Medicine as first clerkship - good/bad experiences?

[Sureshot83]

Hi everyone,

I just got my 3rd year schedule, and I am starting off with medicine. I am currently thinking that I want to enter a surgical field, but medicine is still a definite possibility.

My question is - what have other students' experiences been with taking medicine first? On the one hand, I feel like my knowledge base will be really high coming fresh off of step 1, but on the other, I feel like I might jumping into the deep end without knowing how to swim. Also, in your experience, what does it take to do well on the medicine shelf exam if medicine is the first rotation? I'm obviously going to work really hard while on medicine, both because it is one of the most important clerkships and because it will hopefully give me a solid base for the rest of the year.

FYI, my overall schedule is:

1) Internal Med
2) Psych
***2 weeks of electives***
3) Surgery
***2 weeks of winter break***
4) Pediatrics
***4 weeks of electives***
5) Ob/Gyn
***3 weeks of electives***
6) Family Medicine


Thanks for the help!

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[Medpilot]

Maybe I'm biased because I did Internal first, but I can't imagine doing it any other way. Yes it is jumping off the deep end, but sink or swim is a great way to learn. I'm kidding.

I did do Medicine first and it helped me get my clinical legs more than any of the others. It's the core of medical knowledge. And believe me they will throw more facts and figures at you than you ever cared to remember. Only the freak Internists-to-be will care by the end. Surgeons will barely say 3 words about a patient and you'll learn squat. The point is that it will build a very good base to work from.

It's scary, but nobody expects you to really know anything anyway. 99% of the house staff understands that you are new to all of it (even if you aren't, milk this for all it is worth) and they will try to help you if you aren't an ass.

 

[Medpilot]

Oh yeah, MKSAP questions and Blueprints Medicine are all you really need to look at for the shelf. It's not all that different from Step 1

 

[AmoryBlaine]

I think starting with IM will be great. It really is the foundation of everything else so you'll be comfortable as you move on.

It was interesting to me b/c I did Ob/Gyn second after having done my GenSurg rotation. The girl with me had done Surg but the other dude came off medicine.

We Surgery people were clearly more comfortable in the OR, helping move the pts around, prep etc. We also knew how to assist alot better with suction, cutting, following running sutures etc.

The other dude was definitely more comfortable on L/D, interpreting labs, doing thorough exams, ordering meds.

Plus, if you do Medicine first you probably wont' be expected to come up with a 10 diagnosis differential on each of your patients and you can focus more on learning the nuts and bolts. If you come onto Medicine in the 2nd half of your 3rd year the residents expect you to be an active and helpful part of the team (and not just for scut.)

 

[Pinner Doc]

I'm currently doing Internal Med towards the end of my 3rd yr (started with Surgery, Ob/Gyn, Psych, then Peds, now IM).

I feel like I'm unlearning all the bad habits I picked up all year and finally feeling competent as a history-taker and physical examiner... and especially as a clinical reasoner. I wish everyone could take IM first. It would have served me well the earlier part of the year. Consider yourself lucky!

 

[kito]

I agree with much of what has been said. Medicine is a great way to start because you will learn the most important clinical skill from third year, and that his the history and physical. You will also drown in the richness of the variety of disease, and everything you see thereafter will be a repeat of some part of what you learned on medicine.

Depending on where you go to school and where you rotate, you will see a lot, do alot and learn a lot on medicine, and that will serve you well for the rest of the year, so consider yourself very lucky. It also helps on medicine to be fresh from Step 1, because it will make up for whatever experience you will lack for having taken the medicine shelf first. By the time the shelf rolls around, you will likely know medicine than you will ever know for quite some time, so definitely relish it.

The biggest deal about getting medicine and surgery done by christmas is that you will spend winter, spring and summer basking in the glow of senioritis. It is a glimpse of what to come in third year, and boy is it awesome.

 

[Heavenly2008]

I also agree with everything that is being said. I started off with medicine and enjoyed it immensely. I felt that I became very proficient in taking a good history in addition to honing in on my clinical skills. It served as a great foundation to every other rotation I have had, and I would not have done it any other way. Contrary to popular belief I think that you can do well on medicine even if it's your first rotation. As far as doing well on the shelf, you will have just finished taking step 1 and your pathophys knowledge will probably never be stronger. This will help you succeed on the shelf exam, because it is basically like a mini-step 1. Use Step-Up and MKSAP and you are set for the shelf.