How do rotations work?

[tinyhandsbob]

Can someone explain to me how clinical rotations during medical school work. Specifically- how many of med students are assigned to the same rotation/department at the same time? I assume it would have to be at least several at the same time in order to be able to give everyone the rotation opportunity. If so, are several students supervised by the same physician concurrently? For a psychiatry rotation, for example, would all medical students in my class get assigned to the same psych department or would it be different departments/different hospitals? Thanks for your feedback.

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[chemdoctor]

I’m also curious.

Can you choose which rotation u wanna do at the school u attend?

 

[907914]

you limited flexibility in third year rotations in both when/where you do each rotation.

And this will vary by institution. For example, one of the most lenient and geographically diverse clinical options is University of Washington with 350+ different clinical sites across 6 states (WWAMI + a couple in OR I think?) that, aside from a few dozen that have lotteries because everyone want to go there, you can pick any that you want.

 

[MedicineZ0Z]

2-3 per service team. Rest depends on the institution/school.

 

[tinyhandsbob]

Very generally and simplistically, you have a core set of rotations across medical specialties third year and more elective choices for fourth year. In each rotation you will be part of a treatment team that will include medical residents, medical students, perhaps PA or NP, usually directly supervised by a third or fourth year resident and overseen by an attending, usually on morning rounds. I will also add, at least in my experience, you limited flexibility in third year rotations in both when/where you do each rotation.

That is interesting, I did not realize that your direct supervisor is a resident. Good to know.

 

[ciestar]

That is interesting, I did not realize that your direct supervisor is a resident. Good to know.

You spend much more time with your resident team than your attending. My inpatient peds rotation recently wrapped up and it was a new attending every week who you mostly saw only for rounds or new admissions. (This becomes significant when asking for LORs)

Your team will usually have an intern or two and a senior resident. My school doesn’t allow an evaluation from an intern, but some do. Team also usually includes an M4 and a varying amount of M3’s. (Ive been on teams of varying sizes.. one PGY3, one PGY2, two interns, one M4 and 1-2 M3’s... others with only two residents which was the case for IM, peds had a senior and two interns, surgery was in its own league since it is five years worth of residents)

EDIT: completeness

 

[907914]

(This becomes significant when asking for LORs)

Even though the residents likely know the MED student better, do you only ask attendings for LORs as opposed to residents?

In general who writes LORs for residency and how many do you submit?

 

[ciestar]

Even though the residents likely know the MED student better, do you only ask attendings for LORs as opposed to residents?

In general who writes LORs for residency and how many do you submit?

Yeah, you only ask your attendings for LORs.
Most programs want ONLY 3 letters, some will be okay with 4.

 

[ciestar]

Even though the residents likely know the MED student better, do you only ask attendings for LORs as opposed to residents?

In general who writes LORs for residency and how many do you submit?

You get letters from those you feel can write a strong letter. Depending on your specialty choice, you might need two from your chosen specialty. For FM, you usually don’t need two LORs from FM docs, but these programs (well all programs) are pretty clear about this when you apply.

 

[ciestar]

Since I have no idea what I am doing with my life (and i need to know in.. 7 weeks or so), I am likely going to have 5 LORs to pick from. It all really depends on what specialty i decide on which ones I use.

For me; im in between peds and family. I might dual apply, but idk yet. I will likely have two FM, two peds, and one OB.

 

[Goro]

You spend much more time with your resident team than your attending. My inpatient peds rotation recently wrapped up and it was a new attending every week who you mostly saw only for rounds or new admissions. (This becomes significant when asking for LORs)

Your team will usually have an intern or two and a senior resident. My school doesn’t allow an evaluation from an intern, but some do. Team also usually includes an M4 and a varying amount of M3’s. (Ive been on teams of varying sizes.. one PGY3, one PGY2, two interns, one M4 and 1-2 M3’s... others with only two residents which was the case for IM, peds had a senior and two interns, surgery was in its own league since it is five years worth of residents)

EDIT: completeness

This yet another nuance about clinical education that reminds me of the similarities between grad school vs medical school. A clinical student spending more time with residents than attendings is like those grad students spending more times with post-docs than the PI.

We now return you to your regularly scheduled SDN thread!

 

[tinyhandsbob]

You spend much more time with your resident team than your attending. My inpatient peds rotation recently wrapped up and it was a new attending every week who you mostly saw only for rounds or new admissions. (This becomes significant when asking for LORs)

Your team will usually have an intern or two and a senior resident. My school doesn’t allow an evaluation from an intern, but some do. Team also usually includes an M4 and a varying amount of M3’s. (Ive been on teams of varying sizes.. one PGY3, one PGY2, two interns, one M4 and 1-2 M3’s... others with only two residents which was the case for IM, peds had a senior and two interns, surgery was in its own league since it is five years worth of residents)

EDIT: completeness

I assume for LORs, it is easier to get a strong one after a smaller rotation, where you had more chance to interact with the attending?

 

[907914]

I assume for LORs, it is easier to get a strong one after a smaller rotation,

This, I believe, is one of the benefits of going to a smaller school/opting for one of the non-academic rotations in your field of interest. You are first in line next to the attending to see what is going on instead of being behind the senior residents, the residents, the interns, the midlevels, the 4th years, and THEN you. Is this a (mostly) accurate assumption @ciestar?

 

[ciestar]

I assume for LORs, it is easier to get a strong one after a smaller rotation, where you had more chance to interact with the attending?

Yes, the more time you spend with an attending, the better chance you have to impress them and get a strong letter.

This, I believe, is one of the benefits of going to a smaller school/opting for one of the non-academic rotations in your field of interest. You are first in line next to the attending to see what is going on instead of being behind the senior residents, the residents, the interns, the midlevels, the 4th years, and THEN you. Is this a (mostly) accurate assumption @ciestar?

I go to a school with the second largest MD class in the country.

And ehh, these aren’t always the best rotations either. From reading the DO threads where preceptor-based rotations can be more common, they aren’t always the best experiences since (at least in the case of my friend) it was really busy and she didn’t get to do much of anything by herself.

Of course, if you get one of these rotations with a lot of autonomy on the student part, you really have a chance to shine.

Other thing with academic center rotations is that you’re exposed to programs. If you’re trying to match a specialty, you want to impress the people at places you could match at

 

[tinyhandsbob]

Yes, the more time you spend with an attending, the better chance you have to impress them and get a strong letter.



I go to a school with the second largest MD class in the country.

And ehh, these aren’t always the best rotations either. From reading the DO threads where preceptor-based rotations can be more common, they aren’t always the best experiences since (at least in the case of my friend) it was really busy and she didn’t get to do much of anything by herself.

Of course, if you get one of these rotations with a lot of autonomy on the student part, you really have a chance to shine.

Other thing with academic center rotations is that you’re exposed to programs. If you’re trying to match a specialty, you want to impress the people at places you could match at

What does a non-academic rotation refer to, a rotation in a non-teaching hospital like a community clinic?

 

[ciestar]

What does a non-academic rotation refer to, a rotation in a non-teaching hospital like a community clinic?

Yeah, that is what i meant by that.

 

[AnatomyGrey12]

This is how rotations work:

1. Get assigned your 3 patients
2. Go see them, take a history, do a physical, etc.
3. Pour over the chart for 2 hours writing down all the lab values, looking up the MOA and indications for all their meds, why certain labs are what they are, what you think the diagnosis is, and calculating every possible clinical score you can think might apply to them.
4. Create your own assessment and plan list.
5. Go over the actual assessment and plan with the intern because you will be wrong 95% of the time
6. Round with the attending and present your patients to them, get pimped on various aspects of the treatments, diagnoses, meds, pathophys, criterias and various scores associated with their presentation.
7. Try not to look like an incompetent monkey while you do 6.
8. Realize you know absolutely nothing and need to study a lot more.
9. Rinse and repeat.

 

[tinyhandsbob]

This is how rotations work:

1. Get assigned your 3 patients
2. Go see them, take a history, do a physical, etc.
3. Pour over the chart for 2 hours writing down all the lab values, looking up the MOA and indications for all their meds, why certain labs are what they are, what you think the diagnosis is, and calculating every possible clinical score you can think might apply to them.
4. Create your own assessment and plan list.
5. Go over the actual assessment and plan with the intern
6. Round with the attending and present your patients to them, get pimped on various aspects of the treatments, diagnoses, meds, pathophys, criterias and various scores associated with their presentation.
7. Try not to look like an incompetent monkey while you do 6.
8. Realize you know absolutely nothing and need to study a lot more.
9. Rinse and repeat.

what is the MOA?

 

[ciestar]

what is the MOA?

Mechanism of action

Edit: i got pimped recently on why you need higher doses of amoxicillin for acute otitis media vs strep throat. I had to know how amoxicillin works and what specific protein mutations can call for the need for higher doses. This was covered in pharm for like a minute 18 months prior, but i didnt remember any of it.

They can pimp you on literally anything.

 

[AnatomyGrey12]

Mechanism of action

Edit: i got pimped recently on why you need higher doses of amoxicillin for acute otitis media vs strep throat. I had to know how amoxicillin works and what specific protein mutations can call for the need for higher doses. This was covered in pharm for like a minute 18 months prior, but i didnt remember any of it.

They can pimp you on literally anything.

It's always a little redeeming when they move up the chain and even the senior resident says they don't know it lol

 

[ciestar]

It's always a little redeeming when they move up the chain and even the senior resident says they don't know it lol

It is indeed satisfying lol
When i was on surgery i knew the answer and the pgy-2 did not. I felt very good that day

 

[tinyhandsbob]

It is indeed satisfying lol
When i was on surgery i knew the answer and the pgy-2 did not. I felt very good that day

Are these questions asked on the spot or do you have some time to look it up previously? I mean that amoxicillin answer would only take a quick pubmed literature search to find out. I guess it depends on in depth they want you to go also, versus just showing familiarity with the conclusion. And how much does knowing the answer really matter? If the resident does not know the answer, I can't imagine you'll be graded down too much for it, especially if you had no time to look it up. Practicing medicine entirely from memory would lead to malpractice eventually even for experienced doctors.

 

[ciestar]

Are these questions asked on the spot or do you have some time to look it up previously? I mean that amoxicillin answer would only take a quick pubmed literature search to find out. I guess it depends on in depth they want you to go also, versus just showing familiarity with the conclusion. And how much does knowing the answer really matter? If the resident does not know the answer, I can't imagine you'll be graded down too much for it, especially if you had no time to look it up. Practicing medicine entirely from memory would lead to malpractice eventually even for experienced doctors.

Pimping is on the spot. If you don’t know, you can be told to go look it up and present on it the next day.

And in regards to the amoxicillin thing, the resident knew the answer.

Nobody expects you to practice medicine from memory but there are a lot of things you should just know.

 

[907914]

If you don’t know, you can be told to go look it up and present on it the next day.

No joke, pimping sounds genuinely fun. I love not knowing stuff and teaching others. (this is not a joke).

 

[ciestar]

No joke, pimping sounds genuinely fun. I love not knowing stuff and teaching others. (this is not a joke).

Until it is counted against you on your evaluations. At my school we’re graded on clinical knowledge.

Pimping isn’t all bad. Just hope you don’t get a malignant resident or attending who belittles you for not knowing the answer.

 

[NickNaylor]

As others have mentioned, a lot of it will depend on your institution.

The core clerkships that you are required to complete are the same everywhere. These include internal medicine, family medicine, surgery, OB/GYN, family medicine, neurology, pediatrics, and psychiatry. You will do these clerkships no matter where you go. Some institutions also have other requirements that they may add to that; for example, a rotation in emergency medicine is not uncommon.

Where you rotate and what kind of service you're on will be very institution-dependent. Whether or not you have a choice in that will also be institution-dependent (at my school, we didn't have any choice in that). If you're at a fairly large academic system, you may rotate with one or two other medical students, if that. For smaller systems, there may be several medical students on your team. An attending may be responsible for supervising a couple of medical students or only one. At the institution I'm currently at, for example, we typically have 3-4 medical students rotating on our inpatient psychiatric unit, but we have 3 different teaching teams, so an attending may supervise 2 students at most.

The length of the clerkship will also vary from institution to institution. Generally, you will likely spend time on a couple of different services during your clerkship. At my school, for example, our internal medicine clerkship was 3 months, but that time was split among several different services: 1 month was general internal medicine and the remaining 2 months were split into 2-week blocks on various services (e.g., general outpatient internal medicine, inpatient specialty services, etc.). The goal is to get you a broad exposure to several areas of medicine during your clerkship. Again, how this specifically works out will depend heavily on your institution and the individual department.

tl;dr: There's a lot of variety here, and it's difficult to say what, specifically, you will experience. The broad strokes of what is expected during clerkship experiences is spelled out, but medical schools have wide latitude with respect to how they're going to implement those guidelines.

 

[FreeMedEd]

Can someone explain to me how clinical rotations during medical school work. Specifically- how many of med students are assigned to the same rotation/department at the same time? I assume it would have to be at least several at the same time in order to be able to give everyone the rotation opportunity. If so, are several students supervised by the same physician concurrently? For a psychiatry rotation, for example, would all medical students in my class get assigned to the same psych department or would it be different departments/different hospitals? Thanks for your feedback.

It's actually very diverse and largely depending on the physician and/or the clinical coordinator. As most answers here are related to school/coordinators scheduling events, I will focus on the independent side of things.

Many students wish to set up their own rotations outside of their school network (independent away rotations) or do not have a strong affiliate hospital in which to rotate (the Caribbean/foreign schools). In these situations, it is common for a preceptor not directly affiliated with a university hospital to take on these students. For these, it is completely up to the preceptor how many students they will take.

Many wish to keep it to a minimum (2-4) to provide more individualized instruction or due to having a small clinic. Others may take on 8+ students for various reasons (I do not recommend these situations as they often provide fewer educational experiences for each student).

In this setting, it is also generally occupied only by medical students, not mixed with residents/fellows/etc., which can be a benefit to the students and preceptors. Instead of needing to decipher information for several different levels of knowledge, a preceptor can focus on students that are generally within 1 academic year of each other, and likely know much of the same material.

 

[salpinx minx]

Seems like everything has been well-covered here - only thing I'll add is, don't be too scared about pimping. I'm at a T5 school and they tell us that you're being graded less on your clinical knowledge than your ability to learn, adapt, think on the spot, and take care of patients. They realize that you don't know much at this level of your training - they just want to see that you're eager to learn, you're putting in the work, and you can be a team player. Case in point: one time I royally effed up an anatomy pimp question during my surgery rotation, I guessed that a branch of the celiac trunk was...the aorta itself. I shudder when I remember it. On ortho, I think I got maybe one pimp question correct in the span of two weeks. I looked like a total ******* in terms of my clinical knowledge, and yet still got an honors on that rotation because I was working my butt off and asking good questions.

I've found that nothing helps me remember something than the shame of having gotten it wrong while pimped. So really, be grateful when someone asks you something you don't know - thanks to the (hopefully healthy) stress they've induced, they've probably made it something you'll never forget. That's what rotations are for, after all - learning. It's more about continuing your education than it is about assessing what you learned in the first two years. You'll do great!