you hate medicine?

3) If your school has any flexibility in the scheduling of electives, take medicine early; it's a prerequisite (explicit and/or implicit) for most electives.

Cheers,
doepug

 

[TulaneKid24]

At my school, we don't have any choice when are 3rd year rotations are. A schedule is simply handed to us. A group of students will always have medicine last. The order of third year ultimately does not really matter that much.

However, if I had a choice, I would take the medicine clerkship fairly early in the 3rd year (first or second block). Internal Medicine is, without a doubt, the back bone of most all medicine. IM will help you in everything.

 

[Amy]

If I think I want to go into medicine, is it still a good idea to do it early? I guess that would help me figure out if it's what I really want, and help with the rotations that follow it, but I want to do really well (impress my attendings, get good LOR for residency programs, etc.). Suggestions?

 

[rirriri]

im in Chicago right now doing my cores. i started with obstetrics and gyn in September.....then did Pediatrics.

i just started IM and i must say that im VERY happy im doing it 3rd and in this order.

it helps because im very oriented to the system of doing rotations. i don't have to fool around trying to figure out what goes where in a patient chart and i don't feel as if im completely unknowing about what is happening in a hospital setting.

IM is the "heart" of our core rotations, and i wanna maximize my learning during it. the fact that i dont have to worry about all the useless *orientation* stuff right now is very much helping me focus on learning the information and listening better.

another major advantage for someone who has N0 interest in doing IM/FP/etc. for residency is that my Step 2 will be much nearer to the time period of my rotation......i finish IM at the end of march, and im taking step two in may or june.

cheers
rirriri

 

[Nestle]

thanks for the input.
Can you elaborate more on why the order of 4th year rotations is more important? what exactly do 4th years do anyway?? i'm so confused about that. if i have to take medicine at the end of 3rd year and end up wanting to do medicine, will that hurt me when I am trying to schedule my sub-I and 4th year stuff?

oh, and what month do most people take Step 2?

thanks!!

 

[docB]

You have to do your fourth year rotations in your chosen field early so you can get the grades and letters you'll need for interviewing.
If you think you might like to do a medicine residency you should schedule a medicine Sub-I and electives early in your fourth year.
I was assuming before that you just got stuck with medicine last in the luck of the draw. If this is the case I don't think it'll hurt you much.

 

[Samir Desai]

I am a medicine attending who has the opportunity to work with many students during their third year of medical school. My personal feeling is that the medicine rotation should not be done first or last but rather sometime in between. Having said this, there are many who favor taking medicine first. Why? Because once you have taken medicine and gotten comfortable performing H&Ps, presenting patients, and doing write-ups, it is easier to take these skills that you have acquired and adapt them to your other rotations. The reason I do not advise students to take medicine first is because the start of the third year of medical school is difficult for most students. The world of clinical medicine is very different than the first two years of medical school and students are often overwhelmed by their new clinical responsibilities. This anxiety coupled with inexperience often leads to students not performing at the level they are capable of, a level which they achieve with subsequent rotations. In a perfect world, attendings would take this inexperience into account and adjust their expectations accordingly but I can tell you that this does not often occur.

As for doing medicine last, my feeling is that this is also to your disadvantage. As I mentioned above, the skills that you acquire can serve you well on your other rotations. In addition, some of your other rotations will expose you to topics that you would already have seen in medicine. And your question about high expectations is a good one. Right or wrong, many attendings do expect more from their third years at the end of the year. So mistakes that may have been more easily tolerated at the beginning of the third year may leave an attending shaking his head, saying "I'm surprised that this student hasn't learned this by now".

These are just my opinions and to my knowledge, there is no data that says students who do medicine first, last, or sometime in between are better doctors than their counterparts. Hopefully that helps but if you have any other questions, please feel free to send me a PM.

Samir Desai
Assistant Professor of Medicine
Baylor College of Medicine

 

[Airborne]

Interestingly, at my school your grade for each rotation is graded with the peers you rotate with - 20% of students in each roation get honors. Thus 20% of students who take IM first and 20% of students who take IM last will get the big H. Clearly, the expectations are greater as the year ends (since the the end of your last rotation, you are an MSIV!) - but all your fellow rotation-mates have this same expectation. The converse is true for taking the course at the beginning.

I agree that the order of 4th year is VERY important, especially if you are considering an early match - but that is for another thread.

Airborne