Question for current interns/residents: doing MS4 rotations before internship starts

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radioconum

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I am applying for IM internships starting June/July 2016. However, my last clinical rotation was in the Fall of 2014 (I took a research year afterwards) and I do not have any more required clinical rotations (as long as I do a certain number of research months, which I want to do anyway).

This means it could theoretically be about 1.5 years between my last IM rotation and the start of internship....which is scary to say the least given that I have forgotten almost everything from 3rd/4th year. If anyone has had a similar experience, how many months of inpatient medicine MS4 rotations should I think about doing in the Spring after residency interviews are done to get back into the swing of things before starting internship this summer? 1 general medicine-type rotation? 1 ICU rotation? 1 of each? I want to maximize vacation/relaxation and research time while also making sure I am ready for internship.

Thanks in advance!
 
You should not worry about this and enjoy the heck out of your fourth year. Nothing really prepares you for the slog of medicine intern year and doing an extra month in the ICU isn't necessarily going to change that.
 
Mistake. You will be slow, you will be put under the microscope, this will make you miserable at best and possibly terminated at worst.

Do a family medicine or psych rotation and rock it hard, just in case the match goes horribly wrong or you are terminated and have to switch. That should be laid back enough.

Do at least one ICU rotation, especially if you've never done one. In fact, you could just do one ICU and skip wards. If not ICU then do wards. If you can operate on the ICU floor, you'll be fine on the wards.

Fourth year rotations can supplement your specialty choice, they don't have to dovetail exactly. People doing EM did a radiology elective for example.

If you are going IM do an FM rotation anyway. You'll get some outpt experience (a weak spot for IM interns and IM in general) and be poised to rebuild your career should **** hit the fan.

TLDR:
Do an ICU preferably, maybe a wards instead.
Do an FM for outpt exposure & insurance against career disaster
If you need one more, do psych to further your insurance against career disaster
Don't take it easy and sit on your ass, med school does actually prepare you/matter for intern year start
 
I disagree with the general sense of panic @Crayola227 has with his/her advice. I do think it's a good idea to schedule at least one serious month (wards or ICU); however the odds of termination as a result of being rusty for a week are slim. I would advise against a meaningless FM/Psych month for that reason. Many residents have their first ICU experience as an intern and do just fine (though you might have already had one). I would argue that a good attitude and hard work go further than an extra rotation in adjusting to the intern learning curve.
My advice: Travel, spend time with friends and family, and schedule a single wards/ICU month.
 
FWIW, the last rotation I had prior to starting intern year that was even remotely clinical was an EM rotation in Feb. My sub I was in September. I started intern year with a full patient panel and did just fine.

So I think it's true that it's different strokes for different folks, but intern year frankly for me was hard. It required a lot of time, work, and an immense learning curve which basically had me exhausted by the end of the year. I was happy to have entered it destressed, healthy, and rejuvenated and have not regretted it in the slightest. I genuinely do not feel that having done any extra rotations to bolster my knowledge base would have been either effective or helpful and ultimately I learned the most when thrown into the thick of things thanks to amazing senior residents being there to guide me.
 
if you really want to do something, watch the onlinemeded intern content / watch indiana U basic ICU lectures on youtube.

i'd recommend doing nothing though. just relax. you will be stressed regardless intern year
 
This person is describing a 1.5 year gap from clinical medicine.... unless they sign up for some rotations.

I just read another testimonial on these boards from someone who was let go after that long a break and then a return to training. Something about being slow.
http://forums.studentdoctor.net/thr...s-s-p-forced-to-resign-2nd-specialty.1169925/

I had a very slow 4th year as most do, and my co-intern had come off of like 3 subI in that last half of the year. Everyone remarked how much they looked like a rockstar, how efficient, fast, and how they got home to the family. Then there was me sitting next to them....

All I suggest is an ICU month if you've never done one, or a wards month to refresh. You've got the right idea run with it.

As far as total career implosion planning, while the rate of resident attrition is rather low, when it does happen that's when you see all the threads about SI around here.

Put into perspective, we put 1667 people on aspirin to take every single day for an entire year to prevent just 1 cardiovascular event, and in exchange get 1/3333 bleeds in return. Is it worth it? Sure when you figure how dangerous that CV event could be weighed against the bleed.
http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-attack-or-stroke/

Not being set up to fall back to FM, psych, or path, could be the end of your clinical career. It doesn't take much to become an SDN horror story. Just food for thought. Depends how scared you are about bad outcomes which will depend on your risk factors and what you think is reasonable as a precaution. I think everyone should set themselves up to match a second time and into FM or psych just in case you get cancer your last year and now comes the red flag of delayed grad and your app not making it past enough ERAS filters.

And it's totally fine for people to say this is overly alarmist. In medicine though we tend to at least consider all outcomes and management.
 
I am applying for IM internships starting June/July 2016. However, my last clinical rotation was in the Fall of 2014 (I took a research year afterwards) and I do not have any more required clinical rotations (as long as I do a certain number of research months, which I want to do anyway).

This means it could theoretically be about 1.5 years between my last IM rotation and the start of internship....which is scary to say the least given that I have forgotten almost everything from 3rd/4th year. If anyone has had a similar experience, how many months of inpatient medicine MS4 rotations should I think about doing in the Spring after residency interviews are done to get back into the swing of things before starting internship this summer? 1 general medicine-type rotation? 1 ICU rotation? 1 of each? I want to maximize vacation/relaxation and research time while also making sure I am ready for internship.

Thanks in advance!
I can relate to this. I did a research year after year 2 of med school. Coming back and trying to remember and apply the large volume of clinical knowledge plus learning new material was very difficult. It was doable because the expectation was that I was there to learn and because I spent a lot of time studying. I can't imagine trying to do that after 4th year. It is surprising how quickly ones forgets even the most basic knowledge. My advice would be so get back on the wards or icu.
It would be awful to be in the position of having the stress of being an intern plus having to relearn a bunch of basic knowledge. Put the work in now to avoid that. My 2 cents.
 
After 3rd year I did one year of b school. My first rotation back was my subI, which was annoying and difficult because, on the one hand the 3rd years who just took Step 1 were on top of the basic sciences stuff and on the other hand the interns were pretty much 2nd years by that point, so they were on top of internal medicine stuff.

However the difficulty came from the fact that my evaluations mattered for my residency applications. For intern year, however, it doesn't really matter. The evaluations you receive are primarily for your own improvement (while some people might be gunning for intern of the year/eventual chief, those are the folks for whom dunce caps are made).

As part of my convoluted MBA I spent my final five months of fourth year in b school and had no clinical experience whatsoever. My second rotation as an intern was ICU. It was totes fine.

Spending your final few months of freedom on an ICU/wards month would be helpful in getting back in the swing of things, but the cost/benefit isn't worth it. You will pick stuff up as an intern. Also, if you have applied reasonably and broadly for IM you shouldn't have to worry about fall backs, that's also a waste of your time.
 
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