Order of Rotations

[PimplePopperMD]

Okay, okay, I know. It doesn't really matter what order you have them in, as long as you specify that you want your intended specialty toward the middle/end (after knowing what you're doing).

Despite that, and despite the fact that people have all survived doing say medicine first, since I need to schedule this soon, I'd like to open up a discussion on:

What order did you have?
What did you like/dislike about it?
What would you suggest?

Thanks in advance to those whose wisdom will be shone upon the rest of us. And phooey to those who choose to lurk.

---

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[Annette]

my order (not by choice):
medicine-12 weeks (trial by fire!)
surgery-12 weeks w/3 week break for x-mas
psych- 6 weeks- painful, forgot all clinical skills
peds- 6 weeks and going quite quickly, but so much to learn
OB/gyn- 6 weeks

I am a traditionalist in thinking medicine should be first. It really is a model of the basics- how to take a history and do an exam. The medicine you just sort of end up absorbing. I would have rather done psych last because I have forgotten all of my clinical skills. Also, Ob/gyn then peds might work out better the other way because then you can follow child development all the way through.

 

[drusso]

My order:

MS-3

Osteopathic Manipulative Medicine (4 weeks)
Medicine (8 weeks)
Elective Medicine-Pulmonology (4 weeks)
Psychiatry (4 weeks)
Pediatrics (4 weeks)
Family/Ambulatory Medicine (12 weeks)

MS-4

Ob/Gyn (4 weeks)
Surgery (8 weeks)
Ortho elective (4 weeks)
Rehab Medicine elective (4 weeks)
Occupational Medicine elective (4 weeks)
Cardiology (4 weeks)
Neurology (4 weeks)
Ananesthesiology (4 weeks)
Rheumatology (4 weeks)
ICU (4 weeks)
Radiology (4 weeks)

Doing medicine and psych early is nice--it's almost a third of every other specialty. Ob/gyn before sugery was convenient because you learn good OR etiquette and sterile technique before being hammered by the surgeons. If you have no intention of dealing with kids, get peds out of the way early too. Try not to do hard rotations back to back if possible and keep your schedule relatively light during Nov-Feb of your MS-4 year for residency interviews. Try to rotations you're seriously interested in early in your MS-4 year to get letters of rec in on time.

--Dave.

 

[SW-Adrian]

My 3rd year:

Pediatrics (7 weeks)
Psychiatry (7 weeks)
ObGyn (7 weeks)
Medicine (13 weeks) includes ambulatory (4 weeks)
Surgery (13 weeks) includes Urology (2 weeks)

4th year:

Radiology (4 weeks)
Elective Ambulatory Obstetrics (4 weeks)
Neurology (4 weeks)
Primary Care (4 weeks)
Geriatrics (4 weeks)
Elective GI consult (4 weeks)
Medicine Sub I (4 weeks)
CCU Sub I elective (4 weeks)
Medical Business Entrepeneurship Elective (4 weeks)
Medical Informatics Research ( 8 weeks)

My 4th year was more like a holiday compared to my 3rd year (except for the 2 SubIs).

Starting with Peds gave me all the necessary basics for clinical work in general (ie. h&p's and so on...). ObGyn was a great prep for the upcoming surgery rotation. With medicine in between, I didn't feel like I was in the OR all the time.
Anyway, I'm glad I'm done with it all... Time to move on to residency... (finally)

Adrian Zai
Scutwork.com

 

[Winged Scapula]

My order (in which I had little say at my school, so would have done things differently):

MS-3:
Ob-Gyn (10 weeks)
FP (4 weeks)
Vacation (1 week)
Paeds (10 weeks)
Surgery (10 weeks)
Vacation (1 week)
IM (10 weeks)
Exams

MS-4
Psych (6 weeks)
Ambulatory Care (6 weeks)
EM (6 weeks)
Gen Surg (6 weeks)
Plastics (4 weeks)
Plastics (4 weeks) - both electives
Research project (8 weeks)
Trauma (4 weeks)

If I had it to do over again, I would have done IM first during my 3rd year. I was absolutely useless during FP and by the time I got to IM the lectures were too little, too late - I had had to learn most of the stuff on the fly during other rotations. IM gives you a good foundation for everything else, IMHO it is best done first.

I loved Ob-Gyn and it is a good rotation to start with, given the relatively healthy and happy patients. As far as them being easy to stick, depends on the allied health available at your hospital - some places medical students don't get to do lots of procedures because there are employed people to do them (which doesn't make for good student experience). OB-Gyn is good experience for FP and Surgery, as many women use their OB-Gyn as a PCP and you will learn the basics of surgical practice.

Hope this helps.

------------------
PGY1
Penn State University
Department of Surgery

 

[Djanaba]

Our advice was to NOT take the things you're most interested in right away, so that way you can make your silly mistakes and do really well on your rotations of interest. BUT, it makes sense to do them not too late, so you can do more advanced rotations in the area, get stellar letters of recommendation, etc. And taking really demanding/long call rotations back to back can be a killer, so I interspersed the cushier requirements in there (psych) to break it up. My order:

YEAR ONE
Urology surgical subspecialty (2)*
***two weeks off***
Surgery (6)*
Psych (6)*
Med I (6)*
Electives (6)
OB (6)*
Clin Med (8)
***3 weeks off***

YEAR TWO
Peds (6)*
(18 weeks of electives, time off, study away)
Med II (6)*
(12+ weeks of electives, time off, and step II)
Sports med subdivision of orthopedic surgical subspecialty (2)*
Neuro (6)*
More electives, time off, graduation!

The () are weeks, the asterisks mean they're required (we can choose 2 of 4 surg subs). I also plan on taking anesthesiology, radiology, an advanced OB externship, an elective away in Boston, an international rotation, women's health, and sexual problems in clinical practice. There's a good chunk of vacation time.

I complete the registration next week, woohoo!

 

[Whisker Barrel Cortex]

Much of your schedule selection does depend on what you are thinking about going into. Here are a couple of things that I recommend based on my experience:

1. Do not take a rotation you are very interested in first. Although they say grading will be based on your level of training, I have found from personal experience and from my classmates that it is very hard to Honor your first rotation because you are just getting used to the hospital and the way things work. I took peds first since I knew I didn't want to do it.

2. Medicine and Surgery are the most important grades next to the specialty you are going into. I actually saw on my residency interview file an area where they had room for three grades: Medicine, Surgery, and Radiology (the one I'm applying to). My recommendation is to take these some time in the second half of the year so that you will do better and be able to learn more as well.

3. You should schedule the specialty you are interested in also in the second half of the year or early fourth year. I took Radiology in August of my senior year.

4. Try to give yourself a break between very intense rotations such as surgery, OB/GYN, and medicine with either vacation or easier rotations if at all possible. That way you can be fresh for the next challenge.

Thats just the way I experienced things. Everyone has their own opinions on the best way to do it.

 

[PimplePopperMD]

If you do a search, you'll find that I asked the same question last year. The responses I got included the above comments, along with "it really doesn't matter". Well, I felt it did! Of course it did! But it only matters in the following situations, in my opinion.

1. Don't do what you think you want to do as residency first.

2. Do Medicine as soon as possible.

3. Don't do surg/ob back to back

4. Listen to upperclassmen about various sites (if site choices are available to your school)... keep in mind a hospital for one rotation may be great, but for another may suck.

I was afraid that I would be burned out from boards, so I tried not to have surgery first. However, my lottery pick screwed me, and I ended up with surgery first. I was pissed, but in hindsight, I am SO glad i got it over with first (I don't want to be a surgeon). Reasons:

1. Surgeon wanna-bes AREN'T rotating with you.

2. The hours suck, but at this point, you're psyched to be in the hospital rather than studying all the time, so you can better cope.

3. The way you get treated, in general, in surgery is worse than in other clerkships (by faculty, residents, etc)... so you experience the worst first, and you are pleasantly surprised by the rest of your year!

4. Your confidence level, that you can handle what's thrown at ya, increases exponentially on this rotation, particularly if it's done first.

But the above is true: a lot of medicine was on the exam, and that totally screwed everyone who had it first. We still talk about it.

Pros and cons, people! Just realize that there's no right answer to the best schedule, and we wouldn't know for sure anyway, since we each have only one reference point. But I hope that this helps you as much as I was helped last year!

 

[hotdog]

•</blockquote>Medicine before Surgery is ideal in all situations, IMHO.

I'd disagree. The earlier you take medicine, the more likely you are to learn more of the nitty-gritty details of taking care of patients and being on the wards (i.e. chasing down labs, drawing bloods, etc.) and less of what makes the medicine clerkship valuable, which in my opinion is the thought process required to work your way through challenging clinical problems. You can learn the former on most clerkships, though I'd say some (in my experience, neurology) are less willing to do this kind of teaching. I had surgery towards the beginning of the year, and wouldn't have done it differently for two main reasons. 1) You have more energy this early in the year to put into a rotation in which you need LOTS of energy. 2) I think you learn a very efficient manner on the wards. You develop a very good sense of what's important and what's not.
Another thing to keep in mind is that students do better (grade-wise) towards the end of the year, and a higher medicine grade is better than a higher surgery grade.
Just my two cents.

 

[Whisker Barrel Cortex]

Acro Yali,

I think your schedule sounds good.

Pros: You have medicine (your interest) in the middle and late in your third year, making it more likely you will do well in my opinion. Plus you can learn more about the actual specialty instead of getting used to the hospital.

Cons: Having inpatient medicine and surgery at the end of your third year when you are already tired might be tough. Many people do their sub internship and specialty rotation early in their fourth year and this could be a very hard few months for you.

Scully,

Much of the advice about medicine and surgery holds true for people going into radiology. These two rotations are important to do well on and to get letters of recommendations from. If your school has a radiology option in your third year I would recommend taking it later in your year when you won't look like a complete idiot, just a partial idiot. My school had a non graded 2 week elective in third year which I took and got some good contacts from. I then did my full radiology elective in August of my senior year. I think anything later than August is too late. My schedule was as follows:

1. Peds
2. Medicine (got one letter of rec)
3. Psych/Anesthesia
4. Surgery
5. FP
6. Radiology 2 week elective
7. Vacation
8. OB/GYN

Fourth year:
1. Medicine sub internship (got one great letter of rec)
2. Radiology (got one letter of rec)
3. Required surgery
4. EM
5. 2 months vacation for interviews (Dec-Jan)
6. Radiation oncology
7. Advanced anatomy
8. Pulmonary consults (to learn chest x-rays really well)

You'll notice I did Medicine kind of early. This was actually my second choice of schedule, I wanted it in January. I was lucky since all my residents and attendings loved me so my clinical grade was awesome. My exam grade on the Shelf exam was just a pass, but it was only 20% of our grade so I still got an honors overall. From what I have heard from my friends, your grade on shelf exams in medicine and surgery definitely go up later in the year (average for my block was 68%, for the last block was 82%)

Sorry for the long winded reply. If you have any specific questions I didn't address, please post them or PM me. Good luck.

 

[dr.evil]

This is why schedules really probably make little difference when it comes down to it. WE ALL HAVE A DIFFERENT OPINION ON WHAT IS IDEAL.

I had medicine and surgery back to back from January-April. This worked out so much better than I had expected. I was rejuvenated post-Christmas enough to get through medicine. I did well on the medicine test because there is no surgery on that test: only medicine. I then had a large amount of knowledge pertaining to renal function, vascular medicine, clinical pulmonology, and cardiology which was highly valuable on surgery and really helped me score highly on the surgery shelf exam (which has a large amount of medicine).

Granted, this is coming from someone who is going in to surgery. So my ideal schedule would not likely be the same as someone going into medicine/radiology, etc. But I do feel my schedule gave me the best opportunity to get the best grades (for me I guess).

No matter what happens, your last month or two of third year seem painful. It's as if you see the green grass in the valley but must travel through that final leg of rough terrain. It wore me out.

If you end up like me, my "lottery number" was so bad that you pretty much took what you could get by the time it came to me.

 

[dr.evil]

Acro Lali,

The green grass paragraph was pretty much to anyone scheduling their 3rd year rotations. Surgery, OB, and Medicine tend to be the most rigorous rotations of 3rd year and would take more effort (hour wise) than I could have found at that time.

Surgery at the end actually does have advantages. #1--You actually know kind of what's going on. #2--You likely know how to scrub and write a quick note from OB/Gyn. #3--Surgeons have a little more confidence in you cuz "you're really like a 4th year" and will let you do more.

It really has to do with your attitude at that time of the year.

If your attendings like you and you ask them for a letter on your rotation during 3rd year, the time of year you take the rotation should not be at a disadvantage. They will usually remember you after you meet with them prior to actually requesting the letter in early 4th year. Whiskey Barrel has listed good anecdotal evidence of that.

 

[tulanestudent]

I think it's best to start with a rotation that is very time-consuming. I started with surgery and am so glad I did. I was so excited to start third year and had tons of energy and enthusiasm at that point. After working from 5am till 8pm daily, pluss Q4 call, the rest of the year has seemed so easy in terms of work hours. Plus I was used to studying when I was exhausted, which I think is a challenge everyone has to overcome with 3rd year. Starting with OB or Surg makes you more able to study after a full day of work than some of the easier rotations where a "full day" is only 6-8 hours vs. over 12 on OB or Surg.

The only drawback is that you must remember that whatever you do first you might not get to do as much hand-on procedure stuff b/c the interns are also enthusiastic and ready to do it all, so students might get to do less than later in the year.

 

[jaydoc3]

Let me start by saying that if you are truly worried about your clinical experience, you should definately be coming to Wichita! Talk to anyone down here and he/she will tell you that the experience and people down her are great. (I couldn't resist that)

Now about your rotations, I think the most important thing is that you make the most of what you get, and don't go into it thinking that a bad choice could ruin you education. Ultimately all orders are equally valid for different reasons.

I started on ambulatory and ended the year with IM and surgery (kinda backloaded). That wasn't my first choice, but in the end, I really think that I gained a lot from the experience. By the time I got to IM and surg, I could really focus on "learning medicine" and not where the H/P forms go in the chart! Friends that did the same rotations were just as happy as I was. On the other hand, I spent most of April-May inside doing 110-120 hrs a week, where as people on Ambulatory were sun-bathing. Also doing surg last made it much harder to find the time to set up externships, but that would have been avoided had I made up my career decision a tad bit earlier.

Another thing to think about is areas in which you might have interest. Some say to do those rotations early so that you can find out if you really enjoy it. Others say to wait so that you can really wow your attendings. I chose to do OB/Gyn in Oct, so that I could get a little bit of both. Ultimately though, I think hard work is what gets noticed, not whether you already know all the info or not, so doing the rotation early will not negatively effect you. You can also do subI's or electives in chosen fields later as well.

Hope that helps a little (especially the part about WICHITA). Just don't sweat it.

 

[Burton]

With respect to doing the rotation related to your career choice, the general consensus is: don't do it first, don't do it last. You want it early enough that you can see if you like it; but you don't want it first, because you won't know what you're doing yet, and it will be more difficult to perform well. For instance, I'm interested in IM, so I'm doing it now, on the 3rd of 6 rotations for the year.

 

[dr.evil]

When it comes right down to it, it really doesn't matter. I made a big deal of it when I was a 2nd year too. In hindsight, it didn't really matter.

If I had to give a generic order, I would say to do peds first. Why? Well, the residents tend to be a little more laid back and will take it easy on you (usually) while you learn how to do an H&P or SOAP note. Do surg and medicine somewhere in the middle if you can. I say surg before Christmas then you get a break then you do Medicine. That would probably be ideal. End the year with something easy like Psych or elective.

So in my ideal world I would do:

Peds
OB/Gyn
Family
Surg
Medicine
Elective
Psych

 

[Ludy]

I agree with the above posters in that it really doesn't matter in the end. I didn't get the rotation sequence I wanted, but I ended up being very happy with it. I started with psych, which I thought was great because I was able to adjust to the quirks of the hospital and figure out how the whole system worked on a relatively easy rotation. I also got to spend a lot of time talking with patients and overcome my last little bits of insecurity with my interviewing skills before moving on to adding the physical exam skills on my next rotation.

I agree that you should try to do surgery before Christmas. If you think you want to do surgery, then that's all the more reason - to see what it's like. If you're pretty sure you don't, get it out of the way! I hated my surgery rotation, but it would have been much, much worse if I'd done it in April and May rather than September and October. I also wouldn't do OB/gyn last, for the same reasons. It's a grueling schedule and you tend to lose enthusiasm more quickly as the year goes on. That first week is always pretty exciting, but unless it's a specialty you're considering, it's all downhill from there

But, honestly, you'll find pluses and minuses in whatever you end up with so I wouldn't worry too much if you don't get what you want.

 

[Fah-Q]

I think starting with medicine is the best way to go. Every other rotation you will have will require that you know something about medicine. Also, nobody does H+P's as often or as thorough as in medicine. You will really start to sharpen your physical exam skills and you will learn how to take a complicated history and make it simple when you present to your attending (which is a huge part of your evaluation). Another reason is board tests. Almost every other shelf exam you will take will be a lot easier if you have already had medicine. Most of the surgery test is actually medicine in my opinion. I say start with medicine but everybody has a different opinion on this and you will probably never get a consensus.

 

[johnd]

One other thing that you may want to consider is the schedule that the residents are on at your institution. You may not get to do as many procedures right after the new interns start so it might be better to do rotations without many procedures (psych, pedi, neuro) when the new interns are there.

 

[squeek]

I got exactly the schedule I wanted, and thus far it's been absolutely perfect. I'm the "work really hard, then relax" type, so I staggered hard rotations with easy rotations, or made sure a break was in between them. (I know others who wanted to power through, and get all the hard ones done first, and that works for them.)

I started with Ob-Gyn, as I heard this was one of the worst, and I knew early on I wasn't going into it. It was one of the most miserable experiences in my short life...I would wake up at 4:15 and cry before going in to the hospital at 4:30. However, I am SOOOOOOOOOOO glad that I did it first. I was so miserable and ready to quit medicine for good during that rotation, but as a result, everything following has been like heaven. I've loved everything subsequent. Also, Ob-Gyn is a good intro, as the knowledge demanded of you is relatively defined. You don't get pimped on random, esoteric factoids, and the exams are straightforward.

I followed ob-gyn with ambulatory primary care (which, in retrospect, I may have wanted to have sometime next spring. It's a pretty comprehensive body of knowledge, and it might have been nice to have medicine and surgery first). Now I'm in surgery, and I have the bonus of 4 days Thanksgiving break in the middle, with Christmas break following.

The rest of my schedule is, in order:
Medicine
Neuro
Surgical subspecialties
Peds
Psych

I agree with putting the careers you're interested in as 3rd or 4th block. I was interested in surgery, now I'm not, and I still have plenty of time to explore other options.

Wish you luck...

 

[doepug]

Peds is a nice rotation to take early in your third year. I haven't met a pediatrician who I didn't like. It's a really fun rotation, and it's a nice way to get used to being on the wards. You'll do better in medicine and surgery if you've taken another inpatient rotation (e.g. peds) first, since you'll already know how to write admit notes, progress notes, order/check labs, and write orders.

One more thing... my dean advised me that my first rotation would seem especially rosy (since you've been released from the prison of the lecture hall), so your first rotation should be something you're sure you won't do for a career. You won't get an idea of what that field is really like... you'll still be in awe that you get to wear the white coat every day, and if your first clinical grade isn't the greatest, it won't keep you out of a field that you'd want to go into.

Good luck,

doepug
MS III, Johns Hopkins

 

[doepug]

Medicine should be taken relatively early, but not first.

Lots of specialties require an IM residency, and you'll do better in your medicine rotation if you wait a few months to take it. Some of the better IM residencies won't even interview you if you don't get honors in medicine.

Medicine is very important, and it will help you in other rotations. I'd take it second or third though, so you can rock it.

Good luck,

doepug
MS III, Johns Hopkins

 

[ckent]

I wouldn't do medicine first either. There's a lot to be learned during your medicine rotation, and it would be better to focus on learning medicine during your medicine rotation rather then learning how to present pts to attendings or what your role on the team is during your medicine rotation. If I were you, I would choose something you don't like (like OB/gyn or peds) first. Ob/gyn is particularly good to have first because most people find it to be one of their worst rotations so you get it out of the way, and there is not very much evidence based medicine to learn about in ob/gyn. If you have a horrible time in ob/gyn, every rotation you do afterwards will seem that much more enjoyable.

 

[Foxxy Cleopatra]

Hi-

I think peds is a pretty good start. They may be more willing to teach you the basics of being around patients and the hospital system. The other good thing about taking peds early is that you may miss out of lots of repititous viral admits that can flood a service during the winter months when RSV and rotavirus are more likely to be going around.

I'd take medicine before FP or surgery.
1. FP tends to be variable with more clinic time, so you may enjoy it more if you have a good background in medicine, where you are already familiar with most common adult pathologies as well as proficient and charting and writing prescriptions.

2. Depending on your school, on surgery, you may get several very sick patients in the unit and the residents are often very busy and not eager to teach. Not a good time to be learning how the hospital system works- just too busy and potentially confusing.

Psych and OB- probably doesn't matter too much; what you see in these 2 are somewhat more independent of the other rotations. If OB is notoriously difficult where you go, I wouldn't take it before any rotation that you are seriously considering as a career. It's easy to come off of OB a little burnt out and unenthusiastic; in other words, if you are seriously considering IM, don't take OB right before it.

My ideal order would be:

1. Peds 2. Medicine 3. Surgery 4. Surg. subspec. 5. Psych 6. OBGYN 7. FP

Good luck!

 

[ckent]

I would reccomend that you do medicine early in the year, but certainly not first. I think that starting out with peds, ob, psych, or neuro would be a good way to start learning how the hospital works and how to write notes and call consults. You want to be a seasoned hospital worker by the time that you start your medicine rotation. If you can't get a medicine rotation until your spring semester, I think that's fine too. In my class, the shelf exams were graded on a curve, so since everyone didn't have their medicine experience when they were taking their fall surgery shelf, the curve reflected that. I wouldn't have medicine last (because it is the basis for a lot of your other rotations and you want to make sure that you want to do medicine before scheduling your fourth year clerkships), but I wouldn't have it first or second either.

 

[irlandesa]

I tried to get Medicine first but unfortunately (or perhaps a blessing in disguise) got it last through the school's lottery system, but the schedule seems to be working out so far:
1A-Psychiatry (NEMC consult)-6 weeks
1B-Pediatrics-6 weeks (3 outpt, 3 inpt)
2A/B-Surgery 12 weeks (2 weeks elective (transplant for me), 1 week Anesthesia, rest General Surgery). 6 weeks at each hospital site, 2 different groups of residents (1 Tufts-NEMC, 1 BWH)
X-mas break 3 weeks
3A-Ob/Gyn-6 weeks (3 weeks OB, 3 weeks Gyn (incl. 1 week Gyn Onc. and a decent amt. of outpt. exposure)-NEMC
2 weeks vacation
3B-Family Medicine (mainly suburban office-based)-4 weeks
4A/B-Internal Medicine-12 weeks (3 outpt, 9 inpt.)-Faulkner (BWH community hospital affiliate)

 

[DOtobe]

I agree with 12R34Y.

I had medicine before surgery (which I am in now), and a lot of what I learned in medicine is coming into play during surgery.

I have loved the order of my rotations so far -
1. Psych/Neuro (3 weeks of each)
2. FP
3. Medicine
4. Surgery
And then after surgery is finished...
5. Elective (I am doing endocrine)
6. Ob/Gyn
7. Peds

I started off with two "easy" rotations, so I didn't feel like I was drowning at the beginning of my third year. By the time I hit my medicine rotation I had written a ton of SOAP notes, and I was experienced enough not to look stupid (although every once in a while an attending makes you feel stupid, no matter how much you think you know)

I would suggest having medicine somewhere near where I did mine, but as ckent said, not first, especially since it is what you are interested in. I'd say somewhere in the middle (third or fourth).

 

[surgicane]

Medicine seems to be a good prep for any rotation, since it encompasses alot of information that you'll see repeated in every rotation. My MS-3 year I started with fam and then surg, and seemed to do all right.

Definitely don't put surgery first if you think you're interested in it, so you give yourself a chance to get used to clinical medicine. And you might regret having surgery and OB/Gyn back to back since both of these specialties seem to be time-intensive, often requiring students to take night call.

Just my $.02

 

[lowbudget]

There's a lot of Medicine on the Surgery shelf. Plus all the scut work you do on Medicine will help you help the intern out when you do Surgery. But you don't want to do Surgery too late, because you'll start forgetting crap from Step 1.

It would be nice to do OB before Surgery also, just to get used to the OR and see the routine whipping patients in and out of the OR. You may or may not get sewing practice on OB, but getting used to being in the OR and helping them set up the room helps make you look good.

If I were interested in Surgery, I would do Med, Ob, Surg... but these are 3 of the hardest rotations when you look at time at work vs. time reading vs. time sleeping. Whatever the case is though, whatever your schedule is, you'll make it work for you.

 

[Seaglass]

Rules of thumb - don't do your preferred rotation first, have a warm-up rotation, and for EM you'll need to do it after you've done the basics (IM, Peds, OB) if you want to look good or even have a good time.

That in mind, I would schedule something like Fam/Peds, Surg, IM, Ob, EM. Keys are putting IM after something like peds or Fam Pract to get into the groove of things.

C

 

[irlandesa]

Well, if I had to do it over again (as someone going into IM) under the constraints of my school's scheduling; I would have done Psych and FP during the first 12 week block, Medicine during the next 12 weeks, followed by Peds and OB, then finish out with Surgery. The reason I say this is that it's just too much of a pain to do Medicine last (being stuck in that position now) plus, Medicine provides you with the best foundation to do well in both your IM and your Surgery clerkships, so it's good to do it somewhere in the middle if you can.

 

[Jaded Soul]

After agonizing about this same thing last year, I realized a few things that I'll share too.

- Make the first half of your year more intense than the second half. e.g. schedule surgery and medicine before Christmas. You'll thank yourself in the spring.

- Try not to schedule what you're considering going into as the very first rotation. Not because of letters of rec, but because you'll want to get a good grade. It's definitely more difficult to impress people when you are still figuring things out.

- On the other hand, getting letters shouldn't be that much of a factor in deciding when you schedule things. You'll have time to plan early Year 4 accordingly and get letters out of those rotations.

- Try to schedule an inpatient rotation first. Learning the hospital system has no academic benefit, but it's one of the biggest obstacles to overcome early.

- Having medicine before surgery is very beneficial, especially if you have to take shelf exams. Not so much with having surgery before medicine.

- If you don't get the schedule you want, it's not the end of the world.

 

[irlandesa]

no, we don't have a hospital...which is why I was hoping to head home and find some rotations in Boston....however, I'm having a very difficult time trying to find hospitals who will take on 3rd year students who are not affiliated with their own school. Any advice?

externships (rotations at non-affiliated sites) are not generally permitted during 3rd year core clerkships at any of the Boston schools (Tufts, BU, Harvard). However, you MIGHT be able to find a rotation by contacting department chairs/course directors directly at some of the smaller hospitals here like Faulkner (joint Harvard/Tufts with rotating residents from BWH, just plain awesome), Caritas-St. Elizabeth's (Tufts/UMass), or Newton-Wellsley (Tufts students/MGH residents) The W. Roxbury VA may also be an option, and has residents and attendings from 3 different hospitals (BWH, BIDMC, BUMC). I don't know if you have contacted any of these sites, but it's worth a try and more likely to work than contacting the big hospitals. Independent hospitals like Norwood or Caritas-Good Sam in Brockton might be worth a look as well. As far as fourth year goes, rotations around here should be pretty easy to get. good luck!

 

[tigershark]

IM first half of year, surgery and family in the second half. Ideally at least pysch or ob/gyn before IM so you aren't a total noob on the wards.

I suggest getting Ob/Gyn out of the way early, as it will make every other rotation seem cush in comparison. Might be different where you are, but Ob/Gyn was the most miserable academic experience of my life for a multitide of reasons. Whenever I think I have it rough, I just remind myself that somewhere some poor soul is going through Ob/Gyn.

My theory and schedule for 3rd year:
1) Ob/Gyn (go ahead and get this torture out of the way)
2) Psych (cause you need a break after Ob/gyn)
3) IM (You have a little knowledge now in soap notes and presenting)
4) Elective/break
5) Family (good deal of IM invloved here, still fresh in your mind)
6) Elective/break
7) Pediatrics (good base developed with IM and family, dont do this during winter unless it's what you want to do.)
8) Surgery (lot of medicine invloved here, in rotation and on shelf. At this point you are battle-hardened and wiser, hopefully with some humility pounded into you over the past year. You are now ideally prepared to deal with the long hours and abrasive personalities in surgery)

 

[dancelover]

I'm not sure it really matters that much in the end. Everyone at my school seems pretty happy with their rotation order, and everyone has a different reason for why their particular schedule worked for them. We have a lottery system, so sometimes you get what you want and sometimes you don't. The basic things i heard were Medicine before Surgery (b/c the surg shelf has a lot of medicine), not to do medicine first just since it's a bit overwhelming as a first rotation, and put the specialty/ies you are interested in later in the year so you have a bit more experience. That said, plenty of people began with medicine and thought it was great prep for the rest of year and plenty had surgery early on and did fine on the shelf. So pick whatever you think is best but realize that you will be fine even if you don't get the exact schedule you were hoping for.

FYI: my schedule is:
1. Peds
2. OB/Gyn
3. IM
4. Psych
5. Radiology
6. Surgery
7. Family

And so far, so good.

 

[bigfrank]

Assuming you don't want to do Peds....

FP --> Peds --> IM --> GSurg --> OB-Gyn/Psych/Neuro

Believe me -- this works.

 

[fourthyearmed]

I've posted a reply to this question before so I won't go into detail. It doesn't really matter what order you do things in. We don't get a choice at our school but no one really cares. I do not recommend doing Surgery near the end as the people above has because I was so burnt out by the end of the year there was no way I would have had the energy to survive. I had OB and Surgery both before Christmas and it was nice to have the tough rotations over.

 

[kutastha]

Mine's been like this:

Family Med
Outpatient IM
Peds
Psychiatry
Neurology
Inpatient IM
Gen Surg
Urology
Vascular Surg

All I have left is OB/Gyn, so I can't comment on that yet. But I felt this was a pretty good schedule. The two outpatient experiences I started with got out of the way at the beginning, and allowed a calm intro into third year (leaving me with ten straight months in the hospital). Doing all the others before surgery has definitely prepared me well for the intensity and hours required by that rotation, as well as giving me a good background in so many varied disciplines. It's nice to see the finish line in sight though.

 

[DOtobe]

A couple good ones from the SDN archives...

One

Two

Three

I did my third year rotations in this order:
Psych - FP - IM - Surgery - Elective - Ob/Gyn - Peds.

I was happy with that order becaused I eased into rotations by starting with an easy rotation (Psych) and did medicine early enough that it could help me with my other rotations. There is a lot of medicine in surgery, so doing IM before surgery would be a good idea.

Just my two cents...

 

[14022]

I agree that it doesn't really matter. The only thing I feared of having was internal medicine first. Of course, I drew IM for the first rotation and it ended up working out wonderfully. First of all, the residents didn't expect much for our first rotation. Second, the interns were new and coming of an easy fourth year. Compared to the third year students coming off step 1 and being a walking, talking first aid review book, we (ie, MS3's) tended to know more pimping-style questions than the interns. Also, IM prepares you for the rest of the year as well, and I think it was easier to learn psych and OB having medicine first. I am on psych now and my attending appreciates my knowledge of IM since we always have to manage medical problems like HTN, DM, UTI, asthma, etc on the psych floor.

The moral of my story is if you tend to think your glass is half-full then you will probably deal with whatever schedule you get and use it to your advantage. If the glass is half-empty, youll be miserable regardless. So just relax and make a schedule that you think will work for you and prepare for it to be the exact opposite and deal with it.

 

[pimpdogg]

I don't know how your school words but at ours we have a few easy rotations. Geriatrics, Radiology, Family Med, Psych. My only advice is to not do one of these first. Going from a cushy 2nd year or summer schedule to any rotation is tough. So if you start with an easy rotation it won't seem as easy as it would have had you taken it later. That way when the easy rotations come around it seems like a break. Start with OB, Surgery, or IM. That's my advice.

 

[12R34Y]

I'm definately in the do IM first camp. I did it and I can't tell you how much it helped for the rest of the shelves and doing H&P's etc... on all the subsequent rotations. Afterall, it is the bread of butter of "medicine." I felt a little sorry for the folks in our class who started with psych or surgery because they just didn't have a background in getting good H&P's, looking and working up lots of labs, interpreting studies etc....

Having said that....10 years from now it won't mean a lick what order you do. it does all pan out, but in the short-term (ie. 3rd year) it will start you off on a solid foundation of basic stuff.

I vote medicine.

later

 

[lindyloohoo]

I vote medicine first too. I had it first and I can't thank myself enough for wanting to get it over with. I remembered a ton from Step 1 that made studying for the shelf easier. It also has made subsequent rotations/shelf exams easier. I think the only thing it wouldn't help you a ton for is peds just because thier ddx is pretty different from adults. Also, it didn't hurt that I had the rotation I was dreading the most over with (although now I'm dreading psych). Good luck.

 

[tigershark]

Do something you are interested in, screw doing a month of medicine (unless you want to go into IM). This is a good opportunity to make connections in the field you are interested in early, most students dont get to do any electives until late 3rd or fourth year. You are lucky because you can begin cultivating contacts and letters of rec now.

Of course the other posters are right in that medicine would give you a nice base for other rotations, I dont think that outweighs the value of making early contacts in a field you are interested in.

 

[doc05]

trust me, you'll get more than enough of medicine during your core rotation. writing H&P's and looking up labs is incredibly easy, and you'll learn all that when you need to. I recommend going with gas, if that's what you're interested in.

the good thing is that anesthesia is really different than many other specialties, so you don't really need a "background" of IM, etc, for your student rotation. you'll have plenty of contact with patients in pre- and post-op areas, check out what the surgeons are doing, and have an early opportunity to see if gas is the right specialty for you.

the only downside is that all the new pgy-2's will be starting as well, which means less opportunities for you to intubate, etc.

 

[tupac_don]

I'm definately in the do IM first camp. I did it and I can't tell you how much it helped for the rest of the shelves and doing H&P's etc... on all the subsequent rotations. Afterall, it is the bread of butter of "medicine." I felt a little sorry for the folks in our class who started with psych or surgery because they just didn't have a background in getting good H&P's, looking and working up lots of labs, interpreting studies etc....

Having said that....10 years from now it won't mean a lick what order you do. it does all pan out, but in the short-term (ie. 3rd year) it will start you off on a solid foundation of basic stuff.

I vote medicine.

later

Well said. In the long term it won't mean squat what rotation you took. But in the short term it will give you an edge as a result it might help you perform better in other rotations and get better clinical grades that can improve your application to GAS.

 

[Jalopycat]

I would try and do medicine first and then surgery. I did this and although the first 4 months were hell, now the rest of the year is a down hill slope.

I would also do the gas elective toward the end or at least after surgery so you don't commit some weird OR faux pas and end up worrying about it. Just my opinion though.

 

[pottsy2]

I think in general, attendings base what they expect from you knowledge wise on how far into third year you are. That said, getting honors can be kind of a crap shoot. Different attendings can rate the same student totally different. If you want to do medicine, I think as long as you don't it first, it should be fine. Just be enthusiastic, know your patients well, kiss a little behind and you'll be fine.

Hey guys,

I am now in the process of selecting my rotation track for the 3rd year. Here is a little info about me. I sort of think that I will probably apply for an internal medicine residency. I hope that I don't change my mind during the 3rd and/or 4th years. I would like to do very great in my IM rotation for 3rd year. The tracks that I am interested in look more or so like this:
6wks of Peds
6wks of Ob/gyn

Then either:
6wks of IM followed by 6 wks of Gen Surg.
Or
6wks Gen Surg followed by 6 wks of IM

I am thinking about doing it in this order: Peds, Ob/gyn, Gen Surg and IM.
I think I will get enough experience in the hospital to help do excellent in Gen Surg and especially IM. I want to leave the not so demanding rotations for last. How much knowledge do they expect from a 3rd student? Do you think the above order of rotation will help me to achieve a honor in IM? Please give your inputs!!!!

 

[ears]

I'm a 4th year now; I remember being stressed about ordering the rotations for 3rd year. I don't think it matters that much. If you have a good attitude, you're eager to learn, and you're not being judged by weasels, you'll be fine. (And you actually control the first two!)

If it were me, and I wanted to make especially sure to be at my best for IM, I'd try to do IM before surgery. Surgery can really take it out of you. Also, IM does more to get you ready for surgery than vice versa.

But don't forget the most important point: either will probably be fine.

 

[fourthyearmed]

Don't worry about it. The order doesn't really matter. No one knows anything during their first rotation, they expect this and it may work to your benefit. Another good thing is that you will be very enthusiastic and hard working because it's your first rotation and the novelty will make you more enthusiastic. By the middle to end of the year you'll be tired and less worried about the impression you make. Also you'll probably study harder and do better on the test since that's a new experience as well. I am going into the field that I had first during 3rd year. It was one of my highest grades of 3rd year.