Order of 3rd year clerkships - experiences?

[nope80]

I'm wondering how many people did surgery/medicine first or in the beginning or third year versus towards the end and how they felt about the order in which they did the rotations? We have a bunch of different options in terms of order but basically the way I see is, surgery/medicine in the beginning versus doing obgyn/peds in the beginning versus towards the end. i have heard to many mixed things about this and am wondering what peoples experiences are?

In some sense it may be good to start out with meds/surgery to form a foundation for everything else but then at the same time, I will be taking the hardest shelf exams first. At the same time, maybe its good to start out with less demanding rotations and working up to it? Who knows Any advice on how to do this?

---

Members don't see this ad.

 

[diosa428]

Eh you will probably hear a lot of different things. Medicine is good to have first because it gives you a really solid foundation and medicine will likely be present on all of your shelf exams (and is an expecially good foundation to have for surgery/your surgery shelf). Both medicine and surgery are also good to have at the beginning of the year b/c you will be less burned out. However, having them in a row could be really long and exhausting.

It also kind of depends upon what you're interested in... doing that towards the end is often recommended because you will have a better idea of what goes on on the wards, etc. (ie, if you want to do ob/gyn, having surgery beforehand will teach you some OR tricks and vice versa). However, if you do it first, then they have really low expectations... so I guess it's really up to you and what you feel comfortable with.

 

[nope80]

Unfortunately I have no idea what I'm interested in yet!

No matter if we take it in the beginning or end, surgery and medicine are always back to back. So, I guess it depends, do people feel more burnt out in the end or more easily overwhelmed in the beginning? Is it a general principle that towards the end people burn out more...?

For second year classes, we started with an easier block then did cardio then renal and now that I think about it, if we had started with renal for example, I would have been really overwhelmed - I needed that initial buffer block in the beginning to get used to things. I don't know if thats how I will feel about third year. At the same time, I definitely want to establish a good foundation for myself and so with that in mind, I think it may make sense to do medicine/surgery first. I just dont know, its scary to think that rotations that important will be my first, when i have no idea what is going on.

 

[Cards21aceking]

There have been old threads about this. Try searching the forum. Here's one recent one:
http://forums.studentdoctor.net/showthread.php?t=514328

 

[diosa428]

I think that if you HAVE to take them back to back, I'd do them first. No matter what you do first, you will probably be overwhelmed. Medicine and surgery also have a certain structure that makes them very easy to follow and the expectations that are pretty clear, which can be different than other rotations, depending upon your school. It will also give you a more solid foundation for the rest of the year. And I think that you will probably be really tired by the end of the year and it's important to do well in medicine and surgery regardless of what you want to go into, so it's good to be fresh and new and excited. Like I said before, the expectations will be lower so don't worry about it being your first rotation.

 

[RxnMan]

Another poster, QofQimica, did IM and Surg back-to-back, and she hated it. Killed her. I did IM and OB/Gyn back-to-back (see sig), and while I'm not regretting it, it has been a haul. Of pain. And humiliation.

That being said, I have cush rotations from here to April starting next week.

 

[Doctor Bagel]

I'm on medicine right now and am so glad I'm not doing medicine and surgery back to back. I'm definitely a fan of mixing up the harder and easier rotations. Lots of people do it, though, and think it's great to get them out of the way. Also, you need to figure out what rotations are like at your school because there's a lot of variation. From what I've gathered, surgery is pretty much hard everywhere, but the other rotations aren't necessarily. For example, peds is supposed to be a hard rotation at my school -- go figure. Ob/gyn is also more time demanding than medicine here, but medicine has more call.

My general thoughts are that it's good to start with something more challenging, and I still wouldn't feel comfortable starting with what I wanted to go into for the first rotation. But if you get stuck with that it's not the end of the world because yes the expectations are lower during the early rotations.

 

[Keg]

So, here are my 4 rules:

1) Psych before Neuro
2) OB/Gyn before Peds
2) IM before Surgery
3) Do what you think you want to do in the third block (for us, blocks are 12 weeks and there are 4 of them).

My schedule:

OB/Gyn (6 weeks), Peds (6 weeks), IM (12 weeks), Surgery (12 weeks), Elective (4 weeks), Psych (4 weeks), Neuro (4 weeks).

 

[nope80]

Yeah we pretty much don't get an option - we have to do surg/med and obgyn/peds back to back.

 

[Cards21aceking]

So, here are my 4 rules:

1) Psych before Neuro
2) OB/Gyn before Peds
2) IM before Surgery
3) Do what you think you want to do in the third block (for us, blocks are 12 weeks and there are 4 of them).

My schedule:

OB/Gyn (6 weeks), Peds (6 weeks), IM (12 weeks), Surgery (12 weeks), Elective (4 weeks), Psych (4 weeks), Neuro (4 weeks).

Agreed wholeheartedly. Exact same schedule as what i have. An additional rule that I had when I was picking my schedule was having OB/Gyn before surgery as well.

Good thoughts keg

 

[nope80]

Agreed wholeheartedly. Exact same schedule as what i have. An additional rule that I had when I was picking my schedule was having OB/Gyn before surgery as well.

Good thoughts keg

If I do Obgyn before surgery, I won't get to the surgery medicine block until the second half of the year. I feel like by then, id be burnt out?

 

[socmob]

I did IM/Surg back to back and at the beginning of the year. Wasn't bad and overall I'm happier that I did it early in the year b/c I was definitely burned out by the end.

 

[45408]

My school has "the big three" grouped together. Surgery, medicine and peds are all two month rotations, and they all have to be taken in the same semester. I did medicine first and surgery second. I think it was great - I got a great foundation during medicine, and taking the medicine shelf is great prep for the surgery shelf. It was pretty time-consuming and fairly challenging, but residency's going to be a lot harder. I think it's also a lot easier to muster a lot of enthusiasm and energy early in the year. I'd hate to start surgery in January, when it's dark by 5pm, and you're trudging to your car in the cold snow in the dark at 4:30 in the morning.

 

[dilated]

People say it doesn't matter, but it does - a bit.

You need to do medicine early. It's a huge edge for other clerkships and if it's like it is here, it's by far the rotation with the most cramming of knowledge into your head by the school and department.

If you want to do surgery, don't do it right in the middle/second trimester. All the other people who want to do surgery are doing it at that time because they want to look good but not be too late to apply and you'll probably be in a vicious gunner crew. The average shelf score at my school was like six points higher in January than August, then went back down a bit in May. You may be better off biting the bullet and doing it early. As long as you work hard the lack of knowledge won't hurt you terribly and you'll be hanging with the "want to get surgery out of the way" crew.

Other than the big 2 the rest is kind of unimportant when you do it.

 

[Trail Boss]

Surgery in the middle. Crushing the gunners at their own game will be the culmination of my master plan to get a surgery residency at Duke. I eat gunners for lunch and wash them down with a charge nurse or two. Ahh ha ha

 

[mercaptovizadeh]

What if we want to do internal medicine for residency? Should we stick it in the middle or the end? I don't want to be hampered in the other clerkships by not knowing enough medicine, but I don't want to squander the chance to do well by doing it too early.

Also, I'm MD/PhD and will have forgotten everything by the time I reenter.

What clerkships are medicine-ish? Peds/Ob-Gyn/Fam-Med? Can you do well on surgery if you do it before medicine?

 

[ginger60]

What if we want to do internal medicine for residency? Should we stick it in the middle or the end? I don't want to be hampered in the other clerkships by not knowing enough medicine, but I don't want to squander the chance to do well by doing it too early.

Also, I'm MD/PhD and will have forgotten everything by the time I reenter.

What clerkships are medicine-ish? Peds/Ob-Gyn/Fam-Med? Can you do well on surgery if you do it before medicine?

Peds is a good warm-up for how medicine wards work, and fam med for common (especially outpatient) medical problems. If you are pretty sure you want to go into internal med and are a bit out of practice either or both of those two rotations could definitely help you get back into the swing of things. Otherwise its a lot of personal preference, neuro could also help if your school has it separate from medicine. You don't want to be burned out especially for shelfs so try not to stick your favorite specialty at the very very end (or immediately after surgery).

 

[Mikhail]

1) OB
2) Peds
3) IM
4) Surgery
5) Psych
6) Fam medicine

If you want to do surgery, you can do medicine before surgery. If you want to do medicine, do surgery before. In my school, we have to take fam med during the 3rd year. The rotation is not difficult but it's really difficult to prepare for the shelf. So, if you have to do it, try to do it later in the semester.

Good luck!

 

[anon-y-mouse]

Clearly IM first. I differ with any other answer but that. It's pretty much the basis for every other rotation, you're still fresh from your boards with all that knowledge, EAGER to learn, not jaded, and can learn pretty quickly... It's a bit of a learning curve, but I was on top of ACS protocol etc. by day 4-5. Plus, it helps with pretty much every other rotation- my medicine knowledge has come in useful for every rotation. IM, then surgery -- yes, back to back. It was hard, but whatever. Life's hard! Med school's hard! Deal with it!

 

[nope80]

I just got my schedule - we do a lottery system and I got one of my last choices!!!! I wasn't even paying attention to the last choices, as I thought I'd NEVER get one (all my classmates got pretty much their first few choices).

Anyway, tell me how me how bad or how not so bad my sched is:

Pediatrics, Ob/gyn, rural medicine primary care, family medicine, elective
- winter break -
surgery, medicine, elective, psych.

 

[MSKalltheway]

Sucks to have med and surg back to back from a sanity standpoint, but other than that I really dont think order matters. At my school, medicine and surgery are both 12 weeks long, so my classmates who have both from jan to june I really feel bad for. From my standpoint, you can learn some medicine from other rotations and use it to help you out more when you actually do the medicine rotation, if you want to see it the other way around. I have it starting january and ive had surgery, peds and am finishing OB right now and I dont feel like I'm at any disadvantage at all.

Just work hard and study hard and everything will go well for you. Plenty of people manage to get A's or Honors without having medicine early so its def not necessary. I think the order thing is overhyped anyways.

 

[Pontifex Maximus]

At my school, medicine and surgery are both 12 weeks long, so my classmates who have both from jan to june I really feel bad for. \

Shut. up.

 

[LadyWolverine]

Shut. up.

Relax, dude. The 2 months of inpatient medicine will make you want to slit your wrists, no doubt - but that's why God created the outpatient medicine rotation. Aside from having to study for the shelf, this month has been the highest point of my medical school career since M1-M2 summer (except for, perhaps, family med). Try and get it as the last 4 weeks of the block, if you can. If not, it's still nice to have a comparatively low-key month.

I'm on surg next block - will I see you there? We can make fun of the gunners together.

(PS: I'm doing med-surg back-to-back, each 12 weeks long, and I don't think it's going to break me. I guess I can't say for certain until March, but what saved me so far has been the fact that this 6-month continuum was broken up decently by having outpatient medicine during December followed by 2 weeks of winter break. Hopefully, I'll be pretty well-rested and ready to get back on the horse when I start surgery in January. Then it's a 3-month sprint to Spring Break!!)

 

[Doctor Bagel]

Ahh, that outpatient month in IM makes it sound much more palatable. We have 8 weeks, but it's all inpatient. The same is true for surgery with us. We do a month of outpatient IM 4th year.

 

[LadyWolverine]

Ahh, that outpatient month in IM makes it sound much more palatable. We have 8 weeks, but it's all inpatient. The same is true for surgery with us. We do a month of outpatient IM 4th year.

After the first 2 inpatient months, I may have either died or quit had I been faced with another month of the same thing. No matter how early I got there, I never felt prepared enough during rounds. No matter how late I stayed, I never got everything done. No matter how much I read, I never knew enough. I've never been so frustrated or felt so lost and useless in my life. I don't know how the IM interns and residents do what they do, but God bless them.

 

[eforest]

I signed up to have medicine early in third year and I'm glad I did so. The things I learned in medicine formed the basis for the things I learned in all subsequent rotations. The only drawback is that I didn't do as well as I would have liked in Medicine.

I also did surgery during the first half of the year, and that was helpful. But medicine was the single most helpful rotation of the year, and looking back, I wouldn't do things differently

 

[Samoa]

We had a 2-yr "clinical continuum" instead of separate 3rd & 4th years. So my master plan was:

Med
Surg
Psych
Neuro
Surg Path vs Anesthesia
Neurosurg
OB/GYN
Peds

---END OF 3RD YEAR--

Aways (2 months)
Family Med
OP surg
ER/Rads
OP med
Surg Path vs Anesthesia
ICU (post match)
Vacation till graduation

 

[medstylee]

i'm a big advocate of doing IM first, if possible. First off, the shelf is a tough one (at least i thought it was much tougher than both psych and obgyn... haven't done the others yet), and it will help that you are taking it relatively soon after taking step I. Also, I think the foundation you get in medicine (or at least while studying for the shelf) will help you on all your subsequent exams. I was definitely surprised at how much medicine was on the psych shelf. after doing part of my med rotation at the VA, i knew more than i cared to know about benzos, which worked out nicely for psych...

 

[RussianJoo]

at my school you're assigned the order and have no say at all. I had surgery first, and thought that was terrible. but it turned out amazing. Here's why. Since it was my first rotation the attendings didn't expect too much from me and realized I was nervous since this is my first time in a hospital, so when ever I did something slightly above and beyond of my duties they were very happy and thought I was doing an amazing job. Also getting surgery out of the way and getting used to being at the hospital at 5am and leave at 5 or 6pm, makes all the other rotations seem like a joke. Most of my other rotations started at 6 or 6:30 so it was like sleeping in after surgery, also I wasn't tired at all at the end of the day and would get a lot more done. Doing surgery first worked out great for me. And I would recommend it for anyone else.

 

[TUNCOM]

I liked doing OB/Gyn and then Peds... it is pretty much a continuation of care from the newborn. I also think doing FP before internal medicine helps a lot because there is overlap and FP is usually a slower pace.