Order of MS3 rotations...

[Frazier]

Looks like it gets asked on here every year dating back to 2003 (***links below for those interested).

I'm hoping to get the feedback of our current MS3/MS4 members.

During clinical years, we have to take:

8 weeks:
Medicine
Surgery/Gas (6/2)
Combined Ambulatory Medicine/Peds
Psych/Neuro (5/3)

4 weeks:
OBGYN
Inpatient Peds
FM
Specialty care: EM+ENT+Ophth (2/1/1)

Then there are elective/research/interviewing months that can be mixed in.

Any thoughts from the batch of our currently active members given their recent experiences?

Thoughts on front-loading the expected toughest rotations to get them done with and move on to focusing on specialty/subspecialty-specific electives sooner?

Medicine or Surgery first?


***
http://forums.studentdoctor.net/threads/rotation-order-burning-out-too-soon.986421/
http://forums.studentdoctor.net/threads/choosing-the-order-of-rotations-in-m3-clerkship.945999/
http://forums.studentdoctor.net/threads/order-of-ms3-rotations.798815/
http://forums.studentdoctor.net/threads/interested-in-neuro-neurorads-rotation-order.574555/
...
http://forums.studentdoctor.net/threads/order-of-clinical-clerkships-important-for-residency.77030/

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[DermViser]

Make sure you take Internal Medicine before General Surgery. Mainly bc the Surgery shelf is more non-surgery (i.e. pre-operative evaluation) topics than actual surgery and surgical technique. How did you get only 4 weeks of OB-Gyn?!!? It's almost always 6-8 weeks.

Oh and try to take Family Medicine last. The shelf can be quite a doozy - just ask @Ismet.

 

[Frazier]

Make sure you take Internal Medicine before General Surgery. Mainly bc the Surgery shelf is more non-surgery (i.e. pre-operative evaluation) topics than actual surgery and surgical technique. How did you get only 4 weeks of OB-Gyn?!!? It's almost always 6-8 weeks.

Oh and try to take Family Medicine last. The shelf can be quite a doozy - just ask @Ismet.

lol for better or worse, I was super happy when I saw it was only 4 weeks here.

 

[DermViser]

lol for better or worse, I was super happy when I saw it was only 4 weeks here.

4 weeks is definitely bearable. Might be harder though since you have an OB-Gyn shelf which can be quite tough.

Oh, and don't front load with hard rotations. you want hard rotations with easy ones in between so that you can attack each clerkship with full energy. So for example, OB-Gyn and Surgery back to back is a very bad idea. Yes, you'll be done but you'll be exhausted which can affect your performance.

 

[Frazier]

4 weeks is definitely bearable. Might be harder though since you have an OB-Gyn shelf which can be quite tough.

Oh, and don't front load with hard rotations. you want hard rotations with easy ones in between so that you can attack each clerkship with full energy. So for example, OB-Gyn and Surgery back to back is a very bad idea. Yes, you'll be done but you'll be exhausted which can affect your performance.

Someone in one of the other threads I posted recommended OBGYN prior to surgery, idea being that you would get somewhat introduced to the OR/scrubbing in/tying/etc prior to diving into surg rotation.

What do you think about that?

 

[Ismet]

lol for better or worse, I was super happy when I saw it was only 4 weeks here.

Don't get so excited. It's pretty intense, as it used to be 6 weeks and now they cram it into 4.

Someone in one of the other threads I posted recommended OBGYN prior to surgery, idea being that you would get somewhat introduced to the OR/scrubbing in/tying/etc prior to diving into surg rotation.

What do you think about that?

We get an intro to the OR and scrub lessons at the start of the surgery rotation too. And if you take Specialty Care before surgery, you do a couple days in ophtho and ENT surgery, plus suturing in EM. Not the same, but some exposure. I don't think it's necessary to do OB/GYN before surgery. I'm not, plenty of people don't.

Definitely take Internal before Surgery. Definitely push FM until after you've had Internal, Peds, and probably OB/GYN.

CAMPC is whatever and I think it's good to do at the beginning or at the end. It was my first rotation and it was a good way to ease into 3rd year. Except the exam is a doozy. But not as bad as FM.

Somehow most people's schedules end up with either front loading or back loading. Mine is back loaded. I have IM and surgery back to back in the winter, I've already done all of the "easier" rotations. I kind of prefer the back loading, but it's fine either way. It's just really really really hard to honor IM or surgery if you start with it. I'd rather start with something lighter or something that's really specific to our school (CAMPC) so you get your feet wet without the grade mattering too much.

Also peds is the best. Just sayin'

Also you have minimal control over how your schedule ends up due to the lottery, although you can always switch stuff around. My suggestion is to figure out where you want your specialty of choice (still psych?) and list that as your priority 1. Priority 2 should be what you want first.

 

[DermViser]

Someone in one of the other threads I posted recommended OBGYN prior to surgery, idea being that you would get somewhat introduced to the OR/scrubbing in/tying/etc prior to diving into surg rotation.

What do you think about that?

I took OB-Gyn before Surgery, and we learned more about suturing, tying knots, etc. on General Surgery than we ever did in OB-Gyn in which the only times you go to the OR is for Gyn Onc cases specifically - even then you won't be suturing someone's uterus. Gynecologists are not surgeons and most of their training is not OR-based. That's why they have to do a Gyn Onc fellowship. Doing it for that sole reason will probably leave you disappointed as far as OB-Gyn preparing you for General Surgery.

 

[Frazier]

Don't get so excited. It's pretty intense, as it used to be 6 weeks and now they cram it into 4.



We get an intro to the OR and scrub lessons at the start of the surgery rotation too. And if you take Specialty Care before surgery, you do a couple days in ophtho and ENT surgery, plus suturing in EM. Not the same, but some exposure. I don't think it's necessary to do OB/GYN before surgery. I'm not, plenty of people don't.

Definitely take Internal before Surgery. Definitely push FM until after you've had Internal, Peds, and probably OB/GYN.

CAMPC is whatever and I think it's good to do at the beginning or at the end. It was my first rotation and it was a good way to ease into 3rd year. Except the exam is a doozy. But not as bad as FM.

Somehow most people's schedules end up with either front loading or back loading. Mine is back loaded. I have IM and surgery back to back in the winter, I've already done all of the "easier" rotations. I kind of prefer the back loading, but it's fine either way. It's just really really really hard to honor IM or surgery if you start with it. I'd rather start with something lighter or something that's really specific to our school (CAMPC) so you get your feet wet without the grade mattering too much.

Also peds is the best. Just sayin'

Hows this lottery thing work? We received this paper form today, but it looks like we just put our preference for three rotations? Is that right -- or does the online form have more slots?

 

[DermViser]

We get an intro to the OR and scrub lessons at the start of the surgery rotation too.
Also peds is the best. Just sayin'

Exactly - the intro to OR stuff and scrubbing tutorial happens at the start of Surgery. You're not expected to know it coming in, and having OB-Gyn beforehand won't give you an advantage. The people who had OB-Gyn before hand only had practice getting gowned and gloved and so got to skip that part of the tutorial that was done by the scrub tech staff anyways.

I would have seen you more as PM&R for some weird reason (there is Pediatric PM&R).

 

[Ismet]

Hows this lottery thing work? We received this paper form today, but it looks like we just put our preference for three rotations? Is that right -- or does the online form have more slots?

Online form has more slots. It's pretty much a complete crap shoot after the first two. I got my priority 1 and priority 2 and after that seems like completely random.

 

[Frazier]

Online form has more slots. It's pretty much a complete crap shoot after the first two. I got my priority 1 and priority 2 and after that seems like completely random.

Is there a way to request a specific hospital for a rotation (random example: surgery at St. Margarets) or a specific region for outpatient (random example: outpatient in Carnegie area, etc)

 

[Ismet]

I would have seen you more as PM&R for some weird reason (there is Pediatric PM&R).

I was actually looking into Peds PM&R, but you go through a PM&R residency and then a peds rehab fellowship (although there are a couple combined peds + PM&R programs out there). I really only want to work with kiddos, so that main pathway doesn't appeal much to me :/

I really enjoyed the general inpatient medicine part of the rotation and I'm pretty sure that's what I want to do. Endocrine was nice too. There was MATH!!!

 

[lisi326]

IMHO I think it really depends on what you think you might be interested in. If you're more into surgery, then do medicine first, perhaps ob/gyn before surg, and surg in the middle of the year. If you're more into medicine, I'm a huge advocate of getting done with surgery as quickly as possible (I did it first - worst part of 3rd year by far, but the rest of the year was much more bearable bc I knew I didn't have to go to the OR) and medicine later. Generally speaking, you want to do the rotations that you think you'll be most interested in mid-year.

If your school heavily weights shelves or if you really care how you do, you want to do medicine before surg (can't speak for FM, we don't take it). Neuro, ob/gyn, and psych are the most stand-alone shelves (aka, you don't need to study for other shelves to do good on them).

In the end..... you'll survive no matter what your schedule looks like, and it'll all be okay. Haven't heard of many schools where the students have THAT much control over what their schedule looks like.

 

[DermViser]

I was actually looking into Peds PM&R, but you go through a PM&R residency and then a peds rehab fellowship (although there are a couple combined peds + PM&R programs out there). I really only want to work with kiddos, so that main pathway doesn't appeal much to me :/

I really enjoyed the general inpatient medicine part of the rotation and I'm pretty sure that's what I want to do. Endocrine was nice too. There was MATH!!!

Nerd!! LOL. j.k.

Yeah, if you love inpatient (never understood why people like inpatient - although in a children's hospital it's quite fun!) then Peds PM&R is a deal breaker.

 

[lisi326]

Nerd!! LOL. j.k.

Yeah, if you love inpatient (never understood why people like inpatient - although in a children's hospital it's quite fun!) then Peds PM&R is a deal breaker.

Haha, what a fantastically derm thing to say 😀

 

[Ismet]

Is there a way to request a specific hospital for a rotation (random example: surgery at St. Margarets) or a specific region for outpatient (random example: outpatient in Carnegie area, etc)

Depends on the rotation. They don't let us request for surgery anymore (although you can try wink wink). You submit preferences for Internal Med (everyone does a month at Monte, the other month is either Shadyside, VA, or Mercy). There are a number of options for CAMPC and there's definitely opportunity to be placed in an underserved part of town. I did a rural placement for FM which was pretty good and VERY different. You can also submit preferences for services on neuro/psych. Peds is obviously at CHP and you get randomly assigned to an inpatient team and subspecialty week. Specialty care is randomly assigned as to where you go for ophtho and ENT.

 

[DermViser]

Haha, what a fantastically derm thing to say 😀

Psych and PM&R are outpatient based specialties too. I've just never understood people who say they hate clinic. But apparently having a patient stay on an inpatient census for days to weeks is somehow gratifying. There's no closure, so to speak. I think it's just bc I see hospitals as more nefarious corporations (I'll admit I'm biased).

 

[lisi326]

Psych and PM&R are outpatient based specialties too. I've just never understood people who say they hate clinic. But apparently having a patient stay on an inpatient census for days to weeks is somehow gratifying. There's no closure, so to speak. I think it's just bc I see hospitals as more nefarious corporations (I'll admit I'm biased).

I can say I actually really like both in and outpt, to the extent of probably not choosing a job/career that wouldn't allow me to do both.

Inpatient, you get to the see your patients everyday, and (at least every once in awhile), actually watch them get better right before your eyes! Your get to make medical decisions and see the consequences of your choices almost immediately. I love that, and I love getting to connect with patients and families because you're seeing them every day and updating them on what's going on.

Outpatient, you get to have truly long term relationships with your patients. If you have a patient you really dislike, you only have to see them every 6mos or yr for 15min at a time. The day moves quickly and can be pretty varied in terms of what you're seeing. And most importantly, normal work hours!

In the end, I see the pros and cons of both and appreciate that there are some who prefer one vs the other -- glad to have you all around to do the stuff I don't want to 🙂

 

[Ismet]

Psych and PM&R are outpatient based specialties too. I've just never understood people who say they hate clinic. But apparently having a patient stay on an inpatient census for days to weeks is somehow gratifying. There's no closure, so to speak. I think it's just bc I see hospitals as more nefarious corporations (I'll admit I'm biased).

I like clinic too! I want both!

And I thought I was interested in EM (it's what I came into med school thinking I want to do), but I HATE not having some form of closure. I like the trauma part of it, but I'd rather manage patients day to day and do clinic work.

 

[URHere]

Getting medicine or pediatrics done early will probably give you the best intro to doing a thorough medical work-up. I started with peds and I personally think it was a much gentler transition than medicine would have been (both in terms of the more cuddly attendings and the relatively straightforward cases without a dozen additional comorbidities).

I've also had classmates say that doing OB early is a good idea because no one has any clue what they're doing on that rotation so it's hard to look more incompetent than your peers unless you're really doing something…special.

 

[DermViser]

I can say I actually really like both in and outpt, to the extent of probably not choosing a job/career that wouldn't allow me to do both.

Inpatient, you get to the see your patients everyday, and (at least every once in awhile), actually watch them get better right before your eyes! Your get to make medical decisions and see the consequences of your choices almost immediately. I love that, and I love getting to connect with patients and families because you're seeing them every day and updating them on what's going on.

Outpatient, you get to have truly long term relationships with your patients. If you have a patient you really dislike, you only have to see them every 6mos or yr for 15min at a time. The day moves quickly and can be pretty varied in terms of what you're seeing. And most importantly, normal work hours!

In the end, I see the pros and cons of both and appreciate that there are some who prefer one vs the other -- glad to have you all around to do the stuff I don't want to 🙂

I guess it depends on why they are an inpatient in the first place (and not in the ICU) and if their condition is treatable/curable. I think updating families is fine and you can really connect with them - it's nice to have their trust (assuming it's a nice family - which isn't always the case, vs. a demanding family). It sucks though when you're the crosscovering intern and they come in at 11 pm or midnight when the original team has long left and then suddenly want an update on the patient's status.

 

[DermViser]

I like clinic too! I want both!

And I thought I was interested in EM (it's what I came into med school thinking I want to do), but I HATE not having some form of closure. I like the trauma part of it, but I'd rather manage patients day to day and do clinic work.

Ick. The type of patients can emotionally wear you down. That's why it's so exhausting. Peds EM might be much better though.

 

[DermViser]

Getting medicine or pediatrics done early will probably give you the best intro to doing a thorough medical work-up. I started with peds and I personally think it was a much gentler transition than medicine would have been (both in terms of the more cuddly attendings and the relatively straightforward cases without a dozen additional comorbidities).

I've also had classmates say that doing OB early is a good idea because no one has any clue what they're doing on that rotation so it's hard to look more incompetent than your peers unless you're really doing something…special.

Also if you do OB-Gyn first. The interns won't let you deliver bc they obviously want to deliver since they just started. So if you hate OB-Gyn and don't want to do that stuff, do it first.

 

[Ismet]

Ick. The type of patients can emotionally wear you down. That's why it's so exhausting. Peds EM might be much better though.

I kind of liked adult EM better than peds EM. Maybe it's because I got to do a lot more on the adult side.

 

[DermViser]

I kind of liked adult EM better than peds EM. Maybe it's because I got to do a lot more on the adult side.

It's the belligerent ones that I don't like: intoxicated, high on illicit substances, violent towards staff, etc. It's great in spurts. Not great for 3 years of residency and then the rest of your life. There is very good reason why the burnout in that specialty is so high - which they then go on to administrative positions, urgent care centers, etc.

 

[LostinLift]

It's the belligerent ones that I don't like: intoxicated, high on illicit substances, violent towards staff, etc. It's great in spurts. Not great for 3 years of residency and then the rest of your life. There is very good reason why the burnout in that specialty is so high - which they then go on to administrative positions, urgent care centers, etc.

Get out of urban areas. Suburban hospital I worked at was really great, definitely had their share of drunks and seekers but not common.

 

[DermViser]

Get out of urban areas. Suburban hospital I worked at was really great, definitely had their share of drunks and seekers but not common.

Of course quaint suburbia won't have that. The problem is that residency is usually in academic medical centers.

 

[LostinLift]

Of course quaint suburbia won't have that. The problem is that residency is usually in academic medical centers.

Rotations and hopefully some county shadowing soon will open my eyes to that reality sooner rather than later. But 3 years vs. 5-8 for surg? I could definitely put up with that. This is not a determining factor, just a perk compared to others paths.


Also I love quaint suburbia 🙂

 

[DermViser]

Also I love quaint suburbia 🙂

We all do. 🙂

 

[DermViser]

Disagree - I had medicine --> surg --> obgyn and though it wasn't the most fun in the world, it's not a death wish. You'll have to work hard. If you know it's coming, it's not too bad. Especially once you get to residency. It's not that bad. My opinion of course.

Never said it was a death wish. It's just tough to do, esp. if you're shooting for Honors on each clerkship and maintaining enough energy as if you're starting fresh at the beginning of each rotation (i.e. Psych --> Surgery vs. OB-Gyn --> Surgery). If you're able to do so, then the last half of your MS-3 will be a breeze.

 

[Flamen04]

It. Doesnt. Really. Matter. That. Much. In. The. End.

 

[DermViser]

It. Doesnt. Really. Matter. That. Much. In. The. End.

🙄

 

[redpanda]

CAMPC is whatever and I think it's good to do at the beginning or at the end. It was my first rotation and it was a good way to ease into 3rd year. Except the exam is a doozy. But not as bad as FM.

I disagree with the CAMPC exam being hard. I took it at the end of the year and it was far, far more well-circumscribed in the subject matter as as opposed the FM or neuro shelfs. You just need to accept that the first (or maybe many, depending on who you are) shelf exam will suck so bad because you can't learn everything in 4-8 weeks. Agree with surgery shelf being much medicine, so surgery after medicine would help.

Also, while you're scheduling, let me warn you that the school's policy on core clerkships does not allow time off to do residency interviews, so don't be that person pushing off CAMPC or specialty care late into MS4 so that can do 12 bazillion electives who somehow then finds out that they've screwed themselves. It happens every year, despite warnings.

 

[NickNaylor]

I didn't read through the rest of the thread, but I would say that doing medicine as early as possible is advantageous. Everyone at our school said that it "didn't matter" - and I would largely agree - but so much of the other rotations is simply medicine in a different context, so being exposed to that material will make it easier to study for the other rotations and give you a good solid foundation clinically.

It's not the kind of thing to stress about or otherwise think you'll be screwed if you don't do medicine first, but that'd be my advice. I did medicine first and found it very helpful.

 

[operaman]

I think it depends on three things:

1) how strong a student you are

2) what field you're interested in

3) personal plans, life events, etc.

Personally I did surg and med first and then didn't care beyond that. It's tough but the rest of the year is easy and it's a great way to see which you like more or which you despise. shelves are tough but if your step 1 was high then medicine shelf will be pretty straightforward. Surg is a tough first shelf but doable and some schools have lower honors cut offs early in the year. If you might want a competitive sub specialty, put it earlier but after the big cores. This gives you time for research before residency apps are due. If you're interested in a core, put it late fall so you can shine and set yourself up for great letters. Finally, any weddings or family events are much easier during family or the psychation.

 

[evilbooyaa]

It. Doesnt. Really. Matter. That. Much. In. The. End.

In.The.End.It.Doesn't.Even.Matter.

I tried so hardddddddddddddddddddddddddddddddddd

I would recommend doing medicine before surgery as it will make the surgery shelf a bit easier.

I would recommend doing FM at the very end because it makes the shelf much easier when you've had focused studying for every other shelf exam. (at least do it after Peds, IM, and OB/Gyn)

If you want to do OB, do Surgery before it (as your suturing skills will be on point and possibly better than an OB-Gyn interns, like mine were)

If you know you want to go into one of the 3rd year specialties, I'd recommend trying to do it later in the year. You'll be accustomed to the day-to-day life of being in the hospital and will generally be more calm than the anxiety that incorporates the first couple days in the hospital as a MS3.

 

[lisi326]

We all do. 🙂

Not me. The times I had to go out into suburbia during 3rd year made my skin crawl. Despite the immense amount of challenges associated with urban (or rural) practice, I'd take it any day over suburbia.

 

[maxxor]

As an aside, I was in a lot of c-sections and the interns/residents were at the end of their year, so I closed every pfannenstiel. When I got to surgery, they were curious where I learned to suture, so you can learn a lot of technical skills in OBGYN, it just depends...

 

[evilbooyaa]

As an aside, I was in a lot of c-sections and the interns/residents were at the end of their year, so I closed every pfannenstiel. When I got to surgery, they were curious where I learned to suture, so you can learn a lot of technical skills in OBGYN, it just depends...

When I was on OB/Gyn, the residents kept telling me to do 2-handed knots even though I had just finished surgery and hadn't thrown a 2-handed knot since the first week of my surgery rotation. Eventually one of the attendings told them to piss off and let me do my 1-handed as I was doing it properly with enough tightness (this was on skin closure, not on fascia).

Someone I did surgery with (who had done Ob/Gyn previously) kind of walked me through the two-handed tie - I tried to do it on my first lap port closure and got laughed at by the chief. She basically went "omg that's so cute, baby's first tie". That was the day I learned how to do a 1-hand tie.

 

[qw098]

My school's first three rotations are electives.. it's f*ck**. Any advice what I should do in that regard..?

 

[Ismet]

As an aside, I was in a lot of c-sections and the interns/residents were at the end of their year, so I closed every pfannenstiel. When I got to surgery, they were curious where I learned to suture, so you can learn a lot of technical skills in OBGYN, it just depends...

As a further aside, my ED resident was curious where I learned to suture. Both he and the patient had a good laugh at my couple hundred rat surgeries in my undergrad research 😀

 

[Ismet]

My school's first three rotations are electives.. it's f*ck**. Any advice what I should do in that regard..?

Do you have any choice but to do the electives? If you have to do them, then just apply what's been said already to your schedule.

Maybe do a surgery elective if that's possible? Hard to believe they'd allow you to do one without having the surgery clerkship already, but who knows.

 

[qw098]

Do you have any choice but to do the electives? If you have to do them, then just apply what's been said already to your schedule.

Maybe do a surgery elective if that's possible? Hard to believe they'd allow you to do one without having the surgery clerkship already, but who knows.

All our electives are at the start of third year then all the core rotations start.. it's very odd.

Yup, I'll do that, thanks Ismet

 

[Ismet]

All our electives are at the start of third year then all the core rotations start.. it's very odd.

That's...dumb. Sorry :/

 

[evilbooyaa]

All our electives are at the start of third year then all the core rotations start.. it's very odd.

Yup, I'll do that, thanks Ismet

Figure out specialties that you may be interested in that aren't related to the core rotations. Do rotations in those.

I'd have loved to have serious elective time during MS3, would've let me get a jump start on my MS4 residency application (in a non-core rotation)