How Important Are 3rd Year Rotations?

[Low Flow]

At my school, students are assigned a rotation site based on a points system (birthplace, parents' location, spouse, children, etc.). One site is in a major city with two level 1 trauma centers, a couple sites have level 2 trauma centers, and a few have level 3 trauma centers.

My preliminary interests are in some type of critical care (and I realize this is highly subject to change). My question is, how important is 3rd year with respect to quality of education as a function of the size of the hospital and/or trauma level? I ask because based on my points, I may end up at the site which has two 250 bed hospitals, one of which is trauma level 3.

It seems I've read a lot about third year being mostly learning the basics, i.e. it wouldn't matter if the attendings are doing all these crazy surgeries, you're barely able to take a decent history. Does this hold some truth? Ideally, I'd like to shoot for the major city with the level 1 trauma centers, but it's a high demand site and I don't have any points there.

I intend to land a residency in a large city at a fairly big hospital. Am I correct in thinking that getting stuck at a smaller hospital for my 3rd year rotations will not be a major impediment to my education?

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[Guillemot]

Being at a big hospital may or may not equate to a better educational experience. It sounds like you have no choice so no point in worrying about it. Also you can do away rotations your 4th year if you want to check out another venue.

 

[madchemist89]

The people you work with will determine the quality of your education much more than your location.

 

[Psai]

big hospital = busy = residents don't have time to teach you. barely see attendings. likely to see more interesting pathology as drawing from a bigger population
small hospital = less busy, maybe people have more time to teach you things. likely to be more autonomous and get hands on learning

pros and cons but like the guys above me said, it depends a lot on who you're with

 

[doc05]

there's no advantage or disadvantage. at the student level it is actually meaningless. more important to figure out what you will train in before crit care fellowship - surgery or medicine? or anesthesiology?

 

[notbobtrustme]

nothing you do as a 3rd year matters. The only thing that really matters are grades. What you do in a 8 week IM rotation or 4 week EM rotation means nothing in the grand scheme of things. You literally spend 20x - 30x more time in residency doing the **** that matters than you will as a 3rd year. The difference between an all-star 3rd year and an average 3rd year is literally 1 week in your intern year and even less if comparing pgy2 entry specialties.

3rd year is seeing sausage getting made. Residency is learning how to make sausage.

 

[Low Flow]

Being at a big hospital may or may not equate to a better educational experience. It sounds like you have no choice so no point in worrying about it. Also you can do away rotations your 4th year if you want to check out another venue.

I ask because although I may have a slim chance at landing the rotation in the biggest city, I may have the opportunity to go to the site which has a level 2 trauma and a few 300+ bed hospitals, vs the site with 2 200+ beds/level 3 trauma.

nothing you do as a 3rd year matters. The only thing that really matters are grades. What you do in a 8 week IM rotation or 4 week EM rotation means nothing in the grand scheme of things. You literally spend 20x - 30x more time in residency doing the **** that matters than you will as a 3rd year. The difference between an all-star 3rd year and an average 3rd year is literally 1 week in your intern year and even less if comparing pgy2 entry specialties.

3rd year is seeing sausage getting made. Residency is learning how to make sausage.

That's what I thought, but just wanted to make sure. Thanks.

 

[Low Flow]

Being at a big hospital may or may not equate to a better educational experience. It sounds like you have no choice so no point in worrying about it. Also you can do away rotations your 4th year if you want to check out another venue.

Also, I intend to do at least a few away rotations at major trauma centers. By 4th year would you be prepared enough to benefit from doing an away rotation at a major hospital like that?

 

[Kaustikos]

I prefer regional sites for my training because I have learned and done a lot more.
But center sites are where the letters come from.
Sadly, I learned more internal medicine and ob/gyn on my family medicine rotation than the two months internal medicine and month of ob/gyn.
I developed way better skills in my month of cardiovascular in surgery, critical care and anesthesia at a regional site than two months of surgery.
But that's my experience.
If letters weren't so important, I wouldn't have any hesitation doing my third year regionally.

 

[cbrons]

Being at a big hospital may or may not equate to a better educational experience. It sounds like you have no choice so no point in worrying about it. Also you can do away rotations your 4th year if you want to check out another venue.

Being at a big hospital with lots of residents may equate to getting very little experience. Sometimes these community rotations are actually the best way to get the most experience. (Sometimes).

 

[cbrons]

By 4th year would you be prepared enough to benefit from doing an away rotation at a major hospital like that?

Depends what kind of 3rd year you had.
I am actually pretty shocked at the disparity between med students in terms of ability and skill. Not just med students from different schools, but also from the same school. I figured pretty much everyone would be at around the same baseline by M4, but that doesn't seem to be true at all. There are M4s now who can (as attendings here say) "operate at the level of an intern" or even a PGY-2 in rare cases. Whereas there are other M4s who don't seem to be able to do a very basic history and physical exam. For the latter group, an away rotation might actually hurt your chances of matching at the program.

I for one can't really say how you get yourself in that first category. I do know you can really get a lot of experience your 3rd year if you are somewhat aggressive in seeking it out. If you just want to do the bare minimum and go home as early as possible (can't really blame you most of the time) then it is surprisingly easy to do so in many circumstances.

Probably also has a lot to do with luck and how much they actually let you do these days too. There are 3rd year rotations at some schools where you legit spend 6 weeks shadowing (a soul crushingly boring waste of time where you learn next to nothing) whereas the same rotation at another school (or even a different clinical site within the same school) has 3rd year students seeing and "managing" multiple patients everyday, writing your own orders, learning/doing procedures, etc. If you get blessed with the latter experience at most or all of your school's core rotations, it is easy how to see you would have a huge leg up by the time you did away rotations.

 

[Wordead]

I'll be the contrary one. Ask your upperclassmen what their experiences are. It varies so much that you can't really generalize community vs big academic hospital. I used to think community was better for hands on experience, but the institution I'm at lets med students do a LOT. Notes, orders (have to cosign them but its still being used so "important" vs nobody cares about your note so why should you). Lots of procedures.

Plus, and I'm sure this will ruffle some feathers, but frankly the quality of residents are generally better at the big hospitals because the best and brightest want to go there for training. Even if you do less, you might learn a lot more, which is your priority as a med student. Learning good organizational skills and forming a solid formation for being efficient is a lot more important than putting in lines and intubating.

 

[Kaustikos]

Depends what kind of 3rd year you had.
I am actually pretty shocked at the disparity between med students in terms of ability and skill. Not just med students from different schools, but also from the same school. I figured pretty much everyone would be at around the same baseline by M4, but that doesn't seem to be true at all. There are M4s now who can (as attendings here say) "operate at the level of an intern" or even a PGY-2 in rare cases. Whereas there are other M4s who don't seem to be able to do a very basic history and physical exam. For the latter group, an away rotation might actually hurt your chances of matching at the program.

I for one can't really say how you get yourself in that first category. I do know you can really get a lot of experience your 3rd year if you are somewhat aggressive in seeking it out. If you just want to do the bare minimum and go home as early as possible (can't really blame you most of the time) then it is surprisingly easy to do so in many circumstances.

Probably also has a lot to do with luck and how much they actually let you do these days too. There are 3rd year rotations at some schools where you legit spend 6 weeks shadowing (a soul crushingly boring waste of time where you learn next to nothing) whereas the same rotation at another school (or even a different clinical site within the same school) has 3rd year students seeing and "managing" multiple patients everyday, writing your own orders, learning/doing procedures, etc. If you get blessed with the latter experience at most or all of your school's core rotations, it is easy how to see you would have a huge leg up by the time you did away rotations.

Yeah,
There is some luck in the draw; you might get stuck with the worst residents/most malignant and have horrible experience. But then get another rotation where your team is awesome and teaches you a lot. My Gyn Onc was 70/30 good for bad. Most of the residents/interns taught me a lot/let me do a lot. The attendings were very patient as I helped out with the Da-Vinci and tried to pull out the uterus (or the Half-Life crabs).
My internal medicine 3rd year (and even Sub-I) was a joke. I learned very little. Did very little. I was hemorrhaging information by the day.
I think having a third year rotation that's basically "Playskool my first medicine rotation" wherein they just throw you in a hospital with the most patient attendings/residents whom teach you HOW to work in a hospital would be amazing. But, people in hell want ice water.

 

[gobigorgohome22]

What everyone else said above

Plus, smaller hospitals seem to give out better grades (e.g. H and HP)

 

[jw3600]

At my school, students are assigned a rotation site based on a points system (birthplace, parents' location, spouse, children, etc.)

Is this really how rotations sites are picked at your school? That's bizarre.

 

[Low Flow]

Is this really how rotations sites are picked at your school? That's bizarre.

It seems reasonable given the circumstances. There aren't enough spots for everyone to attend one site, so essentially they have to go off "merit" (excluding academic standing, I believe).

 

[username456789]

It seems reasonable given the circumstances. There aren't enough spots for everyone to attend one site, so essentially they have to go off "merit" (excluding academic standing, I believe).

Or they could just stop increasing med school class size, and be responsible enough to accept/manage the proper number of students.

This "shoot first, ask questions later" style of management from some medical schools is getting ridiculous.

 

[seminoma]

The people you work with will determine the quality of your education much more than your location.

I would've disagreed with this 100% a few weeks ago, but now that I've gotten to see this first hand it is very accurate. My team is 2 MS3s (myself included) 2 interns and 2 seniors. Our patient load is identical, but my classmate gets much more "teaching" from his senior/intern, while my senior and intern mostly talk amongst themselves and I just try to listen in when I can. They're both happy to answer any questions I have about the plan, but they're not volunteering info or talking me through things. Not really a problem since it suits my learning style, but other people might not like it. The other upside for me is that my senior doesn't send me on dumb errands like going back to the ward to pickup his phone that he forgot in the patient room.

So far MS3 seems to be as good as you make it. Tactfully let the intern/senior know your needs and wants as a student (and be helpful to the team) and I'm sure you'll get the experience you want.

Also the "see one, do one, teach one" dogma always seemed like a joke to me, but my experience has been pretty much in line. So really pay attention during the "see one" phase and ask if you can do more the next time. For example, I watched a paracentesis, then got to do the lidocaine, then got to do the whole procedure, then got to do the whole procedure again while talking through it to help my classmate understand the steps. Pretty awesome.

It seems reasonable given the circumstances. There aren't enough spots for everyone to attend one site, so essentially they have to go off "merit" (excluding academic standing, I believe).

Yeah haha "merit". My school does something similar with certain rotations.

 

[Slack3r]

Or they could just stop increasing med school class size, and be responsible enough to accept/manage the proper number of students.

This "shoot first, ask questions later" style of management from some medical schools is getting ridiculous.

Heartless. Don't you know there's a doctor shortage?!?

 

[alpinism]

Depends what kind of 3rd year you had.
I am actually pretty shocked at the disparity between med students in terms of ability and skill. Not just med students from different schools, but also from the same school. I figured pretty much everyone would be at around the same baseline by M4, but that doesn't seem to be true at all. There are M4s now who can (as attendings here say) "operate at the level of an intern" or even a PGY-2 in rare cases. Whereas there are other M4s who don't seem to be able to do a very basic history and physical exam. For the latter group, an away rotation might actually hurt your chances of matching at the program.

I for one can't really say how you get yourself in that first category. I do know you can really get a lot of experience your 3rd year if you are somewhat aggressive in seeking it out. If you just want to do the bare minimum and go home as early as possible (can't really blame you most of the time) then it is surprisingly easy to do so in many circumstances.

Probably also has a lot to do with luck and how much they actually let you do these days too. There are 3rd year rotations at some schools where you legit spend 6 weeks shadowing (a soul crushingly boring waste of time where you learn next to nothing) whereas the same rotation at another school (or even a different clinical site within the same school) has 3rd year students seeing and "managing" multiple patients everyday, writing your own orders, learning/doing procedures, etc. If you get blessed with the latter experience at most or all of your school's core rotations, it is easy how to see you would have a huge leg up by the time you did away rotations.

IMO its a little bit of both.

You can be the most aggressive med student in the world but if your residents are overworked, burned out, clueless, don't like to teach, don't care, or really need the procedures and experience themselves you won't be doing much beyond shadowing and writing fake progress notes everyday.

You can also be the laziest med student in the world and leave by noon everyday but if you have really strong residents who love to teach and have time to discuss patient management you'll likely get a ton of hands on experience with orders and procedures in just a few hours everyday.

On the flip side being aggressive will help you to get a little extra autonomy and a few extra procedures here and there.

In the end like everything in life you want a good balance (think of it like trying to reach a steady state of enzyme kinetics):

- Not too many sick patients that no one has time to teach, but not too few that you don't see enough pathology and diversity.
- Not too may residents that they do all of the orders and procedures themselves, but not too few that you have no supervision and guidance.

I'd honestly talk to 4th years but even then your experience can be extremely variable from team to team/resident to resident even in the same hospital. The best you can do is ask which residents/teams are great for teaching/autonomy/procedures.