IM first?

[personal jesus]

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How hard is it to do well in IM as a first rotation? I figure its a good overview for the 3rd year but I dont want to tank. Will all the boards studying help to do well on the IM shelf?

 

[box29]

The advice given to me was that one should want IM and FM early on to learn patient management especially before GS. I really don't know...but my preliminary 3rd year schedule is:

July: IM
Aug: Psych
Sept: FM
Oct: FM
Nov: GS
Dec: elect 1 - Rads
Jan: GS
Feb: IM
Mar: Peds
Apr: elect 2 - ?
May: Ob/gyn
June: Vacation

 

[Samoa]

Like anything else, there are pros and cons.

Pro:
--you still have lots of energy
--you have no track record to color people's expectations
--expectations are slightly lower on the first rotation of the year
--your Step1 knowledge is still fresh in your mind, which helps a little
--your shelf scores are determined only in relation to other early IM rotators
--your clerkship director may set a more lenient curve on top of that
--and finally it prepares you well for everything else.

Con:
--the interns are new and often are too overwhelmed to participate in teaching you
--they've just come off a 2-6 month vacation and many feel too insecure about their own skills and knowledge to evaluate yours objectively
--The interns' training has priority over yours in everything, so students don't really get to do many procedures
--the senior residents are also new to their roles, and solid performance as an intern doesn't always translate into their being a good team leader, and you have no way of knowing what to expect
--the shelf is hard, and you have no prior shelf study to make the mountain easier to climb

You're sure to encounter some of these problems on whatever rotation you do first. So some people choose to do less critical ones first, to get their feet wet, and build some confidence. It definitely says something about a student's confidence in their own abilities, when they have a choice and choose to do IM first. And I don't think it's a coincidence that the majority of students who did so in my class are planning to go into surgery. After all, you know what they say about surgeons: Sometimes wrong, but never in doubt.

 

[velo]

You're sure to encounter some of these problems on whatever rotation you do first. So some people choose to do less critical ones first, to get their feet wet, and build some confidence. It definitely says something about a student's confidence in their own abilities, when they have a choice and choose to do IM first. And I don't think it's a coincidence that the majority of students who did so in my class are planning to go into surgery. After all, you know what they say about surgeons: Sometimes wrong, but never in doubt.

thanks samoa, that was interesting. A few of those cons didn't even occur to me when I was submitting scheduling preferences, but I think they're very true.

funny what you say about the future surgeons--that's where I want to end up, and my scheduling request? 1st rotation: Medicine. 2nd rotation: Surgery. and I thought i was so unique in my thinking...

 

[RonaldColeman]

thanks samoa, that was interesting. A few of those cons didn't even occur to me when I was submitting scheduling preferences, but I think they're very true.

funny what you say about the future surgeons--that's where I want to end up, and my scheduling request? 1st rotation: Medicine. 2nd rotation: Surgery. and I thought i was so unique in my thinking...

My advice would be to do Peds then IM. Peds is like medicine, but the attendings, in many people's experience, tend to be a little nicer. My advice to 3rd years is to hone your skills on the wards on Peds first. Also, the Peds board is almost entirely peds and borrow very little from other rotations...unlike the other shelf exams. You can do well on the peds shelf without the other rotations, which isn't necessarily true for the others. Taking IM before Peds will not help you on the IM shelf, while taking Peds before IM may help you on the IM shelf.

 

[Samoa]

funny what you say about the future surgeons--that's where I want to end up, and my scheduling request? 1st rotation: Medicine. 2nd rotation: Surgery. and I thought i was so unique in my thinking...

I hate to break it to you, but quite a few people in my medicine group (myself included) were doing surgery immediately afterward. Again, mostly the future surgeons. It's just the surgical mentality at work...

 

[njbmd]

Hi there,
The order in which you do your third year rotations is meaningless. You have just as much a chance of doing well if your medicine is first or last. One rotation does not build upon another and you have to master everything. Worrying about the order of rotations is a total waste of time.

njbmd 🙂

 

[loveumms]

Also, think about what you might want to do a residency in. I knew I didn't want to do surgery so I decided to do that first (then IM in the second semester). That way, I was able to get a feel for the hospital on surgery - learned the system, patient care, where things were and what was expected so that I could be better prepared during IM. I was also very lucky on my surgery rotation to have a wonderful sub-I that really helped me learn the ropes ... the interns were so overwhelmed with their new roles they didn't really have any extra time to show me anything (where supplies were, how to work the computer system, what I should be doing, ect).

I was told that you should do the rotations you are thinking about later in the year so you can shine more - that way when you ask for letters from those attendings they will be able to write better ones.

 

[Pinesinger]

I did IM first, and having just studied for Step I was definitely helpful. Also, at my school we start our third year in May so the interns were experienced and incredibly helpful. Also willing to let us do procedures more often than on other services. As far as the shelf goes, it is hard but if you study you'll do fine. You can go around and around trying to decide what is the best schedule, but in the end you all have to do the same rotations, and with few exceptions, it doesn't really matter.

 

[Samoa]

Also, at my school we start our third year in May so the interns were experienced and incredibly helpful.

That's an outstanding idea. I've always thought it was incredibly stupid to have med students start rotations in July with the interns. what you end up with is a critical mass of incompetence that stresses the whole health system. But that's another thread. /hijack

 

[velo]

That's an outstanding idea. I've always thought it was incredibly stupid to have med students start rotations in July with the interns. what you end up with is a critical mass of incompetence that stresses the whole health system. But that's another thread. /hijack

ha, very true. Our hospital has some computer automation to try and catch and correct hospital errors, and its very fun to look at its printout of the number of errors throughout the year--relatively constant most of the year but with huge spikes every june/july.