M3 Clerkship Order - Specific Question

[drtobe88]

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Hi all,

I know there are threads on this every year, but I have a specific question about clerkship order for M3. Our school randomly assigns schedules, and mine is the following:

Surgery
OB
Peds
Family
Internal
Psych

I am interested in OB/GYN at this point, and would like to do well on that rotation. I have the opportunity to switch my internal and surgery rotations which would leave me with:

Internal
OB
Peds
Family
Surgery
Psych

A couple of thoughts. I like the idea of having IM first, as I feel it will lay a good foundation for the rest of M3, and I also like the idea of splitting up OB and Surgery. I've also heard that doing surgery before IM can be difficult, especially for the shelf. That being said, would surgery be better preparation for the OB rotation? I'm sure it doesn't matter too much, and I know there is no perfect schedule, but would still like some input to make an informed decision. Thank you!

 

[inmyslumber]

Hi all,

I know there are threads on this every year, but I have a specific question about clerkship order for M3. Our school randomly assigns schedules, and mine is the following:

Surgery
OB
Peds
Family
Internal
Psych

I am interested in OB/GYN at this point, and would like to do well on that rotation. I have the opportunity to switch my internal and surgery rotations which would leave me with:

Internal
OB
Peds
Family
Surgery
Psych

A couple of thoughts. I like the idea of having IM first, as I feel it will lay a good foundation for the rest of M3, and I also like the idea of splitting up OB and Surgery. I've also heard that doing surgery before IM can be difficult, especially for the shelf. That being said, would surgery be better preparation for the OB rotation? I'm sure it doesn't matter too much, and I know there is no perfect schedule, but would still like some input to make an informed decision. Thank you!

Keep your schedule. Everyone else in your Surg rotation will be in the same boat- i.e. no prior IM rotation. Surgery will help you during OB. Medicine close to the end of MS3 year will help you prepare for USMLE Step 2.

 

[Psai]

surgery will help you with knowing how to suture and how to deal with long hours on L&D

 

[seminoma]

I like the points made for keeping your schedule, but I think you could also benefit from switching to have IM first.
Potential benefits:
Shorter hours than surgery, which means you have a lower likelihood of being burnt out going into your OB rotation.
Surgery shelf is a lot of medicine, so you'll be reviewing medicine at the end of the year regardless (which will help with Step 2).
You'll get better at writing thorough notes and seeing patients on IM, which will help you be more prepared and thorough on OB.

Even though surgery is going to help improve suture technique, you probably won't get an opportunity to do much on OB anyway since it's early in the year and all the residents will be anxious and eager to do everything they can to learn. Having surgery at the end of the year might better prepare you for suturing/sterile technique in your 4th year OB stuff.

MS2 here just basing my opinion on what I've heard from older students.

 

[alpinism]

Keep your current schedule.

It's also nice to have those 2 rotations over with early.

 

[operaman]

I did surgery as my first clerkship and I highly recommend it for a number of reasons:

1) One of the more intense rotations with arguably the most brutal hours. Everything will feel "easier" after it, even most of OB.

2) You know early on whether or not surgery is for you. If you absolutely hate it, then you've effectively eliminated half of the entire medical profession from your list of potential fields and you can focus on deciding between what remains. If you love it, you can start planning early to get the research and LORs you'll need to match well.

3) The shelf is tough, but no tougher than any of the others. What surprises people is the content and a lot of what you're studying and prepping for each day is not what's ultimately tested, compared with other clerkships where you have a chance to reinforce many of the concepts every day. The shelf is definitely NOT a medicine shelf, but many people perceive it that way. It's actually a test on diagnosis and management of surgical patients. Inherent in this is some overlap with IM, so it can be helpful to have had that first, but not essential. If you have surgery first, it just makes the IM shelf feel a bit easier.

 

[VisionaryTics]

3) The shelf is tough, but no tougher than any of the others. What surprises people is the content and a lot of what you're studying and prepping for each day is not what's ultimately tested, compared with other clerkships where you have a chance to reinforce many of the concepts every day. The shelf is definitely NOT a medicine shelf, but many people perceive it that way. It's actually a test on diagnosis and management of surgical patients. Inherent in this is some overlap with IM, so it can be helpful to have had that first, but not essential. If you have surgery first, it just makes the IM shelf feel a bit easier.

I think this all depends on how much clinic/call you take and how much rounding you do. We took q5 overnight call and no days off on my surg clerkship. Usually, often, the resident would send the med students off to see new consults in ED/on floor while he did post-op checks. I saw a ton of undifferentiated abdominal pain and other surgical issues. Also, we rounded on 40+ patients a day. You see a lot of peri-operative management.

As a result, the shelf wasn't too bad because I spent so much time on surgery learning diagnosis and management.

Contrast that with the med students at my current institution who: do not take call (actually, they take trauma call q7 who sends them home immediately, but the students still take post-call days off), do not round with residents, do not go to clinic. They spend all day either in lectures or sitting in the lounge. I have literally seen med students in the OR three times my five months of off-service surgical rotations. They did not scrub.

I'm interested to know how they do on the shelf, since basically they sit around all day and study for it. Probably pretty good.

 

[operaman]

I think this all depends on how much clinic/call you take and how much rounding you do. We took q5 overnight call and no days off on my surg clerkship. Usually, often, the resident would send the med students off to see new consults in ED/on floor while he did post-op checks. I saw a ton of undifferentiated abdominal pain and other surgical issues. Also, we rounded on 40+ patients a day. You see a lot of peri-operative management.

As a result, the shelf wasn't too bad because I spent so much time on surgery learning diagnosis and management.

Contrast that with the med students at my current institution who: do not take call (actually, they take trauma call q7 who sends them home immediately, but the students still take post-call days off), do not round with residents, do not go to clinic. They spend all day either in lectures or sitting in the lounge. I have literally seen med students in the OR three times my five months of off-service surgical rotations. They did not scrub.

I'm interested to know how they do on the shelf, since basically they sit around all day and study for it. Probably pretty good.

Oh man, that kinda sucks for them. I feel like I learned a lot from actually seeing things and being part of the workup that I wouldn't be able to learn from a book.

I had forgotten about the overnight call -- I actually had some rockstar residents on nightfloat when I did it so I got to see and do a lot too. Apparently though it's different this year because my class complained that they didn't have time to sleep and study during overnights (wtf?). I still maintain the overnights were the best part of the clerkship for me even though it was exhausting.

We rounded every morning and sometimes in the pm too and our patients were pretty sick so I probably picked up more doing that than I realized.

I probably spent most of my own time reading for upcoming cases, reviewing the operation, anatomy, and watching youtube videos of the highlights because that was the fun part of surgery for me and let me feel like I knew what was going on in the OR. That's the part that really isn't tested on the shelf.

 

[Ismet]

Contrast that with the med students at my current institution who: do not take call (actually, they take trauma call q7 who sends them home immediately, but the students still take post-call days off), do not round with residents, do not go to clinic. They spend all day either in lectures or sitting in the lounge. I have literally seen med students in the OR three times my five months of off-service surgical rotations. They did not scrub.

Wat. I never want to do surgery again after this clerkship is over, but I still find a lot of the surgeries really interesting... And you can't see anything if you don't scrub! (Unless it's a lap ofc).

If the med students here pulled that kind of thing, there would be consequences and they would be shaped up quickly by the clerkship director. Do the students at your institution just not have rules/expectations for their rotation?

 

[VisionaryTics]

Wat. I never want to do surgery again after this clerkship is over, but I still find a lot of the surgeries really interesting... And you can't see anything if you don't scrub! (Unless it's a lap ofc).

If the med students here pulled that kind of thing, there would be consequences and they would be shaped up quickly by the clerkship director. Do the students at your institution just not have rules/expectations for their rotation?

No, none. And hideous amounts of lecture in the middle of the day. Just an awful job by the gen surg clerkship director.

 

[J ROD]

Do the surgery list first. Get it out the way and then have IM near the end to help with Step 2. Might can even take Step 2 early since you will have to prepare with Psy last.

 

[Psai]

I think this all depends on how much clinic/call you take and how much rounding you do. We took q5 overnight call and no days off on my surg clerkship. Usually, often, the resident would send the med students off to see new consults in ED/on floor while he did post-op checks. I saw a ton of undifferentiated abdominal pain and other surgical issues. Also, we rounded on 40+ patients a day. You see a lot of peri-operative management.

As a result, the shelf wasn't too bad because I spent so much time on surgery learning diagnosis and management.

Contrast that with the med students at my current institution who: do not take call (actually, they take trauma call q7 who sends them home immediately, but the students still take post-call days off), do not round with residents, do not go to clinic. They spend all day either in lectures or sitting in the lounge. I have literally seen med students in the OR three times my five months of off-service surgical rotations. They did not scrub.

I'm interested to know how they do on the shelf, since basically they sit around all day and study for it. Probably pretty good.

the ****

 

[evilbooyaa]

I think this all depends on how much clinic/call you take and how much rounding you do. We took q5 overnight call and no days off on my surg clerkship. Usually, often, the resident would send the med students off to see new consults in ED/on floor while he did post-op checks. I saw a ton of undifferentiated abdominal pain and other surgical issues. Also, we rounded on 40+ patients a day. You see a lot of peri-operative management.

As a result, the shelf wasn't too bad because I spent so much time on surgery learning diagnosis and management.

Contrast that with the med students at my current institution who: do not take call (actually, they take trauma call q7 who sends them home immediately, but the students still take post-call days off), do not round with residents, do not go to clinic. They spend all day either in lectures or sitting in the lounge. I have literally seen med students in the OR three times my five months of off-service surgical rotations. They did not scrub.

I'm interested to know how they do on the shelf, since basically they sit around all day and study for it. Probably pretty good.

I didn't do a ton of call (q7 actually there with post-call days, with weekends either 1 or 2 days off), but after pre-rounds and rounds I'd be in the OR scrubbed in literally all day for 12 weeks. Didn't spend really any clinic time.

In hindsight nights were the most exciting. Thursday nights were the best. Can't imagine not following a chief resident around as a M3 on general surgery.

 

[Kaustikos]

I like the points made for keeping your schedule, but I think you could also benefit from switching to have IM first.
Potential benefits:
Shorter hours than surgery, which means you have a lower likelihood of being burnt out going into your OB rotation.
Surgery shelf is a lot of medicine, so you'll be reviewing medicine at the end of the year regardless (which will help with Step 2).
You'll get better at writing thorough notes and seeing patients on IM, which will help you be more prepared and thorough on OB.

Even though surgery is going to help improve suture technique, you probably won't get an opportunity to do much on OB anyway since it's early in the year and all the residents will be anxious and eager to do everything they can to learn. Having surgery at the end of the year might better prepare you for suturing/sterile technique in your 4th year OB stuff.

MS2 here just basing my opinion on what I've heard from older students.

The first varies. My rotation had me doing the same amount of hours as surgery... I just stayed later. It wasn't necessarily a mandated thing but just my interest in my patients and the team I was with. I loved it.

I agree with second bolded... especially with Surgery. Knowing how to do a medicine SOAP will make you more understanding/able to do surgery notes.

Third; it's hit or miss. Some residents let me suture (I did Surgery first with great teams who let me learn not because I was all about surgery, but I was interested in getting better with my hands for the future. Some residents... just made it obvious it was all about them (like you said) and even not let you suture if the attending tells you that you can. Interesting.

Do the surgery list first. Get it out the way and then have IM near the end to help with Step 2. Might can even take Step 2 early since you will have to prepare with Psy last.

Surgery, IM and Peds all help with Internal Medicine. Some people disagreed with using Step-Up as a supplement to Peds, but it does have information pertinent to Peds. Electrolytes, I felt were better explained in Step Up. Sure, etiology isn't exactly the same, but it explains it better. Cardiology also helps by talking about pathology of certain diseases that children can get. Plus, they have a way more concise treatment regimen for toxins/drug overdose.
So, IM last would help more for Step 2, but you'll have done so much testing with IM that you'll have it come back relatively quick. I only say don't do IM last because god forbid you don't do as well, you might not be as motivated to study for Step 2. But, I see your point.

 

[VisionaryTics]

Third; it's hit or miss. Some residents let me suture (I did Surgery first with great teams who let me learn not because I was all about surgery, but I was interested in getting better with my hands for the future. Some residents... just made it obvious it was all about them (like you said) and even not let you suture if the attending tells you that you can. Interesting.

I think it's a little bit of both: doing your rotations at the right time and having residents who are interested in getting students involved.

You can luck out on surgery/OB early in the year if you are in a lot of cases with more seniors and fewer interns/PGY2s.

If a student was in the room with me in July and August, I'm closing. I needed the practice. I really like having med students around and teaching what I know, and getting them involved in the team. I know you may not like hearing it, but if I'm not very comfortable doing a procedure, I'm not handing it over to a med student. At that point, it is "all about me". If a med student came in the room I knew they were going to watch/retract for a few hours, I would let them know and give them the choice to go to other rooms where they could get their hands dirty (there are always plenty). After a few months, I got more comfortable letting students take lipomas out and close non-cosmetic incisions and stuff. Of course, med students come in the OR once or twice a month at this hospital.

As a med student this was the case for me. My gen surg rotation Jan-March was great as well as my Ob/Gyn rotation immediately following. My ENT subI in July was horrible with regards to hands-on stuff. There was always a PGY2 or intern in the room to snap up the "low-hanging fruit".

 

[Kaustikos]

I think it's a little bit of both: doing your rotations at the right time and having residents who are interested in getting students involved.

You can luck out on surgery/OB early in the year if you are in a lot of cases with more seniors and fewer interns/PGY2s.

If a student was in the room with me in July and August, I'm closing. I needed the practice. I really like having med students around and teaching what I know, and getting them involved in the team. I know you may not like hearing it, but if I'm not very comfortable doing a procedure, I'm not handing it over to a med student. At that point, it is "all about me". If a med student came in the room I knew they were going to watch/retract for a few hours, I would let them know and give them the choice to go to other rooms where they could get their hands dirty (there are always plenty). After a few months, I got more comfortable letting students take lipomas out and close non-cosmetic incisions and stuff. Of course, med students come in the OR once or twice a month at this hospital.

As a med student this was the case for me. My gen surg rotation Jan-March was great as well as my Ob/Gyn rotation immediately following. My ENT subI in July was horrible with regards to hands-on stuff. There was always a PGY2 or intern in the room to snap up the "low-hanging fruit".

Agreed. I think I purposefully took laparoscopic procedures because it was a higher chance of suturing/doing something like learning to use a camera. It definitely does depend on who you're with. Neurosurgery (Peds), I refused to touch anything because it was the brain... lol. Then they let me use the saw and drill and I couldn't say no. The neurosurgeon attending literally handed me the drill and told me to do it. Other times, I just watched. I don't have a problem with that either, as long as it's educational/interesting/they teach me.
Luckiest was doing surg onc with my favorite surgeon (probably had a crush on her because she loved grunge music and was sarcastic as I was. also hated the general surgery director). I spent weeks with her until she let me do the procedures myself (thyroidectomies). It was great. She even trusted me to close the skin, which she doesn't let anyone do.

So, yeah, it depends.

 

[seminoma]

Is it safe to say that there really isn't a need to strategize clerkship order? Our lottery day is coming up and I'm stressing out about not getting a "good" order.

 

[Kaustikos]

Is it safe to say that there really isn't a need to strategize clerkship order? Our lottery day is coming up and I'm stressing out about not getting a "good" order.

I don't think so. You realize that when you're done in May and have fourth year coming up. The order doesn't matter. The only benefit is if you can take a vacation month at the end for Step 2. But that's a moot point considering it's Step 2.