Interested in IM...do it first or last?

[XRanger]

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Basically our school gave us couple preset schedules and we have to rank our preferences. They only have IM as either first or last in their schedules, so if one is interested in IM, is it better to do it first or last?

 

[PistolPete]

There's differing viewpoints on this, but I'd say do it last. You'll be pretty green on your first rotation, plus your first shelf probably won't be the best. Doing it early would give you a good baseline for all the rest of your rotations and shelf exams, but if you are interested in IM, you will want to score good LOR's and be at the top of your game, which you won't be at the beginning of 3rd year.

My 0.02: do it last.

 

[2012mdc]

Basically our school gave us couple preset schedules and we have to rank our preferences. They only have IM as either first or last in their schedules, so if one is interested in IM, is it better to do it first or last?

Do you need to achieve a certain shelf core to get honors? If so, I would do it last because that's a hard shelf to have as your 1st one.

If not then I might consider doing it 1st. Find out if you have reasonable attendings who will understand that it's your 1st rotation. They will expect little out of you and can be impressed more easily.

A downside to doing it last is that you will be tired by the end of the year and they will expect you to be at the very top of your game.

Both options really aren't ideal, talk to upper levels at your school

 

[BigRedBeta]

Basically our school gave us couple preset schedules and we have to rank our preferences. They only have IM as either first or last in their schedules, so if one is interested in IM, is it better to do it first or last?

How is that even possible? I'm pretty sure the longest 3rd year clerkship I've heard of is 12 weeks, though I suppose 16 is possible, but at some point there's diminishing returns, and I can't imagine that other specialties would be too happy about being marginalized if the IM clerkships are that much longer. It begs the question of what are the IM attendings doing during the middle of the year, if there are no students?

 

[BigRedder]

How is that even possible? I'm pretty sure the longest 3rd year clerkship I've heard of is 12 weeks, though I suppose 16 is possible, but at some point there's diminishing returns, and I can't imagine that other specialties would be too happy about being marginalized if the IM clerkships are that much longer. It begs the question of what are the IM attendings doing during the middle of the year, if there are no students?

This. Your school is whack.

 

[XRanger]

ok i should make it more clear..there are IM rotations in the middle but our school choose who gets which schedule based on lottery and it's unlikely i'll get the top choices. It's more likely I'll get my middle/bottom choices, so if you have to choose between doing it first or last, which one would you do first.

Yea the argument that I heard for doing it first is you're still fresh from step 1, attending know it's your first rotation so maybe they would grade easier, but the disadvantage is you have no experience.

 

[go lakers]

I vote last. There are lot of nuances about the wards that your step 1 knowledge won't help with when you're trying to be the helpful medical student.

 

[vicinihil]

last

 

[Gastrapathy]

First. You'll probably do fine and this makes the timing for letters much easier. Also, if you go through the year thinking "this is ok, but I want to do IM" and then it turns out that you didn't like it as much as you thought, you'll regret doing it last. Better to have the frame of reference.

 

[twofer]

If you're a strong student and have a strong foundation by studying for Step 1, do it first.

1. You'll be bright eyed and bushy tailed. This will not last, I promise.

2. You'll get slack for being new and generally not expected to know very much. Medicine is very much so the stuff on Step 1, so if you were a good 2nd year student and rocked (or plan on rocking) the boards, you can impress people w your knowledge. The shelf is tough, but again, having Step 1 stuff fresh was key for me.

3. Medicine will help for many other rotations - primary care and surgery at the very least.

 

[vicinihil]

I did Surgery first and thought it was the best idea...ever. This is because of the bright eyed bushy tailed phenomenon that certainly did not last. However, when it came to Medicine, I perked up again because I knew it was an important foundation and grade for my future career. I also really enjoyed it therefore it made it easier to work hard. Therefore, don't worry about being less than enthusiastic. If you really enjoy it, you'll be fine.

Also, I walked into Medicine midway through my 3rd year VERY well prepared by my previous rotations including Neuro, Psych, Surgery, ENT, and Ortho and ended up kicking the crap out of the rotation to say the least. If you do it first, you'll be given slack but you def will not make their list of best medical student ever. You may make rookie of the year but would you rather it say rookie of the year or MVP of the year?

 

[OCallag]

I did the exact same schedule with vicinihil above, but I'm going to disagree slightly. Both first and last offer advantages - if you do it early, the bar is set lower and the opportunity to look good/rock the shelf is pretty good provided you're enthusiastic, polite, know your patients, and work your tail off. As the year goes on, yes, you will know far more and be better prepared for the rotation, but most attendings are keenly aware of where we are in our training. It's been my experience that their expectations are based largely on where we are in third year. In addition, you may know more of what's tested on the shelf, but so will everyone else, so it gets progessively more difficult to do awesome on shelves (and, by consequence, get awesome grades).

If you can't decide whether to do internal first or last you could possibly decide the schedule based on the timing of the other rotations in those pre-made schedules. For example, I did surgery first with vicinihil because I had zero desire to be a surgeon, and it worked out beautifully being done with that dreaded rotation so early in the year. Some people chose blocks because it allowed them more flexibility to be free during certain times of the year. Etc.

Bottom line: You're not screwed either way.

 

[Deferoxamine]

Last.

 

[PistolPete]

I wouldn't do IM first just because Step 1 material will be fresh. Sure, it'll help, but most of my shelf did not have much Step 1 material, per se.

 

[RySerr21]

you guys are lucky you get to choose, we are just given a schedule and told to deal. I'm interested in IM and I have it in the middle of the year (mid september to mid november). I will have done ob/gyn, peds, and family. Our upperclassman gave similar advice as here, no one seemed to agree on which was better and the conclusion was that it just doesnt matter (the pros and cons are pretty equal).

 

[medsend]

have it scheduled last, wish I had scheduled it earlier since I am currently in a panic trying to figure out what to do w/my life right now

 

[XRanger]

We just got our schedule this week and just my luck, I got my last choice. So my last 2 rotations gonna be surgery and medicine back to back, the 2 specialties that I'm considering.
How hard is the surgery if you haven't done medicine since I heard there's a lot of medicine on the shelf?

 

[Iwy Em Hotep]

You need to rock your sub-I when you have a bigwig as staff. That's the key to IM. Find out the rounding schedule and plan accordingly.