Order of Rotations

[ears]

You can make having it first work to your advantage in other ways, too. Try to leave yourself some relatively relaxing time (three weeks?) before rotations start, and then do a little preparatory reading every day (e.g., Blueprints before Ob/Gyn, Lawrence before Surgery, etc.). It'll make you feel better about stuff, and make it easier when you go to get ready for the exam at the end.

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[KyGrlDr2B]

I did IM first and having just come off on boards, I did really well on PIMP questions that asked that type of stuff. I didn't know any management, but they don't expect you to. Now, if I had done it last, they would have expected way more of that. They definitely take into account how far along you are.

 

[jamie]

Don't do the clerkship in the field you think you may want to go into first -- so you can get oriented to the hospital, teams, med student role, etc., before you really want to shine. May not want to do that one last, either, so you can figure out if it's really what you want to do (helpful in scheduling electives for fourth year).

If you want to go into surgery, may help to do OB/GYN first (and vice versa) so you can get acquainted to the OR.

Just tips. In the end, it probably doesn't really matter.

 

[roja]

Ultimately, it doesn't really matter. However, if you know what you want to do, doing that rotation in the middle is a good idea.

Other than that, it truly doesn't matter.

 

[Dr.Evil1]

I always thought one should do the internal medicine rotation first. Am I wrong? Just because it's so general and a good way to get oriented to treating patients in a large scope.

I would agree but only if you aren't super interested in going into IM. It would be harder to take FM if you hadn't already had IM. I had it pretty good, my order went as follows:

Peds - 2 Mo, 1st month inpatient, 2nd outpatient...good way to get my feet wet with call and managing impatients.
IM - 2 Mo, both inpatient...after this rotation everything seemed easier
FM- 1 Mo, outpatient...good general experience
Elective in Cards - 1 Mo
Psych - 1 Mo inpatient
Neuro - 1 Mo inpatient
Surgery 2 Mo - both inpatient. Only drawback is that alot of the students in my rotation group were interested in surgery and the shelf turned out to be ULTRA competitive.
OBGYN 2 Mo - inpatient. Man this was kind of hard to do in May/June.

Looking back I would have rather had swapped Psych/Neuro with OBGyn, otherwise I think everything went great.

 

[AF_PedsBoy]

Most people do the rotation they want to match in as the first block of the spring, after winter break so you know what's going on and you are fresh from break. Since I wanted to avoid the gunners I did it block 4 - as a ****** I had not come to the realization that peds tends to self-select out the gunners. And use Family and Psych as your buffers for relaxation. Family is tough because it's a bit of every rotation, but if you've finished most of your year you get out at 3-5 PM every day and I high passed it without studying.

My 3rd year schedule after the registrar butchered it was:

Medicine - Good basics. Hideous as a first shelf because of length
Psych - Easy rotation, easy shelf, lots of stories
Peds - Fun rotation, TOUGH shelf

Ob/Gyn - Hideous rotation, pretty easy shelf
Family - Great rotation, medium difficulty shelf
Surgery - Ugly rotation, medium difficulty shelf (which is mostly medicine)

 

[multitasker]

I agree with the above. I think you should do IM in the first half of the year. It gives you a foundation for everything else. I think it's a mistake to do IM last.

I agree that if you want to do surgery, do ob/gyn before that. Also, doing peds, ob/gyn and IM BEFORE family practice is helpful. FP is really a combination of all these so you'll know what you're doing if you've done all these. But if you do FP before, say ob/gyn, you'll be lost with certain patients.

 

[double elle]

Hi - I am a 4th year and my experience was thie:

My third year rotations...1)OB (specialty) 2)Psychiatry (specialty) 3)surgery (specialty) 4)FP.....woah!!....wait...TOTALLY wasn't prepared for all that information...hypertension, diabetes, peds, geriatrics....

I didn't do a medicine rotation until FEBRUARY. I can't tell you how many things I learned on medicine that would have been helpful in EVERY SINGLE ROTATION from day one. If I had to do it all again, I would have chosen to do Medicine first. You may make more mistakes - but you'll learn so much that will be helpful on ALL your other rotations. Hopefully, you'll have a good intern or resident on with you with whom you can feel free to ask questions and such. Our hospital is like that - very friendly. If you decide to do medicine first - just express to your intern/resident that you are here to learn, want to do well, and are interested in applying what you learn in this rotation to your other rotations. If they really sense you want to do well and learn, you will be made part of the team.

If you want to do medicine as a career - I can't see you ruining that by having medicine as your first rotation. Just be sure to talk to past students and residents to see how things work. I found the most frustrating thing was to simply not know the routine...or the flow of things. Good luck.

 

[14022]

Ultimately, it really doesn't matter. You can make an argument for any order. BUT, if you have a choice in the matter, and you are looking for some others with experience, I can tell you how my schedule worked out.

I was originally planning on going into medicine and cards so the only thing I did not want was medicine first cause I did not want to look dumb. Of course, I got medicine first and it was excellent. First of all, a lot of things you learn for step 1 is related to internal medicine. So I knew a lot more than the interns and fourth-year sub-I's because I would get pimped on stuff that I remembered from studying for step 1. This helped me get a great eval. Also, there has been medicine on every shelf I have taken, including psych and OB. Surgery is tough if you havent had medicine as well. I felt the shelf in surgery was very similar to medicine and requires a good medicine education to really do well.

People say that you should schedule the rotation of the specialty you would like to practice later in the year. I do not think this is necessary because the attendings know it is your first rotation and do not expect you to be a stud on the wards. Also, for the first rotation you are working with new interns who just got off a very easy fourth year and two months of vacation between graduation and residency so they are not very sharp either. Just show enthusiasm and willingness to learn in every rotation, especially ones you are interested in, and your attendings will like you. Good luck with scheduling!

 

[vanelo]

Trust me in this.

Best order:

1. Internal Medicine: it will teach you the background you will need in every other rotation

2. Surgery: Shelf Exam has many int. med questions

Those are the most important two. After that I did:

3. Peds

4. OB-GYN

5. Psych

6. Family Medicine


If you are good, you'll do good in Int MEd even if it is your first or last rotation.

Good luck

 

[fantasty]

Hi. I'd like your opinion on something - please don't flame if you like surgery. I know it's not for me (I'm thinking medicine, personally). I'm in a mudphud program, so we enter rotations at weird times (off-cycle from other M3/M4s). Of my remaining rotations, my 6 wk surgery clerkship is the one I'm looking least forward to. Basically, I just want to get through it with minimal psychological damage, a passing grade, and some useful knowledge for boards.

When I schedule it, I could do a couple of things:

1) (Original plan) Take it July (which would be the first block for the incoming M3). I thought this was a good idea because surgery gunners wouldn't take a rotation they wanted to ace as their first rotation. I figured that incoming M3s will be equally clueless and we can all get acclimated to the OR and the staff together (lower expectations from the staff). But, I've been told by the folks at my school that the incoming interns are pretty intolerable at the beginning of the year and made life hellish for the med students.

2) (Based on friends' suggestions) Take it May/June (the last block for the M3's). The logic here is that ALL of the gunners would have surgery earlier, and the only students taking it at this time would be people who put it off. Plus, the interns have mellowed out by then and teach more and aren't as crazy about racking up the procedures.

Or 3) (My current fave) Take it mid school year (Nov - Feb). If I take it after Sept/Oct, grades won't be on my dean's letter or part of the consideration for AOA (not that I'm a likely candidate for that anyhow). It would be nice to take this right before boards. The chances of dealing with gunners may be higher.

I realize the situation may be different for you, but any suggestions about the best time to take it?

 

[ears]

My suggestions about scheduling surgery: First, ideally have a break or an easy rotation right before and right after it. Surgery is intense and tiring, and it's better to be start rested. Also, you don't want to be exhausted heading into a difficult rotation you care about. Second, I don't think avoiding the people who want to go into surgery is necessarily what you want. If people at your school are generally cool, then surgeons-to-be might be looking to do more work, including looking out for you, possibly. Just a thought. Third, it's helpful to do it after a medicine rotation. Medicine helps you a lot for surgery; I think the inverse is less true.

So maybe ideally, you'd do it at the end of the year, after an easy rotation (psychiatry?).

BTW, you might be surprised. I thought I had no interest in surgery (I'm a MD/PhD, too), but my surgery rotation was the highlight of 3rd year for me. Surgery really one of those things you can't know if you like until you really get into it. It's worth keeping an open mind (even if you end up in something else, like radiology, in my case).

 

[doc05]

surgery is the most awesome field of medicine and you'll have a blast if you keep an open mind about it. I suggest you take surgery first when you're still full of energy. no sense in waiting to take an exhausting rotation later on, esp. if you're not interested, when you're not only burned out from 3rd year in general.

as for the interns being "intolerable," that is utter nonsense. most interns are usually pretty cool at the beginning of the year since they are still bright-eyed and unjaded. and besides, the chief residents and senior residents are the ones you should be learning from anyhow.

 

[klubguts]

i felt the same about IM and took it as my first rotation...you will get tired of third year, and surgery is a demanding rotation. Not to mention, expectations for an MS3 in july are much less than they are during the second semester, since you will have had minimal clinical experience/exposure. Just work hard, and nobody will give you any trouble. maybe your situation is different, but ALL my third year evals were in my deans letter and clerkship grades were available to residency programs and factored into AOA nominations. i'm gonna be one of those "intolerable" surgery interns in a few months, and find this comment VERY interesting....good luck.

 

[Michelangelo]

Hi. I'd like your opinion on something - please don't flame if you like surgery. I know it's not for me (I'm thinking medicine, personally). I'm in a mudphud program, so we enter rotations at weird times (off-cycle from other M3/M4s). Of my remaining rotations, my 6 wk surgery clerkship is the one I'm looking least forward to. Basically, I just want to get through it with minimal psychological damage, a passing grade, and some useful knowledge for boards.

My recommendation is to go with your first option:
"1) (Original plan) Take it July (which would be the first block for the incoming M3). I thought this was a good idea because surgery gunners wouldn't take a rotation they wanted to ace as their first rotation. I figured that incoming M3s will be equally clueless and we can all get acclimated to the OR and the staff together (lower expectations from the staff). But, I've been told by the folks at my school that the incoming interns are pretty intolerable at the beginning of the year and made life hellish for the med students."

When I was a third year, I rotated through surgery first because I knew that I would not pursue it as a career. The interns were actually very NICE and patient because they haven't yet been burned out by the long hours of training and they're still positive. Not one gunner will intentionally take surgery first! The rotation was a rude awakening to third year, but everything seemed easy after that. It's your call.

Good luck!

 

[bigfrank]

If you have no interest in surgery AND think you're a shot at AOA, I would suggest taking it dead last in the M-3 year. Because you probably won't succeed in it, it would be a shame to honor everything else but not surgery, which you admittedly don't care about.

I also have no interest in surgery but had it in the middle of the year, so I had to feign interest in it for two months in order to get Honors. Not much fun......

 

[scootad.]

how did the aoa thing work out?

 

[fantasty]

Thanks for all the suggestions. I think I'm going to go with option #3, though, and take it in January (which will be towards the end of my clinical rotations). I'm in a weird boat because I'm MSTP, so we take only 15 mos of clinical (I've already had 3 mos, and we enter back into med school when we finish our thesis, hopefully next March for me). So, even though surg, OB/Gyn, and Peds are required in 3rd year for our school, I won't necessarily have them before dean's letters and applications in the fall. By doing surgery in Jan, I'll have 3 weeks off before hand to rest up (mandatory vacation over winter break), the grades won't count towards applications, and it'll be fresh in my mind for Step II. I'll just have to suck it up and deal with the gunners (hopefully they are ok, like a previous poster said). Also, I'll have OB/Gyn and probably some surgical subspeciality time (uro, orthro) before that to get used to the OR. (Our school has 8 two-week clerkships which we can take whenever).

Also, that story about the surgical interns being "intolerable" in July may have been a fluke with my original class. I just know that multiple students in my original class were treated poorly by the new folks - they weren't paged when needed, they were specifically "sent away" at key times so that the attending thought they were never where they were supposed to be. But, I doubt it is true of all (or even most) interns - I think it may have just been that one incoming group.

 

[VentdependenT]

Surgery rotation is demanding if you actually like it. If you don't you can slack by. Its a unique experience and you will probably enjoy it if you have even only one moderately "cool" resident on your service. If you show even the slightest interest in the field your life will a hell of a lot easier during that service.

 

[bigfrank]

how did the aoa thing work out?

Don't know yet. It hasn't been released.

My school appears to be ridiculously stupid in that they usually pick junior/senior AOA 3 months apart.

 

[the citizen]

Don't discount surgery as a learning experience even if you know you will not be specializing in it. I never really understood GI until I took surgery. For many conditions, surgery is a tool to use once medicine fails--the pathophysiology is the same. Feigning interest in anything will just leave you dead inside, but if you truly like medicine I think you will at least find surgery interesting.

Gunners (or even better 4th year away rotation students) are good if you don't like the OR: "Yes, he is my patient, but you are welcome to scrub in on the Whipple with the big wig attending."

 

[(nicedream)]

I realize the general consensus is for someone strongly considering IM, it's a good idea to do it later in the 3rd year. However, at my school, there are 3 4-wk blocks of IM, and it can be broken up so that one block is done first, and the other two blocks last. Would that be good so that you get a feel for it first, do all your other core rotations, and then go into those last 8 wks at the top of your game?

 

[irvinedawg]

my school wants me to ob/gyn and surgery next. I am trying to decide which one to do first. I am not interested in either of them. Currently, I am doing peds.

please advise
thanks

 

[irvinedawg]

Any advise from anybody

 

[titanjones]

IM last..that way you can take off the first block of 4th year to study for step II and rock it.

 

[71263]

M3 yr (in progress):

Neurology- 3 wks
Ambulatory Care- 3 wks
Peds- 6 wks

OB/gyn- 6 wks

Psych- 6 wks

*Winter break*

Surgery- 8 wks
Family- 4 wks
Emergency- 4 wks
Medicine- 8 wks

As you can see, our school divides rotation into the 8 weekers and 6 weekers. I wanted to do 8 weekers first to get the hard stuff done first, but will instead be doing 6 weekers first. I felt somewhat disappointed, but in the end, I was able to realize the positives of my track. For the first half, Ill start off easy, get progressively harder, than insanely harder, then back to easy. Ill be getting surgery done as the first of my 8 weekers, and EM soon after, both of which Im interested in. I finish with IM, which I wasnt interested in initially (Im starting to consider it as a possible alternative to surgery). On the plus side, Ill ROCK step 2 if I take it early (as I plan on doing), as it is predominantly medicine, which will be fresh in my head.

 

[chadderdo21]

For me, some of you guys get extra time in areas which for me would be good, but tough. I have

Rural Primary Care (4 weeks)
OB/GYN (4 weeks)
ER (4 weeks)
IM (4 weeks)
Geriatrics (4 weeks)
Surgery (4 weeks)
Psych (4 weeks)
Peds (4 weeks)
FM (4 weeks)
Anyone else other than me think some of these are to short or just weird for some rotations. By the way, all of these are mandatory during MS-III at my school. Ugh

 

[UCLAstudent]

I purposely uploaded my schedule with the harder rotations. The end of the school year will be much lighter for me.

Surgery - 12 weeks (done)
Ob/Gyn - 6 weeks (in progress)
Peds - 6 weeks
IM - 8 weeks
Neuro - 3 weeks
Psych - 5 weeks
Family med - 4 weeks
Ambulatory care - 4 weeks

 

[chadderdo21]

I purposely uploaded my schedule with the harder rotations. The end of the school year will be much lighter for me.

Surgery - 12 weeks (done)
Ob/Gyn - 6 weeks (in progress)
Peds - 6 weeks
IM - 8 weeks
Neuro - 3 weeks
Psych - 5 weeks
Family med - 4 weeks
Ambulatory care - 4 weeks

Good Idea
We do not have that option here. I wish we did.

 

[surprisedgirl]

I purposely uploaded my schedule with the harder rotations. The end of the school year will be much lighter for me.

Surgery - 12 weeks (done)
Ob/Gyn - 6 weeks (in progress)
Peds - 6 weeks
IM - 8 weeks
Neuro - 3 weeks
Psych - 5 weeks
Family med - 4 weeks
Ambulatory care - 4 weeks

i did that too....it's so nice knowing htat by the time i start burning out, i wont have to try so hard b/c it'll be so easy