Order of Clinical Rotations — Thoughts?

[jahrslof]

---

Members don't see this ad.

Hi everyone! I got the order of my clinical rotations today, and while the order I received wasn't what I was hoping for, I know each stream has it's own advantages and disadvantages, and I was wondering if you would be able to tell me your thoughts on my order?

First I have Neuro (4 weeks), Psych (4 weeks), and FM (4 weeks). Second I have a Surg Subspecialty (4 weeks) and General Surg (4 weeks). Third I have OB (6 weeks) and Peds (6 weeks). And fourth, I have Internal Medicine (8 weeks).

What might the advantages and disadvantages of this stream be? I think it would help with preparing for each rotation and approaching Step 2 studying. From reading other posts, I am thinking having IM last would be good because it studying for the IM shelf would = studying for Step 2, but I'm worried about 1) not having IM before Gen Surg (since I read a lot of the Gen Surg shelf has a lot of IM), 2) not having OB before Gen Surg (since I read having OB before Gen Surg helps with knowing how to suture etc.) and 3) not having FM last (since I heard the shelf is quite random and has a lot of everything). The order I got is the *exact* reverse of the order I wanted lol...

I guess my questions are 1) what would you think the advantages and disadvantages of the stream I got is, and 2) is there anything I can do to help prepare for each rotation knowing which clinical rotation experiences I will and will not have before each one? I'm interested in Urology, if that helps! Thank you, I'd appreciate any thoughts/advice a great deal!!

 

[mehc012]

If you're worried about knowing OR etiquette, that's easily taken care of with shadowing.

Personally, I'd hate to have IM last. I was originally scheduled for that and actually took the rotation a year early to avoid that issue.

 

[jahrslof]

If you're worried about knowing OR etiquette, that's easily taken care of with shadowing.

Personally, I'd hate to have IM last. I was originally scheduled for that and actually took the rotation a year early to avoid that issue.

Thanks for your response! I edited the post to change OR etiquette to suturing, etc. I have shadowed surgeons before, but shadowing again is a good idea! Why would you hate to have IM last?

 

[FFH]

Your order seems like a pretty good one to me.
I liked having IM later because it was the broadest and hardest to prepare. I enjoy having all of the knowledge from earlier rotations and did really well. Pretty much everybody in my class had the same idea. None of the students who got IM latter wanted to trade. Then again, I am not a surgery person, so it was great to get it over with for good.

Even if you are a surgery person, it's still good to have it early. It helps you clarify the question whether you want it or not. If it is for you, you can start to work on your resume in the remaining part of your clerkship to build your CV for surgery. If not, then it's all the better you get it out of the way and can start thinking about alternative choice.

 

[mehc012]

Thanks for your response! I edited the post to change OR etiquette to suturing, etc. I have shadowed surgeons before, but shadowing again is a good idea! Why would you hate to have IM last?

For the reasons you've said...all of my other shelves have been easier thus far for having gotten IM studying under my belt. Honestly, it was like a mini Step 1, so having it near that time was convenient anyway. I actually took it before dedicated and prepping for the shelf put me in good position for Step 1 AND the rest of my shelf exams.

Suturing you can practice on your own time before surgery, and you're not being graded on your suture skills anyway.

We actually drew the exact same core rotation order, you and I, only I didn't like mine and my school is flexible, so I took the option to pull my IM rotation ahead by a year, making it IM → Step 1 → Neuro/Psych → Surgery/Subsp → Peds/OB and then I finish early, leaving time for early AIs, research, etc. That changed what I thought was a pretty bad schedule to an ideal one, imo.

 

[raiderette]

If you are into surgery, I will admit, your schedule isn't perfect, but you should be fine. I had surgery before IM, and it would have been a bit easier. Basically, commit to studying after long hours in surgery. I had my IM later as well, but that was actually a benefit.

 

[831929]

IM first = you'll probably look better in clinic the rest of the year

IM last = you'll probably have to study very little for step 2 if you take that shelf seriously.

I have IM closer to the bed so my clinical and patient care abilities have not been great since I have had almost no inpatient experience. But I'm still getting relatively good evaluation.

I think the order doesn't really matter.

 

[jahrslof]

For the reasons you've said...all of my other shelves have been easier thus far for having gotten IM studying under my belt. Honestly, it was like a mini Step 1, so having it near that time was convenient anyway. I actually took it before dedicated and prepping for the shelf put me in good position for Step 1 AND the rest of my shelf exams.

Suturing you can practice on your own time before surgery, and you're not being graded on your suture skills anyway.

We actually drew the exact same core rotation order, you and I, only I didn't like mine and my school is flexible, so I took the option to pull my IM rotation ahead by a year, making it IM → Step 1 → Neuro/Psych → Surgery/Subsp → Peds/OB and then I finish early, leaving time for early AIs, research, etc. That changed what I thought was a pretty bad schedule to an ideal one, imo.

I’m glad you had the option to do that, and I’m glad it worked out for you! My school isn’t flexible at all, so I’m unfortunately stuck with this order 🙁 is there anything you think I could do to help with not having IM before the other rotations? Should I keep up with my step 1 Anki deck to keep the material in mind? Or maybe ask a hospitalist I know if I could round with her for a couple days if she has the time so I could learn a little more about how to present well and write good notes? I really want to do well on all of my rotations because while I’m interested in Urology I’m not 100% set on it, so if there’s anything you think I could do before I begin rotations that would help, I would love to hear it!

 

[jahrslof]

Your order seems like a pretty good one to me.
I liked having IM later because it was the broadest and hardest to prepare. I enjoy having all of the knowledge from earlier rotations and did really well. Pretty much everybody in my class had the same idea. None of the students who got IM latter wanted to trade. Then again, I am not a surgery person, so it was great to get it over with for good.

Even if you are a surgery person, it's still good to have it early. It helps you clarify the question whether you want it or not. If it is for you, you can start to work on your resume in the remaining part of your clerkship to build your CV for surgery. If not, then it's all the better you get it out of the way and can start thinking about alternative choice.

Thank you! That’s good perspective, and I’m glad to hear there’s a benefit to having IM last!

 

[jahrslof]

IM first = you'll probably look better in clinic the rest of the year

IM last = you'll probably have to study very little for step 2 if you take that shelf seriously.

I have IM closer to the bed so my clinical and patient care abilities have not been great since I have had almost no inpatient experience. But I'm still getting relatively good evaluation.

I think the order doesn't really matter.

Sorry for the dumb question, but what do you mean specifically by patient care abilities? Like it has been harder for you to know how to present/what to order/etc.?

 

[ciestar]

I’m glad you had the option to do that, and I’m glad it worked out for you! My school isn’t flexible at all, so I’m unfortunately stuck with this order 🙁 is there anything you think I could do to help with not having IM before the other rotations? Should I keep up with my step 1 Anki deck to keep the material in mind? Or maybe ask a hospitalist I know if I could round with her for a couple days if she has the time so I could learn a little more about how to present well and write good notes? I really want to do well on all of my rotations because while I’m interested in Urology I’m not 100% set on it, so if there’s anything you think I could do before I begin rotations that would help, I would love to hear it!

Zanki is much more useful for clerkships.

 

[831929]

Sorry for the dumb question, but what do you mean specifically by patient care abilities? Like it has been harder for you to know how to present/what to order/etc.?

Yep all that stuff.

 

[ortnakas]

IM earlier in the year can help because there's a little bit of medicine in all rotations, but at the end of the day, third year rotation order matters a lot less than it feels like it's going to. I wouldn't stress it.

 

[mrbreakfast]

tl;dr clerkship order doesn't really matter unless you fall in love with your last rotation.

I am thinking having IM last would be good because it studying for the IM shelf would = studying for Step 2

This is true, and probably the most important point. I had IM first and had to re-learn ALL of it for CK.

2) not having OB before Gen Surg (since I read having OB before Gen Surg helps with knowing how to suture etc.)

I had OB well before surgery. My surgery attendings didn't expect us to already know how to suture. My OB attendings did, and I got yelled at for not knowing how to close a laproscopic port hole on my first surgery ever (which was on GYN). If you're legit worried about this, teach yourself beforehand (there are great youtube videos)

not having FM last

This is a tough shelf regardless of when you take it. If you're looking for a silver lining, studying for this may help a bit with pediatrics, which is also a tough shelf.


Starting with neuro and psych is awesome, and you will be well prepared for the tougher shelves/rotations after that.

 

[takeurmeds02]

Granted I've only completed medicine so far and I'm on my last leg of surgery, I'm glad I had medicine first. I feel like it set a pretty solid foundation to learn for the rest of the year adding the knowledge of other specialties. I'm hoping that by the end of the year, medicine will be more of a recall rather than having to relearn everything as was mentioned above.

 

[Redpancreas]

Hi everyone! I got the order of my clinical rotations today, and while the order I received wasn't what I was hoping for, I know each stream has it's own advantages and disadvantages, and I was wondering if you would be able to tell me your thoughts on my order?

First I have Neuro (4 weeks), Psych (4 weeks), and FM (4 weeks). Second I have a Surg Subspecialty (4 weeks) and General Surg (4 weeks). Third I have OB (6 weeks) and Peds (6 weeks). And fourth, I have Internal Medicine (8 weeks).

What might the advantages and disadvantages of this stream be? I think it would help with preparing for each rotation and approaching Step 2 studying. From reading other posts, I am thinking having IM last would be good because it studying for the IM shelf would = studying for Step 2, but I'm worried about 1) not having IM before Gen Surg (since I read a lot of the Gen Surg shelf has a lot of IM), 2) not having OB before Gen Surg (since I read having OB before Gen Surg helps with knowing how to suture etc.) and 3) not having FM last (since I heard the shelf is quite random and has a lot of everything). The order I got is the *exact* reverse of the order I wanted lol...

I guess my questions are 1) what would you think the advantages and disadvantages of the stream I got is, and 2) is there anything I can do to help prepare for each rotation knowing which clinical rotation experiences I will and will not have before each one? I'm interested in Urology, if that helps! Thank you, I'd appreciate any thoughts/advice a great deal!!

The schedule's slightly back-loaded, but not majorly. There are significant inter-school variations to keep in mind, but here's how I'd approach it. Neuro's a good starting point because you'll get comfortable with the H&P and neurologists are reasonably patient people so you'll have a good grasp on the H&P, EMR, and presentation process. The shelf is difficulty is moderate. Afterwards, Psych is a fairly chill. Most places have good hours and the shelf exam is easy to honor. Take the time to get a headstart with UWorld. During this time, do Psych but also finish all of Internal Medicine-GI as well as as much Surgery as you can. On Family Medicine, it's not as chill as you think even though you have weekends. Days typically go from 8-6PM where you stay after for notes. Take time to relax. The material's really broad so I would actually recommend putting a hold on UWorld and trying to focus on Family specific resources and you'll learn a lot of Step 2 stuff by default. On Surgery, focus on just learning from your cases. Trying to do too much outside the rotation is counterproductive because you don't have as much free time. Besides boards stuff, there's lots of practical stuff like knot-tying you'll have to master so you need to set time aside for that. Get through all the UWorld Surgery. In terms of resources to use for the Shelf, you can skim Pestana's but I didn't see a point in mastering it. DeVirgilio's is a solid textbook and it will help for the shelf. Just make an attempt to get through it. Once you're done with that, it's tough having OB/GYN but continue working on those suture skills and do your best with boards stuff. Best resources I felt were Case-Files and those uWISE questions. After that, just get through Peds with UWorld. You'll be feeling pretty burnt out at this point. Then for IM, make a point of finishing UWorld if you haven't. If your Step 1 >240, consider take Step 2 CK. If not, do your home subI then your away subIs and then come back and take some time off to take it.

As for research, unfortunately 3rd year's busy. One thing that really burnt me out was the feeling of guilt that I wasn't doing research. I never ended up getting anything substantial done, but I'd rather have just accepted that instead of trying to get something done when it wasn't happening. Best time for you to start a project right at the beginning frankly because of your back-loaded schedule. Neuro isn't too bad, Psych's super chill, and on Family you'll have weekends. Good luck!

 

[jahrslof]

tl;dr clerkship order doesn't really matter unless you fall in love with your last rotation.

This is true, and probably the most important point. I had IM first and had to re-learn ALL of it for CK.

I had OB well before surgery. My surgery attendings didn't expect us to already know how to suture. My OB attendings did, and I got yelled at for not knowing how to close a laproscopic port hole on my first surgery ever (which was on GYN). If you're legit worried about this, teach yourself beforehand (there are great youtube videos)

This is a tough shelf regardless of when you take it. If you're looking for a silver lining, studying for this may help a bit with pediatrics, which is also a tough shelf.

Starting with neuro and psych is awesome, and you will be well prepared for the tougher shelves/rotations after that.

Thank you so much!! I really appreciate your response, it was so reassuring and helpful. I'm sorry you got yelled at on your first surgery ever 🙁

It is nice to hear there's a silver lining! For FM and Peds and the other hard shelf exams, what makes them hard? Is it the amount of information, is there a lack of (good) resources that cover all of the information, or is it that most people just don't have a lot of free time to study during these rotations?

 

[jahrslof]

The schedule's slightly back-loaded, but not majorly. There are significant inter-school variations to keep in mind, but here's how I'd approach it. Neuro's a good starting point because you'll get comfortable with the H&P and neurologists are reasonably patient people so you'll have a good grasp on the H&P, EMR, and presentation process. The shelf is difficulty is moderate. Afterwards, Psych is a fairly chill. Most places have good hours and the shelf exam is easy to honor. Take the time to get a headstart with UWorld. During this time, do Psych but also finish all of Internal Medicine-GI as well as as much Surgery as you can. On Family Medicine, it's not as chill as you think even though you have weekends. Days typically go from 8-6PM where you stay after for notes. Take time to relax. The material's really broad so I would actually recommend putting a hold on UWorld and trying to focus on Family specific resources and you'll learn a lot of Step 2 stuff by default. On Surgery, focus on just learning from your cases. Trying to do too much outside the rotation is counterproductive because you don't have as much free time. Besides boards stuff, there's lots of practical stuff like knot-tying you'll have to master so you need to set time aside for that. Get through all the UWorld Surgery. In terms of resources to use for the Shelf, you can skim Pestana's but I didn't see a point in mastering it. DeVirgilio's is a solid textbook and it will help for the shelf. Just make an attempt to get through it. Once you're done with that, it's tough having OB/GYN but continue working on those suture skills and do your best with boards stuff. Best resources I felt were Case-Files and those uWISE questions. After that, just get through Peds with UWorld. You'll be feeling pretty burnt out at this point. Then for IM, make a point of finishing UWorld if you haven't. If your Step 1 >240, consider take Step 2 CK. If not, do your home subI then your away subIs and then come back and take some time off to take it.

As for research, unfortunately 3rd year's busy. One thing that really burnt me out was the feeling of guilt that I wasn't doing research. I never ended up getting anything substantial done, but I'd rather have just accepted that instead of trying to get something done when it wasn't happening. Best time for you to start a project right at the beginning frankly because of your back-loaded schedule. Neuro isn't too bad, Psych's super chill, and on Family you'll have weekends. Good luck!

THANK YOU THANK YOU THANK YOU!!! Thank you so much for taking the time to write all of this out and sharing your advice with me, I feel a lot better about the order of my rotations and how I should approach studying during each rotation. I really appreciate your advice and kind words <3

 

[Redpancreas]

Thank you so much!! I really appreciate your response, it was so reassuring and helpful. I'm sorry you got yelled at on your first surgery ever 🙁

It is nice to hear there's a silver lining! For FM and Peds and the other hard shelf exams, what makes them hard? Is it the amount of information, is there a lack of (good) resources that cover all of the information, or is it that most people just don't have a lot of free time to study during these rotations?

My order was OB, Neuro, Psych, IM, Family, Peds, and Surgery.
In terms of difficulty for myself, I'd say OB>Surgery>>IM>FM=Peds=Neuro>Psych, but note FM after IM.
I think the surgery shelf is hard because there was never time so sit down and do much studying and the whole rotation was a train wreck with sleepless nights on call. OB was difficult for me and will remain a weakness even on Step 2CK and now with Step 3 studying. I feel like Neuro and Peds were pretty easy because there's a lot of isolated knowledge you need to know in detail and if you learn all the pathology, you have a good grasp of it. For IM (and also surgery) they can really ask anything. Surgery's not really an IM shelf. The questions they ask are surgical and I think they're harder because most of the questions are trauma/inpatient management and that was a relatively weak point of mine during 3rd year. IM was easier because half of it was outpatient stuff and that was all of family.

 

[ciestar]

Thank you so much!! I really appreciate your response, it was so reassuring and helpful. I'm sorry you got yelled at on your first surgery ever 🙁

It is nice to hear there's a silver lining! For FM and Peds and the other hard shelf exams, what makes them hard? Is it the amount of information, is there a lack of (good) resources that cover all of the information, or is it that most people just don't have a lot of free time to study during these rotations?

FM the issue really was the random hodgepodge of things they could ask and just the amount of things you need to know to prepare for that.

I started on FM and then psych. Psych’s shelf was a lot easier and much more chill overall. I take my IM shelf friday, so i can comment on that then lol

 

[mrbreakfast]

It is nice to hear there's a silver lining! For FM and Peds and the other hard shelf exams, what makes them hard? Is it the amount of information, is there a lack of (good) resources that cover all of the information, or is it that most people just don't have a lot of free time to study during these rotations?

For FM/peds, it's a combination of: not great resources, ton of material, and "boring" material (vaccine schedules/child dev).

These are traditionally the two hardest shelves. IM is also hard to to volume. Surgery is kind of hard due to long hours + few good resources.

OB is weird because you have to pick your poison: crazy inpatient clerkship with zero time to study, or a chill outpatient clerkship where you don't actually see any of the stuff you're tested on. I was most anxious before OB, but it was my 3rd best shelf.

 

[mehc012]

For FM/peds, it's a combination of: not great resources, ton of material, and "boring" material (vaccine schedules/child dev).

These are traditionally the two hardest shelves. IM is also hard to to volume. Surgery is kind of hard due to long hours + few good resources.

OB is weird because you have to pick your poison: crazy inpatient clerkship with zero time to study, or a chill outpatient clerkship where you don't actually see any of the stuff you're tested on. I was most anxious before OB, but it was my 3rd best shelf.

I really got the worst of all worlds for this shelf...they were out of Gen Surg spots, so I was put on Vascular instead during my surgery rotation. So I have longer hours than any of the other students, but I haven't seen the inside of an abdomen all month. I have no time to study, and when I try to do UW, literally nothing I've done helps except for the handful of vascular questions. Fun times!