Order for Rotations for someone interested in neurosurgery

[Detailsmatter]

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Hey everyone, so im trying to finalize my preferences for rotations. for background im pretty sure i wanna pursue neurosurgery. I included a pic of the 4 schedules we can choose from. my 1st preference would be schedule 4 because i can do medicine first and get it out of the way and have surgery in the middle of the year. schedule 3 would be my 2nd preference because of surgery in the middle but this one is less ideal because i would prefer to have medicine before surgery.

What im stuck on is the last two preferences. I would prefer to not have surgery as my first rotation for obvious reasons but ive heard its not good to have surgery last either because of sub-Is and being burned out. is this true and when do you apply for these sub-Is/does it matter if surgery is done after you apply for them? what do you guys think i should pick? thanks!!

 

[Redpancreas]

Hey everyone, so im trying to finalize my preferences for rotations. for background im pretty sure i wanna pursue neurosurgery. I included a pic of the 4 schedules we can choose from. my 1st preference would be schedule 4 because i can do medicine first and get it out of the way and have surgery in the middle of the year. schedule 3 would be my 2nd preference because of surgery in the middle but this one is less ideal because i would prefer to have medicine before surgery.

What im stuck on is the last two preferences. I would prefer to not have surgery as my first rotation for obvious reasons but ive heard its not good to have surgery last either because of sub-Is and being burned out. is this true and when do you apply for these sub-Is/does it matter if surgery is done after you apply for them? what do you guys think i should pick? thanks!!View attachment 333268

Ooh...I like this question. Thanks for actually giving us the table! It allows our answers to be much more helpful.

Short Answer: Rank them Schedule #s: 4 >3>>>2>1

Schedule 4
Pros: Medicine Introduction, Chill Rotations/Winter Break prior to Surgery. Use these to start reading and studying for surgery early.
Cons: Ending on OB/GYN is kind of busy, Medicine won't be fresh for Step 2CK.

Schedule 3:
Pros: OB Introduction (you'll learn how to scrub, can practice suturing on patients if you're proactive, etc.). Same thing for winter break/FM before surgery.
Cons: Medicine on the end is a double edged sword. On one end it's good review for Step 2 CK but it's also busy and has a lot of material best learnt early on.

Schedule 2:
Pros: Chill end to your rotations with FM, etc. that you can use to study for Step 2 CK.
Cons: Surgery to start. Believe me when I say this is not AS bad as having surgery at the end. First off, your cohort mostly wont want to do surgery. Second, everyone expects you to be dumb during July but by the end of the year you'll know more but expectations will already be higher.

Schedule 1:
Pros: Maybe Surgery at the end will give you recency bias with your LOR writers and give you the most time to study surgery. You'll also have the most time to prepare for surgery.
Cons: Surgery at the end will carry higher expectations. You also start off with the chillest rotation right off the bat when you don't really need a break. Additionally, you won't have time to prep for CK during your last block (surgery).

 

[Tangerine123]

4.

Medicine first, but not to get it our of the way fast. Rather, because it's a good base to have for the others.

 

[Detailsmatter]

4.

Medicine first, but not to get it our of the way fast. Rather, because it's a good base to have for the others.

Yeah I agree I should have clarified that I realize doing medicine first helps for the other rotations. Thing is that we have to rank each schedule and then they assign it based on our preferences. I current have schedule 4 and 3 as my 1st and 2nd options respectively but I’m not sure what to rank 3rd and 4th on my list

 

[Redpancreas]

Yeah I agree I should have clarified that I realize doing medicine first helps for the other rotations. Thing is that we have to rank each schedule and then they assign it based on our preferences. I current have schedule 4 and 3 as my 1st and 2nd options respectively but I’m not sure what to rank 3rd and 4th on my list

The correct answer is 4321. Don't do 4312. Schedule 1 is literally taking you in ascending order of busy-ness (OB is a killer too). Surgery expectations will be the highest at the end and you won't have rotation time to get a head start of CK during the second half of your year.

At the end of the day, you'll find silver linings in whatever you get (ex. you may get more hands on time if you do surgery last with interns already procedured out) but definitely rank it 4321!

 

[Detailsmatter]

The correct answer is 4, 3, 1, then 2. Don't do 4, 3, 2, 1. Schedule 1 is literally taking you in ascending order of busy-ness (OB is a killer too). Surgery expectations will be the highest at the end and you won't have rotation time to get a head start of CK during the second half of your year.

At the end of the day, you'll find silver linings in whatever you get (ex. you may get more hands on time if you do surgery last with interns already procedured out) but definitely rank it 4312!

thanks for your insight! super valuable

 

[Banco]

4.

Medicine first, but not to get it our of the way fast. Rather, because it's a good base to have for the others.

This.

Surgery in the middle is also ideal as you won't be burned out yet in the year.

 

[FalconSlice]

Thought about this a long long time with much effort... and now looking back to that moment in my life, I'll risk saying something heretical here and say that I don't think rotation order matters at all. Let the firing-squad have at me.

 

[Matthew9Thirtyfive]

Thought about this a long long time with much effort... and now looking back to that moment in my life, I'll risk saying something heretical here and say that I don't think rotation order matters at all. Let the firing-squad have at me.

I totally agree. I am still at the start of my clinical rotations, but I started with surgery first and want to go into a surgical field. It did not matter at all that I started with surgery lol.

 

[Tangerine123]

Thought about this a long long time with much effort... and now looking back to that moment in my life, I'll risk saying something heretical here and say that I don't think rotation order matters at all. Let the firing-squad have at me.

Oooh, it doesn't

But given the option I would always do medicine first. I had no order choice and got assigned Medicine/Surgery/OBGyn/Peds and was really satisfied with that.

US students will not relate to this next part, but on my last year I was assigned Rural and then Internship. Order did matter there, a lot. Practicing general medicine alone in a village before the internship rotations was hard.

 

[Thesimplelifeofamyloid]

Don't let anyone tell you order doesn't matter. You need to make sure you have enough time to study for the shelf. The exams aren't easy. All of these aren't great options, but 4 is probably the best. Medicine before surgery is critical, because surgery shelf can be heavily based on medicine.

 

[Detailsmatter]

thanks for everyones input. I think theres obviously ideal rotations order depending if you prefer medicine or surgery but i guess in the grand scheme of things its not the end of the world if you dont get the perfect order for your interests.

 

[Matthew9Thirtyfive]

thanks for everyones input. I think theres obviously ideal rotations order depending if you prefer medicine or surgery but i guess in the grand scheme of things its not the end of the world if you dont get the perfect order for your interests.

I don’t think that’s obvious at all. Going through it now, I think order matters very little except in that it may make one or two of the shelf exams easier.

 

[TelemarketingEnigma]

weird that they aren't giving you all the possible schedule variations for blocks 2/3 (the whole next gen curriculum stuff baffles me a little as an old fart/MS3 at your institution). I would've said that an ideal schedule for you would have had Medicine Block 2 > EROR Block 3, or Medicine Block 1 > EROR block 2 so you have the medicine knowledge base going into surgery. As it stands I think I agree with the 4 3 1 2 order.

ETA: actually, a downside of schedule 1 is that by ~feb/march of M3 they're gonna start asking you to make M4 schedule decisions etc based on your expected specialty. It's not set in stone, but doing surgery in block 4 may give you some stress if you're on the fence about anything going in. OB will give you some idea of what it's all like but is a pretty different experience overall

 

[Redpancreas]

@Detailsmatter
It’s actually ideally 4321, I mistyped as 4312 (less ideal) multiple times to confuse things further. Edited the mistakes above. The rotation where surgery is last should go last.

As to the people saying order doesn’t matter even though I suggested an order I kinda of agree. OP, you’ll find a silver lining in everything.