Knickerbocker

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Jun 19, 2006
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I am confused about how medical school works. From what I've read, the first two years are mostly classroom based. Then, one goes into clinical rotations for two years, spending anywhere from two weeks to a few months in one area.

I'm not clear on how these rotations work. Do you get some hands on experience during this, or is it basically intense shadowing? Also, are these rotations graded?
 

Dr Durden

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Jun 15, 2006
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Third year generally consists of five two-month rotations in surgery, obstetrics and gynecology, pediatrics, internal medicine, and psychiatry. The other two months are electives, research, or vacation. These are generally graded Honors, Pass, and Fail with maybe a few more distinctions thrown in (ie High Pass). The level of hands on experience depends on the hospital. Some prestigious well-staffed hospitals might just let you watch, but others will need all hands on deck.

For example, in surgery you'll likely be a "human retractor." You get to hold organs and body fat out of the way so the true surgeons can go to work while you get quizzed on anatomy. You might get to stitch some things up too, but your knots will either be too short or too long, but never perfect. Every fourth night you might be on call with the interns, answering nurses pages and checking on wounds. You might admit patients, take brief histories, and perform exams. Despite missing out on sleep, you'll spend a lot of time reading surgical texts to pass shelf exams at the end and to look good when "pimped" or quizzed by residents.

IM is also pretty intense. Medical problems in adults can be pretty complex and generally occur in tandem with one another. You usually round very early in the morning, charting patient progress, checking vital signs, tweaking prescriptions and IVs, and making sure they'll survive the day. You then round with the intern, then the residents, then the attending. You'll get grilled over disease trivia, why you did what, what you can change, and then be left to work the remainder of the afternoon. You'll likely be a scut monkey, helping the intern fetch lab values and performing minor procedures. You'll probably get the unpleasant task of dealing with the less medical side of things like placing patients in nursing homes, contacting social workers, and tracking down patient family members. You might have call like when on surgery or you might get to go home for the day when all the loose ends are tied up.

Those are the two "specialties" I've heard about the most and have actually observed med students in. Fourth year is generally devoted more to electives in other specialties in which you are interested with some "free" time thrown in to interview for match day. Regardless of the year though, the key to success is to be like a swan, serene and calm on the exterior, but paddling like mad underwater.

However, I'm only applying this year so I freely admit I might not be the best person to reply.
 

91Bravo

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Dr Durden said:
Third year generally consists of five two-month rotations in surgery, obstetrics and gynecology, pediatrics, internal medicine, and psychiatry. The other two months are electives, research, or vacation. These are generally graded Honors, Pass, and Fail with maybe a few more distinctions thrown in (ie High Pass).
Medical schools vary with respect to both what they consider 'core' rotations and their respective lengths. If you'd like to know more about this I would suggest looking at some medical school websites. Generally you'll find that they list their core rotations, elective rotations, etc.

Good luck with your journey....
 

LizzyM

the evil queen of numbers
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Mar 7, 2005
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Knickerbocker said:
I'm not clear on how these rotations work. Do you get some hands on experience during this, or is it basically intense shadowing? Also, are these rotations graded?
At the very least, you'll obtain histories and perform physical exams and write them up in the medical record and/or present them orally to the attending. (the med student is the only one who has hours to do a thorough H&P & sometimes the med student turns up a piece of information that is crucial to making a diagnosis). Honing physical exam skills is one of the key points of the clinical rotations, IMHO. You can expect to present a patient at a teaching conference; this means that you describe the history of the present illness, the past medical history, social history, findings on physical exam, laboratory and diagnostic test results, etc. Some of it is like shadowing as you listen to the attendings pimp the residents. In turn you are pimped by the residents and less often by the attendings.

Depending on where you do your clinical rotations, you may get to perform some procedures after you've watched one being performed. The VA hospitals are well known for providing many opportunities to perform procedures (arterial blood draw, lumbar puncture, etc).

You will be graded on each rotation. Good grades on the rotations are essential to a good residency match. Grades are based both on written exams and on subjective assessments based on your presentations and your work ethic. Letters regarding your performance can also go into your file that is used to write your "Dean's letter" that accompanies your applications for residency.