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[schwasted589]

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My school decided to try unblocking 3rd year rotations and I'm trying to fill in gaps between my core rotations with electives. We still don't have the final schedule with final assignments but I was wondering what good "general" stuff people would recommend for someone interested in EM.

I was thinking Neuro (not a core at my school), radiology, pm&r, and maybe heme/onc. I would ultimately want to do critical care/ICU and anesthesiology but I'm guessing we can't do those until later 3rd year/possibly 4th year.

I don't know if that's a bad plan. And in the event that I get put in an elective first, which rotation would you recommend? I would like to do IM but I don't know if doing ANOTHER month of that would be overkill since we have 2 months already as part of our core.

 

[22031 Alum]

I'm not sure I get how your schedule works, but Neuro would be a good choice for the clinical exam experience. And if IM is an interest, there are enough subspecialties that you could do something different than you'll have in your core rotation. Same goes for surgical specialties.

 

[Kaustikos]

Radiology, nephrology, ICU, trauma, burns.
Basically, take electives that teach you how to properly decide if someone needs a consultant or admittance. Rads to help with imaging, nephro because you'll learn electrolytes, etc etc

 

[schwasted589]

I'm not sure I get how your schedule works, but Neuro would be a good choice for the clinical exam experience. And if IM is an interest, there are enough subspecialties that you could do something different than you'll have in your core rotation. Same goes for surgical specialties.

well for the site I'm rotating at, it's an unblocked schedule with Core rotations (2 months of IM, 1 month of peds, FM, obgyn, psych, surgery) spread out throughout a year. The months we aren't scheduled for a core, we do an elective. Those have to be from at least 1 surgical speciality, 1 "medicine" specialty, and 3 others from whichever we want.

I actually just found out my schedule today and I have IM at the end...is that going to be a huge problem with setting up auditions/taking step2?

 

[evilbooyaa]

well for the site I'm rotating at, it's an unblocked schedule with Core rotations (2 months of IM, 1 month of peds, FM, obgyn, psych, surgery) spread out throughout a year. The months we aren't scheduled for a core, we do an elective. Those have to be from at least 1 surgical speciality, 1 "medicine" specialty, and 3 others from whichever we want.

I'd go with either Trauma (so that you can go to every trauma that comes in) or SICU for surgical subspecialty (alternatively you could go ortho/NSG if there's a lot of trauma), either cardiology or nephro for IM specialty, then radiology for sure. Not sure about burns, but I was never interested in EM

I actually just found out my schedule today and I have IM at the end...is that going to be a huge problem with setting up auditions/taking step2?

Do you get time off between end of 3rd year and Step 2? If so, 2-4 weeks is likely enough (assuming you did decent on Step 1 (230+) and you've been doing decent on shelves (85 or higher)). If not (depends on when your 3rd year ends), it may cut into an audition month. When does your IM rotation end (and is it the absolute last rotation of 3rd year)? Could you slide IM up by 4 weeks and be on some easy elective that would let you study hard for Step 2 (assuming you get no free time off between MS3 and MS4)?

 

[Kaustikos]

I'd go with either Trauma (so that you can go to every trauma that comes in) or SICU for surgical subspecialty (alternatively you could go ortho/NSG if there's a lot of trauma), either cardiology or nephro for IM specialty, then radiology for sure. Not sure about burns, but I was never interested in EM

I can see your point about burns and maybe say just ICU/SICU, but burns did help me a lot learning about some of the things you'll see... especially winter months. Severe frost bite, burns from trying to light up trash bins, etc. I guess I had a good team/lucky week because I saw/learned a lot of acute management, too. My fellow was an amazing teacher and very helpful. But then I got to work with one of the attendings/directors and was like "God... what a douche". He's earned it, considering his accomplishments.

Do you get time off between end of 3rd year and Step 2? If so, 2-4 weeks is likely enough (assuming you did decent on Step 1 (230+) and you've been doing decent on shelves (85 or higher)). If not (depends on when your 3rd year ends), it may cut into an audition month. When does your IM rotation end (and is it the absolute last rotation of 3rd year)? Could you slide IM up by 4 weeks and be on some easy elective that would let you study hard for Step 2 (assuming you get no free time off between MS3 and MS4)?

IM helped me for step 2 ck only because most of it was IM. Then do some peds, OB/GYN (I don't know if it was like this for anyone else, but the revised Step 2 CK had a significant amount of OB/GYN). Peds was minimal. Surgery was trauma. But I honestly thought I was done with question stems "X yo female with vaginal bleeding".

 

[schwasted589]

I'd go with either Trauma (so that you can go to every trauma that comes in) or SICU for surgical subspecialty (alternatively you could go ortho/NSG if there's a lot of trauma), either cardiology or nephro for IM specialty, then radiology for sure. Not sure about burns, but I was never interested in EM



Do you get time off between end of 3rd year and Step 2? If so, 2-4 weeks is likely enough (assuming you did decent on Step 1 (230+) and you've been doing decent on shelves (85 or higher)). If not (depends on when your 3rd year ends), it may cut into an audition month. When does your IM rotation end (and is it the absolute last rotation of 3rd year)? Could you slide IM up by 4 weeks and be on some easy elective that would let you study hard for Step 2 (assuming you get no free time off between MS3 and MS4)?

We have no time off in between and my IM rotation (absolute last one of 3rd year, unfortunately) ends on June 24th. So I'd have to either 1) take the test by july 1 so I could start my audition 2) cut into my audition month by taking an easy elective so I could have 2-3 weeks to study for the test 3) just suck it up and take it the 1st week of whatever rotation I have. I'm not sure what the best option is. I've heard that EM doesn't really require audition rotations besides the 1-2 you should do at a learning hospital to get the SLOR...not sure if that's true.

I can see your point about burns and maybe say just ICU/SICU, but burns did help me a lot learning about some of the things you'll see... especially winter months. Severe frost bite, burns from trying to light up trash bins, etc. I guess I had a good team/lucky week because I saw/learned a lot of acute management, too. My fellow was an amazing teacher and very helpful. But then I got to work with one of the attendings/directors and was like "God... what a douche". He's earned it, considering his accomplishments.


IM helped me for step 2 ck only because most of it was IM. Then do some peds, OB/GYN (I don't know if it was like this for anyone else, but the revised Step 2 CK had a significant amount of OB/GYN). Peds was minimal. Surgery was trauma. But I honestly thought I was done with question stems "X yo female with vaginal bleeding".

Most of the older students at school that I talked to said that though it wasn't ideal, it may work out because by studying for the IM shelf, I'd be studying for step 2.

Another person proposed a trade with me where I'd have IM in the middle and then a few electives followed by Family med last. Not sure if that's worse or better...because I've heard FM is a lot of work at most places too...At this point, I guess it's choosing the lesser of the two evils.

 

[evilbooyaa]

Take the IM for FM trade in a heartbeat.

FM (at least at my school) was entirely clinic based, meaning 7(maybe)-5 or 6 tops, no weekends. Having a basis of the IM shelf before you go into FM is really smart. Infact, doing FM last is insanely smart. I studied the LEAST for my FM shelf and still scored the best on it by about 5 points (whatever that means).

In addition, while studying for IM is studying for like 70% of Step 2 CK, studying for FM IS pretty much like studying for Step 2 CK. If you had FM last and have been doing well on shelves, etc. you could theoretically be ready for Step 2 CK 1 week after the FM shelf. It'll be hard work for the 4 weeks of FM, but it's doable.

Alternatively, since you're going for EM (and feel like you only need one, maybe two rotations) you could take July off (or some easy rotation), murder Step 2 in July, then do your EM rotations in August (and maybe September) for SLORs. If you plan to do an away, sometimes their schedule isn't exactly on par with yours, which could lead to like a July 15th start date (giving you 3 weeks of studying before an EM away).

Honestly I'd focus on getting your SLOR writers ASAP so they're in on Sept. 15th, so if I were in your shoes (at least regarding 3rd-4th year transition), I'd trade IM for FM, study hard for the FM shelf (and Step 2 CK), Take CK before July 1st, then do EM rotation(s) as required.

I can see your point about burns and maybe say just ICU/SICU, but burns did help me a lot learning about some of the things you'll see... especially winter months. Severe frost bite, burns from trying to light up trash bins, etc. I guess I had a good team/lucky week because I saw/learned a lot of acute management, too. My fellow was an amazing teacher and very helpful. But then I got to work with one of the attendings/directors and was like "God... what a douche". He's earned it, considering his accomplishments.

Honestly if you feel like it helped for someone going into EM, then I would tell OP go for it. I just have 0 experience with either the ED or the burn unit.

 

[schwasted589]

Take the IM for FM trade in a heartbeat.

FM (at least at my school) was entirely clinic based, meaning 7(maybe)-5 or 6 tops, no weekends. Having a basis of the IM shelf before you go into FM is really smart. Infact, doing FM last is insanely smart. I studied the LEAST for my FM shelf and still scored the best on it by about 5 points (whatever that means).

In addition, while studying for IM is studying for like 70% of Step 2 CK, studying for FM IS pretty much like studying for Step 2 CK. If you had FM last and have been doing well on shelves, etc. you could theoretically be ready for Step 2 CK 1 week after the FM shelf. It'll be hard work for the 4 weeks of FM, but it's doable.

Alternatively, since you're going for EM (and feel like you only need one, maybe two rotations) you could take July off (or some easy rotation), murder Step 2 in July, then do your EM rotations in August (and maybe September) for SLORs. If you plan to do an away, sometimes their schedule isn't exactly on par with yours, which could lead to like a July 15th start date (giving you 3 weeks of studying before an EM away).

Honestly I'd focus on getting your SLOR writers ASAP so they're in on Sept. 15th, so if I were in your shoes (at least regarding 3rd-4th year transition), I'd trade IM for FM, study hard for the FM shelf (and Step 2 CK), Take CK before July 1st, then do EM rotation(s) as required.



Honestly if you feel like it helped for someone going into EM, then I would tell OP go for it. I just have 0 experience with either the ED or the burn unit.

thanks for the advice. yeah, i'm hoping that the trade goes through. *fingers crossed*

at the worst, I guess I'll just suck it up and do a chill rotation in july (probs radiology) and then do my away in August/Sept...with August being the main one so I can get my SLOR from there. I'm kinda clueless about this whole scheduling thing and our school is atrocious at giving any direction (woohoo DO schools) so I didn't even realize that I had to get my stuff turned in by sep 15th. That's gonna be a problem if EM requires 2 SLORS. :S

 

[Kaustikos]

Advice: don't take radiology lightly. I don't mean in terms of exams, but I'd recommend learning as much as possible from them.

 

[schwasted589]

Advice: don't take radiology lightly. I don't mean in terms of exams, but I'd recommend learning as much as possible from them.

Oh yeah<, I definitely don't want to blow it off. I just meant it's a lot lighter in terms of hours at the site I'm rotating at

 

[schwasted589]

Take the IM for FM trade in a heartbeat.

FM (at least at my school) was entirely clinic based, meaning 7(maybe)-5 or 6 tops, no weekends. Having a basis of the IM shelf before you go into FM is really smart. Infact, doing FM last is insanely smart. I studied the LEAST for my FM shelf and still scored the best on it by about 5 points (whatever that means).

In addition, while studying for IM is studying for like 70% of Step 2 CK, studying for FM IS pretty much like studying for Step 2 CK. If you had FM last and have been doing well on shelves, etc. you could theoretically be ready for Step 2 CK 1 week after the FM shelf. It'll be hard work for the 4 weeks of FM, but it's doable.

Alternatively, since you're going for EM (and feel like you only need one, maybe two rotations) you could take July off (or some easy rotation), murder Step 2 in July, then do your EM rotations in August (and maybe September) for SLORs. If you plan to do an away, sometimes their schedule isn't exactly on par with yours, which could lead to like a July 15th start date (giving you 3 weeks of studying before an EM away).

Honestly I'd focus on getting your SLOR writers ASAP so they're in on Sept. 15th, so if I were in your shoes (at least regarding 3rd-4th year transition), I'd trade IM for FM, study hard for the FM shelf (and Step 2 CK), Take CK before July 1st, then do EM rotation(s) as required.



Honestly if you feel like it helped for someone going into EM, then I would tell OP go for it. I just have 0 experience with either the ED or the burn unit.

Okay so I got the switch and am doing FM last and then Radiology before then. I was thinking of just studying and taking the test right after Radiology so I could get my score back earlier and have my aways scheduled. Is that really stupid? I've heard conflicting things about how necessary FM is for the step 2...

 

[evilbooyaa]

You could study for it during radiology and take it before FM if you're scoring well on practice exams. Otherwise, you could push it back to immediately after the FM shelf.

 

[DrYoda]

I don't know if that's a bad plan. And in the event that I get put in an elective first, which rotation would you recommend? I would like to do IM but I don't know if doing ANOTHER month of that would be overkill since we have 2 months already as part of our core.

The nice thing about EM is you can benefit from pretty much any rotation, as we deal with everything from the smallest babies to geriatrics, pregnant people and everything in between. As far a surgery goes: trauma/SICU would be the most "EM relevant" of those rotations by many peoples measures. however if you aren't at a big high volume trauma center it might not be that interesting. Another surgery rotation that is a little more off the beaten path but could be very helpful in a EM career down the road is plastics, we do a lot of lac closures in cosmetic areas.

Radiology is a great rotation for most specialties. Also probably the most reliably low hour rotation for studying (unless your school has a super cush rotation specific to it). But as another said don't blow it off, many students may not realize this by virtue of being in the ivory tower; but many small hospitals do NOT have 24 hour radiology coverage still. So when I moonlight at some of these smaller rural hospital (and the docs that work there permanently) get a plain film after 5 or 6 pm the medical decision making and documentation is based off our own interpretation (everywhere I've had experience with does have CT nighthawk coverage, but no plain films coverage. but getting competent at looking at CTs is important too).

As far as IM rotations go if you have a good cardiology service with an attending or fellow who is willing to go over EKG interpretations and what not I'd recommend that. Other good rotations are MICU if they let you do that as a third year (my school didn't), but i recommend it at some point during your schooling to get familiar with the ICU specific things that you will deal with during residency (vents. pressors, super sick patients).

Other rotations that could be useful for EM: Ortho (we do lots of splinting, reductions), anesthesia (kind of self explanatory) and ophthalmology (not that exciting usually, but we get lots of eye complaints and most people suck at eye exams). But like I said previously nearly everything is EM relevant to some degree, so if there's something that interests you no reason not to do it.

I've heard that EM doesn't really require audition rotations besides the 1-2 you should do at a learning hospital to get the SLOR...not sure if that's true.

While an away rotation is not a hard requirement to match at our program it does help your chances as long as you don't have any glaring personality flaws. Not that we penalize people for not rotating here but it's much easier to form an accurate opinion of someone over a month than over a few hour interview day and off a piece of paper. So if you really have an interest in specific programs I would recommend jumping the hoops to get an away rotations there and then be hard working and friendly/outgoing while you're there.

 

[schwasted589]

You could study for it during radiology and take it before FM if you're scoring well on practice exams. Otherwise, you could push it back to immediately after the FM shelf.

That was the new plan, unless taking it without completing FM would be detrimental to my score somehow.

The nice thing about EM is you can benefit from pretty much any rotation, as we deal with everything from the smallest babies to geriatrics, pregnant people and everything in between. As far a surgery goes: trauma/SICU would be the most "EM relevant" of those rotations by many peoples measures. however if you aren't at a big high volume trauma center it might not be that interesting. Another surgery rotation that is a little more off the beaten path but could be very helpful in a EM career down the road is plastics, we do a lot of lac closures in cosmetic areas.

Radiology is a great rotation for most specialties. Also probably the most reliably low hour rotation for studying (unless your school has a super cush rotation specific to it). But as another said don't blow it off, many students may not realize this by virtue of being in the ivory tower; but many small hospitals do NOT have 24 hour radiology coverage still. So when I moonlight at some of these smaller rural hospital (and the docs that work there permanently) get a plain film after 5 or 6 pm the medical decision making and documentation is based off our own interpretation (everywhere I've had experience with does have CT nighthawk coverage, but no plain films coverage. but getting competent at looking at CTs is important too).

As far as IM rotations go if you have a good cardiology service with an attending or fellow who is willing to go over EKG interpretations and what not I'd recommend that. Other good rotations are MICU if they let you do that as a third year (my school didn't), but i recommend it at some point during your schooling to get familiar with the ICU specific things that you will deal with during residency (vents. pressors, super sick patients).

Other rotations that could be useful for EM: Ortho (we do lots of splinting, reductions), anesthesia (kind of self explanatory) and ophthalmology (not that exciting usually, but we get lots of eye complaints and most people suck at eye exams). But like I said previously nearly everything is EM relevant to some degree, so if there's something that interests you no reason not to do it.


While an away rotation is not a hard requirement to match at our program it does help your chances as long as you don't have any glaring personality flaws. Not that we penalize people for not rotating here but it's much easier to form an accurate opinion of someone over a month than over a few hour interview day and off a piece of paper. So if you really have an interest in specific programs I would recommend jumping the hoops to get an away rotations there and then be hard working and friendly/outgoing while you're there.

Thank you for all the advice. As of now, I'm definitely interested in EM but I'm also considering peds (more ICU route) and posssssibly anesthesia. I know, I'm all over the place. So far I requested a cardiology rotation with an attending that came highly recommended, neurology with an attending that everyone also raved about, either Surgical critical care/Trauma Surg/ENT (depending on availability), anesthesiology (I've hard it's nearly impossible for 3rd years at our site to rotate with one...I don't know if that seems to be the general rule for anesthesia rotations or just is site specific), and radiology (for the "study" month). I was trying to decide between pulm CC or cardio and went with cardio because I could really use the help with that in general and I find it interesting.

I'm mostly interested in making sure I can do at least 1-2 aways so that I can get an SLOR. I like to think of myself as a fairly normal, amicable person so I'd be open to doing aways if that would help match. I've heard mixed opinions so I was kinda on the fence about that