rotation scheduling + expectations

[mossyfiber12]

Hey guys,

I was wondering in which order should I schedule my rotations? I am 60% sure that I want to go into medicine over surgery. Is there a particular order I should do my clinical rotations so that I can make the best impression on my med/surg attending/resident.

Also, what exactly is it that M3s do during rotations? What are we really responsible for? I have often heard from 3rd year students that they were left to do paperwork for the better part of the day. Is that how it really is? Others often will talk about being aggressive and volunteer to do stuff? Is this true? I mean how am I supposed to know my boundaries when this is my first time around doing this?

I am quite confused so any help would be great appreciated 🙂

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[ucsfstudents]

In the long run, the order of your rotations is not that important. What IS important is that you work your butt off in order to get honors on your rotations. But here are some general tips passed down each year.

1. If you're planning to go into medicine, for example, then do your medicine rotation on your 3rd or 4th rotation. That way you will be well seasoned with a few rotations under your belt, but not tired and burned out (as you might be by your last rotation).

2. It is generally recommended to do your medicine rotation before surgery since the surgery exam has a lot of medicine related question.

3. MS3s do whatever the interns/residents expect them to do. For this information, talk to your intern/residents about what they expect from you, 4th year medical students, friends who completed the rotation, friends in residency, and attendings who have mentored you. Each specialty has their own of doing things and own culture. Some behaviors that is OK in medicine, is frowned upon in surgery. I'm sure other people will give you more details, and searching the SDN site will provide you will a lot more info.

Good luck!!!

 

[deuce924]

I am in the same boat as the OP except I prefer Surgery over Medicine. I feel as though I want to do Surgery early to make sure it is what I want to do instead of wait only to find out during my 3rd rotation that Surgery may not be for me. Any thoughts to this along with all of the OP's questions?

Mossyfiber, sorry if it seems i hijacked your thread.

 

[RB16]

I agree with ucsfstudents. Doing medicine before surgery will help you shine in surgery and do well on your surgery shelf exam.

 

[flipasta]

I'm a second year as well, and have been trying to accumulate information as far as scheduling is concerned. Here is what I've got (and what will be affecting how I schedule):

1. As has been mentioned before, IM before surgery because it'll make the surgery shelf easier (as well as the surgery experience)

2. Peds is busier in the winter. If you're interested in it, you may want to schedule it then. On the flip side, if you're not as interested in it, maybe you'd want to avoid that season.

3. Don't do the rotation(s) you're interested in at the end of your third year. Along with burnout, you will already be into the application process by the point and it may be better to get that experience before this.

4. Psych and Family generally (at least down here) tend to be more laid back, and will accommodate lifestyle situations (such as weddings, etc.) better than other specialties.

1 and 3 have been covered, but I thought I'd just continue to pass on what I've accumulated. And to add credence to my statements: this is just stuff that third and fourth years at my school have recommended, so its not just a second year talking out of his ass. 😉 Good luck bud.

 

[CaptainJack]

In the long run, the order of your rotations is not that important. What IS important is that you work your butt off in order to get honors on your rotations. But here are some general tips passed down each year.

1. If you're planning to go into medicine, for example, then do your medicine rotation on your 3rd or 4th rotation. That way you will be well seasoned with a few rotations under your belt, but not tired and burned out (as you might be by your last rotation).

2. It is generally recommended to do your medicine rotation before surgery since the surgery exam has a lot of medicine related question.

3. MS3s do whatever the interns/residents expect them to do. For this information, talk to your intern/residents about what they expect from you, 4th year medical students, friends who completed the rotation, friends in residency, and attendings who have mentored you. Each specialty has their own of doing things and own culture. Some behaviors that is OK in medicine, is frowned upon in surgery. I'm sure other people will give you more details, and searching the SDN site will provide you will a lot more info.

Good luck!!!

This is pretty good advice. It really doesn't matter as much as you would think, but it's nice to sort of optimize things if you get the chance.

In my opinion, you should try to do what you're most interested in as your second rotation. You'll still be fresh and excited and not burned out, but you'll have a little experience under your belt so you won't look like a total newb. The only time I'd really change this up is if you're interested in surgery. Ideally, I would do medicine and OB/GYN before surgery -- that way you get the medicine background that helps for the shelf and the opportunity to acclimate yourself to the OR with GYN cases. If you've been in the OR doing a ton of shadowing before, that's less important.

The other thing to keep in mind is that you should keep an open mind. You might be really surprised by what you like and what you don't, so your whole carefully crafted schedule may go completely out the window. Start every rotation with the mindset that this is what you want to do with the rest of your life and you won't get bitten in the butt when that turns out to actually be true! That said, if there is something that you are 100% positive that you don't want to do, I'd put it either first or last if you can.

And remember, you can honor any rotation in any spot, because expectations change as the year goes on. Nobody really expects you to be a rockstar right out of the gate in your first rotation.

Good luck!

 

[psipsina]

You have good answers to the rest of your question so I'll try to cover what a M3 does.

This ranges from shadowing to supervised independence to basically being an intern who can't write orders depending on 1) your attending/resident's teaching style 2) your competence 3) how busy the service is

In general on inpatient services you will come in early and see 1-5 (dependent on the above) patients that have been assigned to you. Your job is to know everything that happened since the last time your team visited that patient from flatulence to labs to consultations. To do this you will talk to and examine your patient, leaf through charts, look through labs and hunt down nurses. You will then write a SOAP formated note (look it up). Your residents will be following behind you (sometimes requiring a formal presentation of your patients, often not) writing their own notes and orders. Then you will all get together and present your patients to the attending who will pimp you/teach you and decide what the plan for your patients are. For the rest of your day your job is to make that plan happen which will involve alot of running about and alot of paperwork with the occasional cool procedure. If your team is admitting/on call you will also have to run to the ED and see new patients there and write H&Ps on them. If you are on a surgery service you will have to see all of your patients before 6-7am and then go to the OR, finishing the rest of the work once you are out.

I've had services where I basically follow my resident around and fetch them stuff and I've had services where I'm sent to pull out chest tubes/pacemaker lines etc by myself. Today I had the residents pager and was running around on my own for hours (with the ability to call for help if necessary while he was scrubbed in on a case).

There is a ton of paperwork but this isn't because they are punishing the medstudent, its because there is a ton of paperwork in medicine. The residents spend much of their day with paperwork too. Learning to fill out the paperwork is part of learning to be a physician.

 

[SouthernSurgeon]

Re: scheduling

I second the thought that the order really ends up not mattering much, but with a different rationale:

I think that what really ends up making/breaking the rotation is the people you are rotating with - are they gunners or are they easy-going? Are they pleasant to work with or make you want to scratch your eyes out?

And in reality you have very little way to know who will do what when so you can't predict who you will end up with. I got exactly the rotation schedule I wanted but spent half the year with the biggest gunners in my class. It was not fun.

The one thing I would advice in hindsight is that if you take the rotations you think you want to go into (medicine, surgery, whatever) in those "prime" blocks (usually 3rd, sometimes 2nd) - you will likely be with a bunch of other people who also want to go into that specialty. This increases the gunner percentile dramatically.