programs that allow/require clerkships before starting phd?

[laxgirl04]

hi all,

I'm trying to compile a list of programs that either allow or require clerkships before starting graduate school? if you go to or know of programs that do this, can you please reply with the name of the school, the amount of clerkships (like 6 months, 1 clerkship, etc), and if it's required or optional... as well as any other info (such as how do students get back into their phds if they enter at an awkward time -- like not fall).

thanks! I appreciate it.

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[Shifty B]

Why is this particularly important?

 

[solitude]

Why is this particularly important?

agree. But to humor the OP, to my knowledge all schools are more or less the same (1-2 rotations max), except for Duke where you do the entire 3rd year of med school as your 2nd year, prior to the PhD.

 

[laxgirl04]

well, I know that yale requires 6 months of clerkships as well. I assume there are other programs, but I thought this would be an easier way to find information than doing an extensive google search.

 

[solitude]

well, I know that yale requires 6 months of clerkships as well. I assume there are other programs, but I thought this would be an easier way to find information than doing an extensive google search.

Fair enough. I'm curious whether you feel this will affect your decision on which program to attend?

 

[Hoagie]

UPenn and NYU i think have 1.5 year preclinical curriculum so you can do some of your clerkships prior to starting phd as well. Dont hold me to this but i heard that there is a lot of flexibility at jhu in terms of deciding which year to go into phd.

On the interview trail, I have heard some older mdphd students say that having clinical experience before grad school significantly informed the kind of research project they wanted to pursue. It seems like this approach could be really helpful for people trying to decide how they want to fuse their doctoring and sciencing.

 

[K31]

Off the top of my head:

UPenn
Duke
Baylor
UVA
UT-Houston

 

[Shifty B]

With my earlier post, what I was getting at is that this is not an important factor that should be considered when deciding in programs. It doesn't really make a difference one way or the other, and any advantage of doing it one way is offset by the disadvantages. The only presumed advantage of doing some clerkships prior to the PhD is that it could give you some flexibility about when you rejoin your medical school class once you finish. The problem with this argument is that you spent a month at the beginning of your PhD that you could have spent starting up your research. All you've done is shift your PhD 1 month for each clerkship you do.

That being said, there are at least 2 significant disadvantages of doing clerkships before your PhD: First, any clinical skills/knowledge that you gain, you will forget by the time you do a 4 year PhD. Secondly, and more importantly, you ABSOLUTELY DO NOT want to start your clerkships more than 3 months or so after the class you are rejoining. After step 1, the most important criterion for getting a residency is your clinical grades. You will be judged against the class that you rejoin as if it were a level playing field. If you start 6 months late, your skills will be 6 months behind the other students on your clerkships. This will be evident to the staff and residents you work with, and they will likely not even realize that you have a legitimate reason why you are not as good. If nothing else, the others students will have a 6 month head start in knowing how the grades game is played.

DO NOT UNDERESTIMATE how much these grades count. You will not have another chance to get those grades back. Once you get a pass on medicine and surgery instead of honors, there is no uncrossing that bridge. If you were coming back in January, it's almost better to stay out until April and re-enter medical school earlier than everyone else in the class one year below.

On the interview trail, I have heard some older mdphd students say that having clinical experience before grad school significantly informed the kind of research project they wanted to pursue. It seems like this approach could be really helpful for people trying to decide how they want to fuse their doctoring and sciencing.

I'd be suspicious of anyone saying that what they gained in a few clerkships was enough to modify their approach to the PhD portion of their program. I don't think there is any significant benefit in that regard. In fact, I don't think 2 years of clinical medicine significantly adjusted my research approach.

 

[Neuronix]

I'd be suspicious of anyone saying that what they gained in a few clerkships was enough to modify their approach to the PhD portion of their program. I don't think there is any significant benefit in that regard. In fact, I don't think 2 years of clinical medicine significantly adjusted my research approach.

The only advantage for me was being able to get a good sense of what specialties I would be interested to pursue before the PhD. I started medical school thinking about things like neurology and neurosurgery, and I found that I really disliked the practice of both. I picked a lab in a department that I wanted to join at the time, and ended up choosing a similar specialty. I think tailoring your research to your specialty interest is very important, both to give you a niche area within the specialty and help you obtain a top residency.

I will agree with your disadvantage about coming back to medical school with 6 months to go with the medical students who are already in medical school for 6-9 months. That was PAINFUL. My attendings simply didn't care that I was out for a PhD. They thought I was really stupid for not being as skilled in the clinics as all the other medical students. I was miserable for a year after rejoining the clerkships. And as Shifty points out, those clinical grades are really crucial.

Though it is still an advantage to have flexibility with the timing of your return. It depends on your particular situation. Some MD/PhDs need several rotations to pick a specialty and a couple aways and even a research rotation in their field of interest to get a strong application together. Some already know what specialty they want and don't need as much fourth year time. It all depends. But it is nice to do 3.5 years of medical school and 3.5 years of PhD if you can swing it to get out in 7 years. This may not be possible for everyone.

 

[gbwillner]

I did 6 months of clerkships before the PhD and thought it was a tremendous advantage. I disagree about returning to your new MD class being a problem- it all depends on your timing of your return, so it may make no difference at all. If you do the PhD right after MS2- I don't see how that wouldn't affect you if you take 3.5 or 4.5 or 5.5 years to do the PhD. You would have the same EXACT problem.

The biggest advantage, as Neuro pointed out, is that you can do a trial run of the specialties you are most interested in and see how they fit you. You can tailor your PhD to some degree based on that decision. I did rotations in Peds, Neuro, and IM (my top 3), and afterwards realized I did not want to do any of those. I knew what specialty I was going into before finishing my PhD and planned accordingly, and it was a well-informed decision.

I also disagree about forgetting all your clinical skills. They are still there, lurking in the recesses of your brain. They will re-appear much more quickly than for an average MS3. You will be more mature and knowledgeable in general. I found this to be a tremendous advantage.

 

[ucbundergrad]

I considered it a huge plus when schools had a shortened basic science, then clinics, and then PhD.

First of all you are not delaying PhD work at all. You have a SHORTENED basic science curriculum. I don't see why anyone would consider this a bad thing. You start the PhD the same time all the people following a "normal" schedule (2 years basic science --> phd), but you just saved yourself 6 months of time by using that time for rotations and step1.

Having clinics before step 1 exam may help your score. People argue back and forth about this but I think it helped me in 2 ways. One if I had to study for step1 right after finishing basic sciences I think I would have been significantly less efficient. After 6 months in the clinic I was not too annoyed by a change of just having to study 10-12 hours a day for a month.I think I could have been burned out faster if I just went straight from basic sciences. I also think it helped in being more familiar with some of the more disease oriented questions. After clinics some things just become way more obvious.

Also at most places you can just do surgery and medicine first so you are getting your 2 most important clinical grades right away and are then at no disadvantage compared to your peers. I mean you can complain that now you have to do these rotations first, but if you haven't learned by now no matter when you have to take these rotations medical students can find a way to complain about it.

It definitely does help you get an idea about what you want to do clinically. Also I find that I am still able to better understand clinical medicine and can still have discussions about it with my classmates. I could not do this well prior to clinics.

The only possible disadvantage is the skills you gain during your rotations in those months will probably atrophy but you can just schedule an easier rotation for when you are coming back from the PhD, and I think regardless of what you do (rotations before the PhD or not) you will be at a disadvantage coming back from the PhD. At least this way you have your big clinical rotations finished already. So really, I don't see this as a disadvantage. I bet more schools will start to do this.

 

[Shifty B]

A shortened basic science curriculum is a different issue altogether. That is better under almost any circumstance, but the question wasn't asked that way. If you could do only 18 months of basic sciences instead of 24, then that is better in terms of starting your PhD earlier. However, if you are considering two places that have the same amount of basic science, only one does a significant amount of clerkships before doing the PhD, the problem of coming back with medical students who have been on clerkships for 6 months already is a problem in terms of your grading. When you are being graded against medical students who have been on clerkships continuously for the last 6 months and you did those same 6 months 4 years ago, you will look worse compared to them. This is true simply because it takes you some time to get into the groove more than anything.

I had not considered the notion of getting a better idea of what specialty you want to do a little bit earlier. I can see how that would be somewhat useful.

 

[gbwillner]

A... However, if you are considering two places that have the same amount of basic science, only one does a significant amount of clerkships before doing the PhD, the problem of coming back with medical students who have been on clerkships for 6 months already is a problem in terms of your grading. When you are being graded against medical students who have been on clerkships continuously for the last 6 months and you did those same 6 months 4 years ago, you will look worse compared to them. This is true simply because it takes you some time to get into the groove more than anything.

Shifty, did you go to one of the programs with the early clinical work, or know someone who did and had these problems (and difficulty matching because of it), or is this all hypothetical?

And again, I'm not sure about the 6 month thing- do programs FORCE you to return 6 months later than MS3s start? I have never seen this before.

I did forget that my program did take the time from the basic science years. The downside was no summer break between MS1 and MS2- well, you got 2 weeks.

 

[Shifty B]

I experienced this in a limited fashion and saw others at my program experience it in a worse way.

My program had some flexibility about when you could return. The basic science curriculum lasted until March of your MS2. MD only students then started clerkships in April of their MS2 year and then had a 3 month block of dedicated research during their MS3. As an MD/PhD student, the 3 month block of dedicated research was waived, and ideally you came back in July of your MS3, rejoining the other medical students. If you came back in July (as I did), you were likely joining many people who already had 3 months of clinical experience. There was a discernible difference between myself and other medical students, and it took some time to close the gap.

If you were wrapping up your PhD and needed extra time, you could push back the start of your clerkships until November of your MS3 at the latest. (This was accomplished by giving you 3 months of additional research credit for electives you would have had in your MS4). By this time, you would be 6 months behind MD-only students who hadn't done their research block and 3 months behind those who had. It's hard to get honors when you are inevitably going to be compared with someone who has been playing that grades game for 6 months (because it is something of a game).

If you do those clerkships before your PhD, are you required to go back to medical school later? Well, perhaps not, but there are only so many credits that you need to finish medical school. So if you do 3 months of clerkships before your PhD and time your return with other MD-only students, then you have to fill those months in some way, or you'll complete all your medical school requirements early. I guess you could try to arrange some way to have more dedicated lab time during your MS3 or MS4 to wrap up any leftover projects, but this raises issues about who will pay your stipend/tuition during that time.

 

[meowkat444]

i'm at a program that requires 6 months before the phd, and i think it's AWESOME. and for us, there are 3 entry points, so you don't necessarily go back at the time when others have done 6 months. that being said, i assume i'll just go back asap after i finish my thesis, rather than trying to time it in any special way.

if you are applying at schools that require/allow clinical rotations before the research years, definitely ask about how they transition their mudphuds back to clinic. we have a whole associate director dedicated to this issue, and she is awesome. we have lots of opportunities to keep our clinical skills up. still, i;m sure the first month back will be rough...

 

[Hoagie]

i'm at a program that requires 6 months before the phd, and i think it's AWESOME. and for us, there are 3 entry points, so you don't necessarily go back at the time when others have done 6 months. that being said, i assume i'll just go back asap after i finish my thesis, rather than trying to time it in any special way.

if you are applying at schools that require/allow clinical rotations before the research years, definitely ask about how they transition their mudphuds back to clinic. we have a whole associate director dedicated to this issue, and she is awesome. we have lots of opportunities to keep our clinical skills up. still, i;m sure the first month back will be rough...

MD/PhD in New Haven with a 2.5 year pre grad school curriculum... I wonder where you go to school... 😉

Could i bother you for some questions via PM? I really enjoyed interviewing there and would like some real talk.

 

[miz]

Most schools will let you do at least one clerkship before you join your lab. But keep in mind that you do lab rotations before and after the 1st and 2nd years and you are limited in the number of rotations you can do if you want to graduate on time. So having clerkships might help you decide between a few labs through which you have already rotated, if anything. For the most part you will have already selected those labs for rotation without the benefit of any insights from clerkship.

 

[meowkat444]

MD/PhD in New Haven with a 2.5 year pre grad school curriculum... I wonder where you go to school... 😉

Could i bother you for some questions via PM? I really enjoyed interviewing there and would like some real talk.

ha, didn't realize that my sidebar thingy says new haven. but yeah, pm away. i like the program, and i'm a few years in so hopefully i can give somewhat informed answers.

 

[Codaster]

Vandy also offers an opportunity to do clerkships before PHD beginning with their curriculum 2.0. They also do some "continuing clinical care" (something like this, not the exact title) activities where you're able to do clerkships DURING the PHD. They aren't very diverse yet -- I think you can either do peds or IM -- but they let you stay involved. The primary purpose of these is to have PHD students not forget how to do a write up or a physical exam.

 

[OddNath]

So, just to put it out there, at UT-Houston we do our entire MS3 year (and finish Step 3) prior to the lab years. I personally loved this approach-- I got to do MS3 with my classmates right after Step 1. Then, during lab, we continue going to clinic/Grand Rounds, so by the end of the PhD years, those attendings know us super well (making for great letters). The first month of MS4 is rough, especially the first week, but it comes back pretty quickly. I just made sure to do a random elective that July instead of a sub-I, but actually ended up getting a letter from that July month as well.

There's certainly many different ways to solve the problem of splitting up med school, and not really any one right or wrong answer 🙂

 

[Neuronix]

There's certainly many different ways to solve the problem of splitting up med school, and not really any one right or wrong answer 🙂

There are indeed pros and cons to any approach, but I think that doing MS1-MS3 then PhD is probably the best way to do a combined program. Yet, I think most PDs are too uncomfortable with that approach. There's a lot of fear that if a student is that close to finishing med school, that the student will be less likely to start the PhD program or finish their PhD program. Since MSTPs can't force repayment, the medical school would then only get one year of full tuition out of that student.

I wonder if UT-Houston just accepts the increased risk of drop outs or if they have a repayment contract. I would suspect the latter.

 

[OddNath]

Interesting point, Neuronix- our last round of numbers have shown that the UT-H attrition rate is not higher than the national average, and we don't have a repayment contract. I guess we're kind of a case study in the MS1-MS3 model 🙂 If anything, by the middle of the slog of MS3, we're all looking forward to coming to lab! Dropping out of the program would mean having to start intern year sooner 🙂