Med students or knowledgeable pre-meds: ? about rotations

organdonor

7+ Year Member
Jul 29, 2009
863
178
181
Midwest
Status
Resident [Any Field]
My fiance asked me what my schedule will be like. I told her the extent of my knowledge, that the first two years will be generally book work and the last two are rotations. She then asked an interesting question I will posit here.

What time of day/night are your rotations?

I understand the first two years will generally be during "normal" school hours, with some variance by what school (if you even go to class :p)

I also know that residencies will be hellish hours, with some working 30 hour shifts. So what shifts/times can I expect to be on rotations during medical school?
 

DrBowtie

Final Countdown
Moderator Emeritus
10+ Year Member
Feb 24, 2005
15,488
1,871
281
Classyville
Status
Resident [Any Field]
Generally normal school hours with the day usually starting earlier (some as early as 5:00 am) and the day sometimes ending later depending on evening rounds etc.

Outpatient rotations is generally more 8-5 stuff.
 

Depakote

Pediatric Anesthesiologist
Moderator Emeritus
Lifetime Donor
10+ Year Member
Nov 2, 2004
20,811
102
281
SOCMOB
Status
Attending Physician
Inpatient rotations tend to vary by the service you're on and your call schedule.

On Surgery, OB/GYN and Peds we're expected to take overnight call. (frequency depends on rotation and site). IM we take short-call to 10pm or 2 consults/admits.

For inpatient surgery I had a month of getting in as early as 5am to pre-round while I'd be staying as late as 6-6:30pm. IM hasn't been as ugly but I've had more than a few 630am-6pm days (non-call).
 

mordounhas

10+ Year Member
5+ Year Member
Aug 16, 2007
323
1
0
Status
Medical Student
It may also depend somewhat on the school. We do 2 weeks of night float during our internal rotation and a fair amount of overnight call during surgery and ob/gyn. I wouldn't be surprised if some schools have more overnight commitments and some have fewer.
 

organdonor

7+ Year Member
Jul 29, 2009
863
178
181
Midwest
Status
Resident [Any Field]
What exactly is "night float?" And what does "call" entail as a med student? are you at the hospital, or at home?
 

UTMBstudent

Removed
Jan 5, 2010
30
0
0
Status
I'm a first year so I'm a bit ignorant about the clinical years but it seems odd to me that schools have med students work in the night. Are they really providing that much of a service? I thought they always had to be watched closely by a resident or attending.
 

PSUtoMD

5+ Year Member
Aug 2, 2009
94
9
101
Status
Medical Student
I'm a first year so I'm a bit ignorant about the clinical years but it seems odd to me that schools have med students work in the night. Are they really providing that much of a service? I thought they always had to be watched closely by a resident or attending.
You're there to learn. Despite what your deans/advisors tell you with their flowery speeches, you're really not "providing" any service, regardless of what time of day it is.
 

UTMBstudent

Removed
Jan 5, 2010
30
0
0
Status
You're there to learn. Despite what your deans/advisors tell you with their flowery speeches, you're really not "providing" any service, regardless of what time of day it is.
This is exactly what I assumed. So why have us work long hours and in the night? Couldn't we learn just as well working 6-8 hours during the day?
 

Perrotfish

Has an MD in Horribleness
10+ Year Member
May 26, 2007
7,983
3,861
281
Status
Attending Physician
This is exactly what I assumed. So why have us work long hours and in the night? Couldn't we learn just as well working 6-8 hours during the day?
Yes, you could, if they would let you. The reasons why the vast majority of medical schools won't let you, at least during your hardest core rotations, are:

1) Hundreds of years of senseless tradition

2) The feeling amoung many physicians that medical school/residency should be as much like pledging a 1960s faternity as possible.

3) The belief that they need to prepare you for the equally pointless long shifts during residency (if I don't beat you now, you'll hate it even more when I beat you later)

4) The misery loves company attitude of a certain type of resident who wants you to stay as long as they do (beware of short call where you're 'allowed' but not 'required' to stay overnight)

5) (the only moderately sane reason) The reality that during the night the work to personel ratio increases drastically, so you might have a chance to really play doctor while everyone's too groggy to protest.

BTW I should clarify that when I call the endless shifts in residency pointless, I don't really mean that there's no reason at all for them. I just mean that I think the reason for them is to make the hospital money by squeezing as many hours of free labor out of the residents as possible.
 
Last edited:

PSUtoMD

5+ Year Member
Aug 2, 2009
94
9
101
Status
Medical Student
Haha, basically that.

I would add that there is some added value in actually being there to experience things. Whether this leads to more efficient learning than sittingat home with a book is up for debate, but residency directors I've spoken with have been known to lament that they just don't feel like their residents are leaving their programs as "prepared" as they should be, given the 80 hour/week restriction.

Again, though, that could be more of the senseless tradition thing clouding their mind.
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
You're there to learn. Despite what your deans/advisors tell you with their flowery speeches, you're really not "providing" any service, regardless of what time of day it is.
Unless you're at the VA, because the students actually make a significant difference sometimes. Everywhere else, you're pretty much just there for the ride.
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
Yes, you could, if they would let you. The reasons why the vast majority of medical schools won't let you, at least during your hardest core rotations:

1) Hundreds of years of senseless tradition

2) The feeling amoung many physicians that medical school/residency should be as much like pledging a 1960s faternity as possible.

3) The belief that they need to prepare you for the equally pointless long shifts during residency (if I don't beat you now, you'll hate it even more when I beat you later)

4) The misery loves company attitude of a certain type of resident who wants you to stay as long as they do (beware of short call where you're 'allowed' but not 'required' to stay overnight)

5) (the only moderately sane reason) The reality that during the night the work to personel ratio increases drastically, so chaces are that you might have a chance to really play doctor while everyone's too groggy to protest.

BTW I should clarify that when I call the endless shifts in residency pointless, I don't really mean that there's no reason at all for them. I just mean that I think the reason for them is to make the hospital money by squeezing as many hours of free labor out of the residents as possible.
6. Babies seem to be born at night more often, and "some guy" usually shoots "that dude" around 2am when the bars close.

Trauma surgery and OB/gyn really do need overnight call.
 

Perrotfish

Has an MD in Horribleness
10+ Year Member
May 26, 2007
7,983
3,861
281
Status
Attending Physician
6. Babies seem to be born at night more often, and "some guy" usually shoots "that dude" around 2am when the bars close.

Trauma surgery and OB/gyn really do need overnight call.
No, Trauma Surgery and Ob/Gyn really do need someone to cover the night SHIFT. There's no earthy reason it should be the same person who just worked all day.
 

UTMBstudent

Removed
Jan 5, 2010
30
0
0
Status
Haha, well I'm glad there's at least a little reason for it. I just hope that I don't feel like I'm wasting my time much during 3rd or 4th year. If I'm not actively learning then I will consider it a waste of time.

Luckily in the pre-clinical years my school seems to think that med school should be made as easy as it can be while still learning everything necessary for success. Hope they do the same in the clinical years.
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
No, Trauma Surgery and Ob/Gyn really do need someone to cover the night SHIFT. There's no earthy reason it should be the same person who just worked all day.
Night float wouldn't really work well as a med student rotation (no clinic, no lectures, no rounding, etc), so they don't do it.
 

Squeal

Think for yourself
Feb 24, 2010
182
1
41
Status
Pre-Medical
6. Babies seem to be born at night more often, and "some guy" usually shoots "that dude" around 2am when the bars close.

Trauma surgery and OB/gyn really do need overnight call.

too true. Where I'm from it's "this random guy" and he's usually hanging around street corners, picking on people who were just minding their own business.
 

FirefighterDoc

MS-4
7+ Year Member
Jun 26, 2009
809
43
161
Illinois
Status
Medical Student
too true. Where I'm from it's "this random guy" and he's usually hanging around street corners, picking on people who were just minding their own business.
This.

Cant tell you how often i hear it in the ER lol
 

organdonor

7+ Year Member
Jul 29, 2009
863
178
181
Midwest
Status
Resident [Any Field]
What does being a med student on call entail? Like others, I always assumed that as an MSIII or IV that you are just in the way, so why would you be on call?
 

DrBowtie

Final Countdown
Moderator Emeritus
10+ Year Member
Feb 24, 2005
15,488
1,871
281
Classyville
Status
Resident [Any Field]
What does being a med student on call entail? Like others, I always assumed that as an MSIII or IV that you are just in the way, so why would you be on call?
You're on call with the team aka intern/resident. You're checking in on the patients on your service and assisting the intern if a patient's condition deteriorates.

Conversely on a surgery, they still need retractor *****es at all hours of the night.
 

metallica81788

Keeper of the Llamaworm
Moderator Emeritus
10+ Year Member
Jul 26, 2007
11,991
46
261
Status
Resident [Any Field]
You're on call with the team aka intern/resident. You're checking in on the patients on your service and assisting the intern if a patient's condition deteriorates.

Conversely on a surgery, they still need retractor *****es at all hours of the night.
Dr. Miller: Dr. Turk. Meet me in the O.R.
Turk: Fat flaps?
Dr. Miller: You got it!
Turk: I love fat flaps.
 

sunshinevet

7+ Year Member
Aug 8, 2009
812
4
141
Perth, Australia
Status
Veterinarian
Haha, well I'm glad there's at least a little reason for it. I just hope that I don't feel like I'm wasting my time much during 3rd or 4th year. If I'm not actively learning then I will consider it a waste of time.
Pretty sure that in 3rd and 4th year, you will actually know so little that every second you're awake with your eyes and ears open, you'll learn something.
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
What does being a med student on call entail? Like others, I always assumed that as an MSIII or IV that you are just in the way, so why would you be on call?
Unless it's really urgent, the student is usually the first one to see the new admission or new consult. You do your history and physical, then you get your intern. They see the patient in about half the time that you did, and then they get their senior resident, who sees the patient in about half the time that the intern did.
 

metallica81788

Keeper of the Llamaworm
Moderator Emeritus
10+ Year Member
Jul 26, 2007
11,991
46
261
Status
Resident [Any Field]
Unless it's really urgent, the student is usually the first one to see the new admission or new consult. You do your history and physical, then you get your intern. They see the patient in about half the time that you did, and then they get their senior resident, who sees the patient in about half the time that the intern did.
That sounds annoying for the patient. :laugh:
 

ABRuniverse

10+ Year Member
7+ Year Member
Sep 23, 2008
181
0
141
Status
Medical Student
That sounds annoying for the patient. :laugh:

It most certainly is. When I volunteered at a children's hospital ER I would mostly end up seeing broken bones and what not. Of course, this isn't trauma 1 or anything but I would definitely sympathize with the parents when they would sit there for an hour or so after the child had already been checked by at least 3 people wondering why the kid can't get his friggin cast already!
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
That sounds annoying for the patient. :laugh:
Of course it is, which is why it's important for the student to go first. You're the least important, and the patient is most willing to answer questions when they haven't already answered them. By the time the attending rolls around, the patient is sick of answering the questions, but because this is now the person who matters, they'll still answer the questions.

Good luck if you're the one going in last.
 
Dec 30, 2009
191
0
0
Status
Pre-Medical
Of course it is, which is why it's important for the student to go first. You're the least important, and the patient is most willing to answer questions when they haven't already answered them. By the time the attending rolls around, the patient is sick of answering the questions, but because this is now the person who matters, they'll still answer the questions.

Good luck if you're the one going in last.
I guess this means never be a patient at a University Hospital at all costs, unless your a trama patient! :laugh::D
 

twoinone

10+ Year Member
7+ Year Member
Mar 25, 2007
303
0
141
Status
I also have a question about all this. Do student work on the weekends also or is it strictly a M-F sorta deal.
 

AnotherDork

Senior Member
10+ Year Member
7+ Year Member
Dec 27, 2004
215
0
0
40
Massachusetts
Status
Resident [Any Field]
Intern here. I can't imagine any med school that would make a student do night float (basically covering while the day team is home sleeping). It's just writing a bunch of Ambien orders, renewing IV fluid orders, and dealing with the occasional unstable or unruly patient, etc. There's essentially no educational value at all, and a med student can't independently write orders so they can't really help.

Overnight call is different, because you're admitting new patients and working them up, which could be educational. Though in my experience, the housestaff just want to get the patients admitted efficiently and wouldn't have the time or inclination to do much teaching, so IMO overnight call is also a waste of time for med students on inpatient rotations.

If your school has night float, I would suggest working with the administration to change it, because they're not really doing you a service by having it- that rotation would be better spent somewhere else.
 

45408

aw buddy
10+ Year Member
7+ Year Member
Jun 14, 2004
16,976
45
141
Status
Resident [Any Field]
I also have a question about all this. Do student work on the weekends also or is it strictly a M-F sorta deal.
Lots of weekends. M-F rotations would be when you're on a consult service or in a clinic-only setting. Medicine, surgery, peds, ob/gyn, psych, and neurology all had weekend obligations. As an M3, I only had two rotations without weekends (peds outpatient and family med).
 

twoinone

10+ Year Member
7+ Year Member
Mar 25, 2007
303
0
141
Status
Lots of weekends. M-F rotations would be when you're on a consult service or in a clinic-only setting. Medicine, surgery, peds, ob/gyn, psych, and neurology all had weekend obligations. As an M3, I only had two rotations without weekends (peds outpatient and family med).
Thanks!
 

Law2Doc

5K+ Member
Moderator Emeritus
10+ Year Member
Dec 20, 2004
30,981
9,881
281
Status
Attending Physician
My fiance asked me what my schedule will be like. I told her the extent of my knowledge, that the first two years will be generally book work and the last two are rotations. She then asked an interesting question I will posit here.

What time of day/night are your rotations?

I understand the first two years will generally be during "normal" school hours, with some variance by what school (if you even go to class :p)

I also know that residencies will be hellish hours, with some working 30 hour shifts. So what shifts/times can I expect to be on rotations during medical school?
It varies with the rotation and school, but you can be expected to, during some months, start before 6am, routinely end after 6pm and be on overnight call every 3rd or 4th day. Overnight call means you just don't go home until the next day. You may or may not get any sleep depending on how busy it is. Overnight call can run as long as 30 hours in a row in the hospital. Theoretically it can go beyond this for many med students (ie having med students come in early to preround and then stay at the end to finish something up), since the duty hour rules don't protect med students, but this is school dependent.

Night float is where programs, in order to minimize overnight call, assign residents to cover the hospital at night. Since the shift generally runs from 6pm to 7am (give or take signout), the residents don't need to be there more than 13 hours in a row and it allows programs to stay within the 80 hour duty hour requirement. As mentioned, most places will have med students staying on for overnight call, but generally not for night float.

As for whether it makes sense for students to stay overnight, I actually think it does. At a minimum it helps prepare med students for the reality that is intern year. You don't want to be trying to stay up all night working for the first time as an intern -- you have enough to worry about that year. So if you are used to the pace as a med student, I think that's helpful. Certainly as a sub-I where you are supposed to get some insight into how to be an intern it would be silly to limit those hours to below intern hours. But more importantly, as alluded to earlier, a LOT happens in the hospital at night. Most the the babies get born at night. Most of the patients that are going to freak out and self-extubate or pull out lines or fall out of bed manage to do so in the wee hours when nobody is watching. That ruptured appendix finally decides it's serious enough to come to the ED at 2am, after hoping it gets better all evening. All the major codes seem to happen late in the am. And certainly GSWs and stabbings are all nightlife/bar related. So by not being around at night, you DO miss a lot. Is it enough to justify a med student staying up for? I think so. Additionally, most hospitals are short staffed overnight. So if as a med student you hope to do procedural stuff, suturing, catching babies and the like, a lot of the opportunities are going to come at night.
 

psipsina

Senior Member
10+ Year Member
5+ Year Member
Jun 24, 2005
1,812
8
0
N'awlins
Status
Medical Student
It varies with the rotation and school, but you can be expected to, during some months, start before 6am, routinely end after 6pm and be on overnight call every 3rd or 4th day. Overnight call means you just don't go home until the next day. You may or may not get any sleep depending on how busy it is. Overnight call can run as long as 30 hours in a row in the hospital. Theoretically it can go beyond this for many med students (ie having med students come in early to preround and then stay at the end to finish something up), since the duty hour rules don't protect med students, but this is school dependent.

Night float is where programs, in order to minimize overnight call, assign residents to cover the hospital at night. Since the shift generally runs from 6pm to 7am (give or take signout), the residents don't need to be there more than 13 hours in a row and it allows programs to stay within the 80 hour duty hour requirement. As mentioned, most places will have med students staying on for overnight call, but generally not for night float.

As for whether it makes sense for students to stay overnight, I actually think it does. At a minimum it helps prepare med students for the reality that is intern year. You don't want to be trying to stay up all night working for the first time as an intern -- you have enough to worry about that year. So if you are used to the pace as a med student, I think that's helpful. Certainly as a sub-I where you are supposed to get some insight into how to be an intern it would be silly to limit those hours to below intern hours. But more importantly, as alluded to earlier, a LOT happens in the hospital at night. Most the the babies get born at night. Most of the patients that are going to freak out and self-extubate or pull out lines or fall out of bed manage to do so in the wee hours when nobody is watching. That ruptured appendix finally decides it's serious enough to come to the ED at 2am, after hoping it gets better all evening. All the major codes seem to happen late in the am. And certainly GSWs and stabbings are all nightlife/bar related. So by not being around at night, you DO miss a lot. Is it enough to justify a med student staying up for? I think so. Additionally, most hospitals are short staffed overnight. So if as a med student you hope to do procedural stuff, suturing, catching babies and the like, a lot of the opportunities are going to come at night.
Agree with the above.

So far my worst three weeks of medschool was a rotation where I was in the hospital at 4:30am and routinely went home >8pm (though no call). More common is 5:00 am --> 5:00 pm with 30 hour shifts every 4-5 days which is also difficult.

I do agree that its important to do this as a medstudent however. I can't imagine choosing to apply to surgical residency without knowing how I feel about the specialty after a 100 hour work week or at 4 am going to a BS consult in the ED. Part of third year is about finding the future thats right for you. I've had friends who have realized that they HATE overnight call and that was an important realization for them and their future careers.

I've also learned a TON on overnight calls. Almost every trauma I saw came in after 7pm. I also got to do much more, both in writing multiple consults and in the OR so overall I thought they were more fun.
 

mordounhas

10+ Year Member
5+ Year Member
Aug 16, 2007
323
1
0
Status
Medical Student
I looked again at my school's requirements for the internal medicine rotation and it's either 2 weeks of night float or consult service (I'm a Med 2, so we just had a lecture about it a few weeks ago). I'm not sure how many people actually do night float vs consult as I've never asked any third years about it.