These are the types of questions you ask in your FM interviews/2nd looks, because rotations at *extremely* program dependent, attending dependent, and rotation dependent.
Typically non-FM clinic rotations will have residents see a patient in clinic and present to the attending/preceptor and then you go in together. Some may have you only see new-patients visits or old-patient-but-new-problem visits. I think most clinic-based rotations regardless of specialty run like this.
Hospital-based rotations depend on if you're opposed or unopposed by other residents. If you're opposed, there's typically division of labor. Some hospital-based services may have you cover certain patients or run a certain function (like cover the floor) while some services just tell you to shadow (yawn). Some services function like a consult service.
Hospital-based rotions at unopposed programs are highly variable also because it depends if you're talking about a Teaching service or a Private attending service.
Teaching services in the hospital typically will have you involved in every aspect of the patients' care from beginning to end with division of labor/supervision among the residents. That's because the patients belong to the residents, with the senior resident running the service, and with an attending usually serving as the "consultant" to the senior resident.
Private attending services in the hospital will depend on the attending and what the Programs explicitly (and implicitly) state are the goals of that rotation. Remember, here, the patients belong to the private attending. You may be involved in the initial H&P/consult and work up. You may be asked to follow this patient until discharge. You may write orders, you may not. You may simply follow along during rounds.
Just to give an example, at my program (Memorial Southwest in Houston) which is community-based/unopposed, we do:
-1 month of Gen Surg inpatient and outpatient (2 wks with 1 private, 2 wks with another),
-1 month of CV Surg
-1 month of Ortho (with 1 additional month of Sports Med)
-2 wks of Ambulatory Gen Surg
-2 wks of Breast Surg (basically Gen Surg)
-2 wks of Ophtho
-2 wks of ENT
-2 wks of Uro
-3 mos OB and 1 mo Gyn with OB/Gyn call average q7 half the year x-cover overnight call.
Ortho, Ambulatory Gen Surg , Breast, Optho, ENT, Uro are all outpatient-based with private attendings. The goal is to take home skills that you can use in your FM clinic as well as see what specialists do and what types of patients they like to manage.
During CV Surg & Gen Surg, we have 1 private attending who wants you to write inpatient notes, operate, and see clinic patients. The other private attendings want you only in the OR and clinic. In the OR, you get to the case early to intubate the patient and start central/arterial lines. You typically 1st/2nd assist the case. The surgeon will either move on to the next case leaving you to close under the supervision of the 1st assist, or you may be asked to break scrub and move on to the next case next door to intubate and start the central line. We don't take Trauma call or Surgery call on- or off-service.
On OB, you start by doing 1 month as an intern at an opposed county hospital working triage and doing low risk vaginal delivery (avg 25-30 SVD during the month). The rotation's pretty busy but cookie-cutter and intellectually mind-numbing. You'll be ready to come home after this rotation.
As a 2nd year resident, you come back to the home hospital. We run our own teaching service in the hospital which theoretically should be low-risk but often times they are trainwreck patients with no medical care. Under faculty supervision (no upper-levels or fellows), you work triage, you manage the labor, you deliver the baby, you do the C-section or 1st assist (whatever you prefer), you round postpartum, and follow them outpatient with the baby (if logistically possible).
On Gyn, you run the service, seeing patients in the ER and manage them on the floor. If you have a D&C, it's yours. If it's a scope or ex-lap, you 1st assist the attending. And then, you go to the attending's clinic during the daytime. You also have Colpo clinic during protected time.
On OB/Gyn call, you hold both the OB & Gyn pager and do the job of both of those people at night. Our OB/Gyn teaching service admits q1 24 hours a day, no cap, ball park 3-8 admits (range 0-15) per 12 hours not including those discharged directly from Triage or the ER. As a resident, however, you only take OB/Gyn call on a q7 basis 6-7 months out of the year (off-service residents, like the ones on sports med or geriatrics etc., pitch in overnight during the week). By mid-year, the call's a piece of cake to be honest. Nurses are strong and help a lot. We have 24 hour in house OB faculty. We also have 24 hour in house Neo; but some times, you may be resuscitating the baby until Neo code team gets there. Again, the nurses are strong.
Anyways, the level of responsibility vary a lot, if you ask around. Hopefully you'll pick a program that will give you a lot of responsibility. You've already spent your 3rd and 4th year hunched over books, bored off your butt. Why not get your hands dirty and put it all to work?
