Elective Rotations "Strategy"

[doctorE2010]

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I'm an MSII starting to think about rotation schedules. I'd like to do several peds subspecialty rotations at the hospital where I would ideally like to get a residency spot.

My very first rotation is an elective, but I'm guessing it's probably best NOT to start off in a subspeciallty since I'll know absolutely nothing. Is this true? Should I just do genereal peds then for this first spot?

After that, I'll only have 3 more electives that allow subspecialties: November of 3rd year, and August and October of 4th year. Would November 3rd year be too early to do an "audition away rotation" or should i wait until 4th year? I'll have done two general peds rotations by that point.

When's the latest one can do an "audition rotation" ie--when are residency applications due?

Also, should I try to do as many rotations as possible at the hospital I'd like to be at for residency (probably 3-4 max) or should I just do one or two. My grades are just average so I think my performance would (hopefully) help me. Should I do one or two "audition rotations" at backup hospitals as well?

This is so confusing to plan all this out!

 

[getunconcsious]

I'm an MSII starting to think about rotation schedules. I'd like to do several peds subspecialty rotations at the hospital where I would ideally like to get a residency spot.

My very first rotation is an elective, but I'm guessing it's probably best NOT to start off in a subspeciallty since I'll know absolutely nothing. Is this true? Should I just do genereal peds then for this first spot?

After that, I'll only have 3 more electives that allow subspecialties: November of 3rd year, and August and October of 4th year. Would November 3rd year be too early to do an "audition away rotation" or should i wait until 4th year? I'll have done two general peds rotations by that point.

When's the latest one can do an "audition rotation" ie--when are residency applications due?

Also, should I try to do as many rotations as possible at the hospital I'd like to be at for residency (probably 3-4 max) or should I just do one or two. My grades are just average so I think my performance would (hopefully) help me. Should I do one or two "audition rotations" at backup hospitals as well?

This is so confusing to plan all this out!

If I were you I wouldn't do peds or anything peds-related first (I'm guessing Pediatrics is your intended specialty). This is because whenever you start
MS3 you are so confused and dumb that you WILL look bad, at least at first. In my honest opinion, using an elective in the first month is a total waste. If I were you I would take medicine first, so you can learn how to write good detailed H&P's and SOAP notes. Granted, I haven't taken peds yet but from what I understand the format of the two rotations is pretty similar. I am also thinking about peds as a possible specialty, thus I'm taking it in January and February when I should be at my best. I seriously think you should try to get out of taking an elective first. You should be able to have fun and shine on electives, not be all confused and clueless!

 

[smq123]

My very first rotation is an elective, but I'm guessing it's probably best NOT to start off in a subspeciallty since I'll know absolutely nothing. Is this true? Should I just do genereal peds then for this first spot?

It's best NOT to start off in a subspecialty, but not for the reason you mentioned. It's because you won't learn anything. Subspecialties don't teach you the basics, and so on your 2nd rotation, you'll have to start from scratch. And that's annoying. Subspecialties do not teach you how to present a patient correctly. They rarely teach you good sterile technique and they almost never show you how to write a good progress note.

If you KNOW for a certainty that you will never, ever go into OB/gyn, that's a good one to start with. If you end up hating it, you'll get it out of the way. (Of course - I should add - never knock it until you try it, because you never know.) You'll learn sterile OR technique on GYN, and you'll learn how to quickly and efficiently present patients on OB. You'll have to write up patients for both. I think that it really teaches you the basics of both medicine and surgery, which is good.

After that, I'll only have 3 more electives that allow subspecialties: November of 3rd year, and August and October of 4th year. Would November 3rd year be too early to do an "audition away rotation" or should i wait until 4th year? I'll have done two general peds rotations by that point.

That early in 3rd year, do you really know what you want to do? If you haven't done any of the other core rotations, how do you know if you'll end up liking other things more?

When's the latest one can do an "audition rotation" ie--when are residency applications due?

It depends on what you want. If you want an LOR, then you must do an audition before October - otherwise it will be too late to get it into your ERAS. If you just want to audition, then you can do it before December, probably, if you have to.

This is so confusing to plan all this out!

That's because you're over-thinking it, I think. It's very early in 2nd year, even - your FIRST concern at this point should be doing well on USMLE 1/COMLEX 1 and on the rest of your 2nd year classes. Then, just try and get a schedule that will help you get your core rotations done with. THEN you can think about electives - you don't even know for sure what you want to specialize in, so just wait a little bit longer.

 

[doctorE2010]

Thanks for the replies so far. I don't have a choice in the rotation sequence, I MUST do an elective the first rotation--this cannot be changed so I just have to work with it. After that I have 3 months of IM, then OB and peds.

I'm 99% sure I'll wind up in peds or OB (although leaning towards peds subspecialties at the moment). I don't want to waste and elective doing IM or FP just beacuse it's the first rotation, when I know I'd rather work with kids or in OB. So, maybe general peds outpatient would be a good choice for this first rotation elective?

 

[The Buff]

You know, FP's work with both OB patients and kid patients. Doesn't sound like a waste to do something like this first....

 

[Law2Doc]

I don't want to waste and elective doing IM or FP just beacuse it's the first rotation, when I know I'd rather work with kids or in OB.

I think you missed smq123's point, which is a good one. Your goal in your first rotation, regardless of what it is and regardless of what you ultimately want to do, is to learn how to do a rotation. So pick something where you will learn to present patients and write up notes. (Or something where you will learn proper OR procedure, etc.) So that when you get to a rotation you actually care about, you won't stink up the place.

You will be BAD at all this at first. All med students are. So you are often well advised not to select something you might really be interested in first, because you likely will not make a good impression. You will, however learn what not to do next time. So pick something you think you won't be interested in. Learn from failures. And then step it up a gear when you take on the rotations you care about. Bottom line, you won't be wasting an elective if you master the art of the rotation. Taking something you have an interest in, and burning bridges because you don't know what you are doing is the only way you waste the first rotation.

 

[doctorE2010]

any other thoughts or ideas?

 

[Blade28]

You will be BAD at all this at first. All med students are.

Truer words were never spoken.

 

[baya]

FWIW:
I was (and still am) strongly interested in doing peds, did it first, and honored.

I only honored one other 3rd year rotation, so I'm not a super star or anything. I think it was enthusiasm and hard work that made the difference.

So take the advice against doing what you're interested in first with a grain of salt. YMMV.

I think you missed smq123's point, which is a good one. Your goal in your first rotation, regardless of what it is and regardless of what you ultimately want to do, is to learn how to do a rotation. So pick something where you will learn to present patients and write up notes. (Or something where you will learn proper OR procedure, etc.) So that when you get to a rotation you actually care about, you won't stink up the place.

You will be BAD at all this at first. All med students are. So you are often well advised not to select something you might really be interested in first, because you likely will not make a good impression. You will, however learn what not to do next time. So pick something you think you won't be interested in. Learn from failures. And then step it up a gear when you take on the rotations you care about. Bottom line, you won't be wasting an elective if you master the art of the rotation. Taking something you have an interest in, and burning bridges because you don't know what you are doing is the only way you waste the first rotation.

 

[domer621]

You know, FP's work with both OB patients and kid patients. Doesn't sound like a waste to do something like this first....

👍

Try to do family med first. That's the only other place you'll get exposure to pediatric patients, so you can take the opportunity to learn about peds from that.

 

[latinfridley]

I would take a non-peds rotation first. You need to learn how to write notes and present in an efficient manner, etc... before you can truly shine on a rotation.

 

[doctorE2010]

thanks for the feedback so far. At my school our rotation schedule is set in stone. My schedule is elective (4 wks), IM (12 wks) OB (4wks) peds (4wks) FP (4wks) elective (4wks) surgery (8 wks) etc....so, I can't switch around my schedule and move my mandatory FP to the front, which seems to be what some people are suggesting--I guess it's different at different schools--I wish I could switch it!

So given that I'm fairly certain that I want to go into peds, I don't really understand the reasoning NOT do do my elective in general peds. It doesn't really matter if I don't look stellar because I can get letters of recommendation from other peds rotations. I'm figuring it will just help me learn what I need to know so I rock the remaining peds rotations I do. Plus, I was thinking starting in outpatient would be a nice warm up. any more suggestions?

 

[Law2Doc]

So given that I'm fairly certain that I want to go into peds, I don't really understand the reasoning NOT do do my elective in general peds. It doesn't really matter if I don't look stellar because I can get letters of recommendation from other peds rotations. I'm figuring it will just help me learn what I need to know so I rock the remaining peds rotations I do. Plus, I was thinking starting in outpatient would be a nice warm up. any more suggestions?

I think the point is that doing poorly is more of a possibility in your first rotation because you (like everyone else) will show up knowing squat. And if you have to do poorly, it hurts the most if it's something you hope to go into, and least if it's something unrelated. This is true regardless of whether you will later have a peds rotation from which you can get recommendations. ANY rotation is going to be helpful in teaching you how to handle yourself on a rotation, as they all tend to require writing progress notes, presenting patients to residents, conducting yourself in front of patients, but not every rotation is going to look equally as bad if you tank it. As baya pointed out above, not everyone struggles on their first rotation, but many do, and you really should cover your bases and pick something not so damaging in case you do. Just my opinion.

 

[TheMightyAngus]

I also got shafted in the clerkship lottery and drew 4 weeks of elective for my first third-year rotation. I have surgery then medicine scheduled after my elective. I'm interested in a surg subspecialty.

What do you guys think about starting off with endocrine or vascular surg? Good way to learn the ropes?

Or should I start off with something of breadth, like family med, which I would have to repeat as a core clerkship? Or something known to be cush, like radiology/anesthesia?

 

[smq123]

I also got shafted in the clerkship lottery and drew 4 weeks of elective for my first third-year rotation. I have surgery then medicine scheduled after my elective. I'm interested in a surg subspecialty.

What do you guys think about starting off with endocrine or vascular surg? Good way to learn the ropes?

Or should I start off with something of breadth, like family med, which I would have to repeat as a core clerkship? Or something known to be cush, like radiology/anesthesia?

Don't start off with family med if you have surgery next. Family med is almost exclusively outpatient, so you won't know how to enter inpatient orders/write SOAP notes/present on AM rounds/do post-op checks/control your bladder when the operation hits hour 7. (Not uncommon in some plastics cases.) You'll just wander around like a deer-in-headlights in the OR, especially because outpatient rotations don't teach you anything about sterile technique in an OR.

Also, don't do something "cush" unless you have not taken Step 1 yet. If you need to study for something (Step 1, or, God forbid, a Step 1 re-take), then having a cush rotation is good. Otherwise, don't start out with one. You won't learn anything, and it'll make you lazy.

Which surgical subspecialty are you interested in? I'd recommend starting out with a surgery subspecialty, especially if you have surgery after that. Something like urology or ENT can really help you adjust to life as a third year - most of the residents in those specialties are very laid-back and cool (maybe not at your school, obviously, but from what I've seen....), and you'll learn how to scrub in/retract. If you've got a really cool resident, they'll teach you how to tie knots and suture a little.

 

[8o8o8o8]

@ my school I was continually told the order doesn;t matter, and in a sense it doesn't, you'll be fine with whatever order you do, HOWEVER, I would give these 3 pieces of advice that will improve your life during rotations

1) if you actually know what you want to go into, do NOT do it first OR last. Do it second, and if it's not medicine (or a med subspecialty) do internal medicine 1st, it helps the most with every other rotation and subsequent shelf exams are then easy

2) We have psych / neuro & "the O's" (ortho, ophtho & oto) lumped as one block when we rank. If you have anything similar do this last! If you do it earlier you will waist your efforts and not fully appreciate the beauty of 8-5 & no weekends.

3) if you are thinking surgery, do medicine before surgery. Medicine was far and away the most time intensive rotation, even though the in house hours were less than surg hours, there was ALWAYS stuff to do when I got home. Do NOT do medicine last, you will be burnt out.

Good luck on the wards.