bkflaneur

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I was curious to see if any current residents had advice on electives and figuring out career directions. We have two elective months in intern year. I'm still not sure about a final career path - maybe hospitalist, maybe fellowship. Would it be stupid to pick two inpatient months for elective in intern year like cards and GI? They're both electives I'd like to take. But maybe an ambulatory elective would be very welcome 6 months into intern year?
 

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I was curious to see if any current residents had advice on electives and figuring out career directions. We have two elective months in intern year. I'm still not sure about a final career path - maybe hospitalist, maybe fellowship. Would it be stupid to pick two inpatient months for elective in intern year like cards and GI? They're both electives I'd like to take. But maybe an ambulatory elective would be very welcome 6 months into intern year?
What are the ambulatory electives? (I guess Rheum, Endocrine?)
 

gutonc

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What are the ambulatory electives? (I guess Rheum, Endocrine?)
Depends on the program. Our program has ambulatory Pulm, Rheum, Endo and Hem/Onc. It also has separate Consult rotations in Cards, GI, Pulm, Hem/Onc, Renal and Endo. We only have an inpatient Cards/CCU rotation. All others are Gen Med with consults (although Onc is coming soon).
 

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Depends on the program. Our program has ambulatory Pulm, Rheum, Endo and Hem/Onc. It also has separate Consult rotations in Cards, GI, Pulm, Hem/Onc, Renal and Endo. We only have an inpatient Cards/CCU rotation. All others are Gen Med with consults (although Onc is coming soon).
Yeah, I thought so.

So if you choose to do a Consult Heme-Onc rotation, then you do Gen Med with Heme-Onc consults? That would probably be tiring as well right?

Would you rather advise an ambulatory Heme-Onc rotation, so that its lighter, and plus you can get some research done (or is this being idealistic)?

(P.S. People, dont come down on me for wanting to use my electives to breathe!)
 

gutonc

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Yeah, I thought so.

So if you choose to do a Consult Heme-Onc rotation, then you do Gen Med with Heme-Onc consults? That would probably be tiring as well right?

Would you rather advise an ambulatory Heme-Onc rotation, so that its lighter, and plus you can get some research done (or is this being idealistic)?

(P.S. People, dont come down on me for wanting to use my electives to breathe!)
In our particular instance, you are just seeing consults. The Gen Med service (or Surgery, or Neurology or whatever) is the one actually managing the patient. On consults, you do just that, consult. Make some recs and walk away.

As for which is less work, it really depends. Sometimes the service is light and all is fine. Other times you're getting 8 new consults a day and running your butt off. Clinic will pretty much always be steady/busy but can be less "work" even with more patients.
 

jdh71

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In our particular instance, you are just seeing consults. The Gen Med service (or Surgery, or Neurology or whatever) is the one actually managing the patient. On consults, you do just that, consult. Make some recs and walk away.

As for which is less work, it really depends. Sometimes the service is light and all is fine. Other times you're getting 8 new consults a day and running your butt off. Clinic will pretty much always be steady/busy but can be less "work" even with more patients.
Clinic won't have weekend rounds either
 

gutonc

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Clinic won't have weekend rounds either
Again...depends. In our rotations, weekend coverage is split between those rotating on the consult and outpt services. That way you only wind up working 1 wknd a month rather than 2 or 3.
 

marlena78

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Does anyone have advice on when the best time is to take electives and vacations in intern year? I am thinking of going into heme/onc.
 

Touchdown

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Why not pick vacation weeks that are best for you.

You can try (not saying you will get) major holidays,
Or take your birthday week off,
Take the week your best friend is getting married,
or just space them out so that you have that free time (and easier rotation) every few months.
 

jdh71

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Again...depends. In our rotations, weekend coverage is split between those rotating on the consult and outpt services. That way you only wind up working 1 wknd a month rather than 2 or 3.
That's an interesting solution, but I'd rather have a situation with ZERO weekends one month, than situation where weekends are distributed. Also rounding on patients I hadn't seen all week on rounds, seems kind of like poorer patient care, IMHO. I could do it, but the extra checkout . . .

But you're right every place will do things differently, and the OP will need to find out to get a better opinion of which electives to choose.
 
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What are reasons for an inpatient rheumatology consult? That might be a cush elective if your program offers it. I mean, I can't think of that many reasons - pericarditis/serositis, maybe? I am thinking you should go for cush, but if you had to choose one or the other, cardiology might be more useful. Outpatient, I think rheumatology may be pretty useful.
 

gutonc

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That's an interesting solution, but I'd rather have a situation with ZERO weekends one month, than situation where weekends are distributed. Also rounding on patients I hadn't seen all week on rounds, seems kind of like poorer patient care, IMHO. I could do it, but the extra checkout . . .
Good points. But it almost always works out that either the resident or the attending on during the weekend was also on during the week so there's continuity. OTOH, since most consult follow-ups consist of:
"Did you follow our recs?"
"No, your recs didn't come in until after we went home."
"Well, order what we suggested and we'll check back when that's done, probably Monday."
...it's usually pretty easy.
 

gutonc

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What are reasons for an inpatient rheumatology consult? That might be a cush elective if your program offers it. I mean, I can't think of that many reasons - pericarditis/serositis, maybe? I am thinking you should go for cush, but if you had to choose one or the other, cardiology might be more useful. Outpatient, I think rheumatology may be pretty useful.
Yes...the Rheumaholiday is the worst-kept secret in IM rotations. They generally see 1-2 consults/week (covering 2 hospitals) and are only required to go to 1 half-day clinic a week (on top of their 2 regular half-day clinics) with a few lectures and maybe a joint injection clinic.

The only times I've seen inpt rheum consults called is once everybody else has failed to figure out WTF is wrong with a patient.
 

jdh71

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What are reasons for an inpatient rheumatology consult? That might be a cush elective if your program offers it. I mean, I can't think of that many reasons - pericarditis/serositis, maybe? I am thinking you should go for cush, but if you had to choose one or the other, cardiology might be more useful. Outpatient, I think rheumatology may be pretty useful.
Yes...the Rheumaholiday is the worst-kept secret in IM rotations. They generally see 1-2 consults/week (covering 2 hospitals) and are only required to go to 1 half-day clinic a week (on top of their 2 regular half-day clinics) with a few lectures and maybe a joint injection clinic.

The only times I've seen inpt rheum consults called is once everybody else has failed to figure out WTF is wrong with a patient.
I've seen rheum get involved in the hospital in only a handful of cases, most of it was because: "since he's here get rheum to see him"

But BAD lupus flares should probably get the rheum guys involved and any any possible pulmonary complaint related to rheumatologic disease. I saw a sjogren's with lung involvement rapidly progress to death.