Third year schedule and grading

[Frogger27]

My school got our third year schedules a couple of weeks ago and I have a couple of questions.

1. My cohort of students I am rotating with seem to be a lot of the top students in our class (all the students interested in surgical subspecialty students vs the FM crowd). Does this matter much in terms of how I will be perceived as a student? I have heard mixed things as in it will be harder to standout if all the med students are strong to it doesnt matter at all when it comes to third year since it is so subjective.

2. I am interesting in IM and my rotation is last. I have the option to switch it to my first rotation. Do you think this would be smart so that I can rule it in/out early, or should I do it closer to the end where I will have more rotations under my belt.

TLDR; Do I switch my rotations to have IM first and avoid all the gunners

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[Dr. Death]

I'd move your IM. Better first than last IMO but I'd rather have it somewhere between those options.

 

[curbsideconsult]

Can you move your IM rotation to somewhere in the middle?

If you're worried about looking badly compared to the gunners, you can make yourself stand out in other ways.

• Learn the names of as many nurses and staff as you can, especially the ones the attendings/residents talk to the most
• Employ a lot of small talk and just get to know people
• Have excellent bedside manner so the patients will rave about you to the physicians
• Try to be as helpful as you can, but if you can't be helpful, just stay very far out of the way
• Observe and let people talk

These tips/skills might seem silly, but believe me they go a long way in your evaluations. Even if you don't get top marks for medical knowledge, you can at least get the most points for professionalism, patient care, etc. etc.

 

[theonlytycrane]

sorry to hear about your rotating group- I was pretty worried about this as well (not in terms of gunners, but just rotating with a few odd balls that are not the most fun to be around).

I'm also an M2 (so I know nothing), but I've heard IM first can be challenging (but then I've also heard it makes you strong for the rest of the year). If you'd feel better with the group you'd be rotating with (if you switch) I'd consider it.

 

[Frogger27]

Yeah my main concern is rotating with all of the future AOA in my class lol. I know there is only so much you can control about 3rd year grades, but getting paired with a tougher crowd from the start is a little unnerving.

As for the IM rotation last, I am pretty certain I want to do it (like 90%).

 

[Keona]

You so compared on grades to other students in your cohort. If everyone else can act like an almost intern you would stand out as less than them. Honestly this rarely happens. I’m FM so personality and how you got along with patients and staff mattered a lot to us. Your knowledge and comparison of knowledge to peers was a grading component. For example is this student at the level you expect for current training level? However IM first is going to be tough. However it’ll make the rest of the shelves easier

 

[afib123]

Off topic but advice about rotations:

To be honest, I was also worried about my clinical evals and although I still have my sub-Is and surgery rotation left, I can pretty confidently say as long as you're not a jerk, what gets you good evals is saying smart things and working hard. How charismatic you are and how much residents like you will mean close to nothing because 1) very few times do your patient interactions and how well you build your relationships with them get noticed and 2) residents and attendings can't give you grades if you can't answer any questions on rounds about your patient, give some differential diagnoses and come up with plans.
Lot of the extroverted people in my class had that problem because they would become good friends with the residents, but end up with mediocre evals because they never put in the hard work. On the other hand, a shy introverted person like me did well b/c I worked hard and was well read.
So if the gunners in your group are super smart and personable, yeah that is an issue but that is rarely the case. No one knows everything when it comes to clinical medicine. If you have a patient with hyponatremia and you read everything there is about it before rounds, you will look good on rounds and you will inevitably get good evals. It's not like step 1 where there's unlimited amount of material to master. Each day there are limited topics and as long you read on those topics, you will get good grades.

 

[mistafab]

Team looks good, you look good.

That is the central tenant of 3rd year. That... and don’t be a douche.

A team full of stars should help you for evals. The shelf is up to you.

 

[longhaul3]

If your whole group behaves well and impresses the residents on service, everyone looks good. Evals are about 1) being a team player; 2) fund of knowledge; 3) not being a chore to be around and 4) creating as little work for others as possible. Even if you are outshone in your fund of knowledge, you have these other opportunities to earn the H.

Also, med school really starts with the clinical year. You may think you know who will be at the top of your class—and they probably think so too—but a LOT of pre-clinical gunners are completely lost at sea on the wards and turn into cringe-worthy trainwrecks because they have no social skills or situational awareness. In the end they may still match well because they crushed Step 1 and did well on shelf exams, but that doesn't come through to evaluators, and if you're just a normal person you can benefit from that.

In my clinical year I did IM first and thought it was the best decision I could have made for the reasons explained by others above. Also, a competent evaluator will judge you based on your performance in relation to what is expected for your level of training, so there will (should) be a lot of leeway for a newbie on the first rotation. Make sure to take advantage of that and impress with what you know best—the Step 1 stuff, which no one else will remember at all.

 

[Crayola227]

I could write more later maybe, but take it from a physician who was IM bound, advising was that you do NOT want IM first. No. No. Experience has only made me agree with that wisdom.

It's true that if it's last the expectations will be higher. But you will be better poised to meet them.

No one does well on medicine as their first block. It's too complex. You should cut your teeth on some other rotations before doing your desired specialty rotation, if you can. That's the advice in general for anything.

 

[Crayola227]

Yeah my main concern is rotating with all of the future AOA in my class lol. I know there is only so much you can control about 3rd year grades, but getting paired with a tougher crowd from the start is a little unnerving.

As for the IM rotation last, I am pretty certain I want to do it (like 90%).

No one can ever know if they want IM until they do it. This remains true at every step of IM training, including into attendinghood, lol. And even then.

That said, if you do it last and change your mind about IM, you should still be able to do something else. Just don't take the rest of your 3rd year for granted. I also somewhere have a post on how one interested in some sort of primary care field or generalist practice can plan a plan B (basically you can set up your app for peds, IM, FM, EM, neuro, psych) with not too much difficulty as far as planning for extracurriculars and LORs. The real issue is setting up 4th yr scheduling for the Match.

 

[3characterslong]

If your whole group behaves well and impresses the residents on service, everyone looks good.

This is such absolute bull****. I'm not endorsing cuthroat backstabbing but being compaired daily with a cohort 260s is obviously less-than-ideal.

Also, med school really starts with the clinical year...(a bunch of worthless stuff)...In the end they may still match well because they crushed Step 1

?????? Then who cares ?????
You can't just throw in "oh they might match well but...". There is no but. They win.

 

[Frogger27]

This is such absolute bull****. I'm not endorsing cuthroat backstabbing but being compaired daily with a cohort 260s is obviously less-than ideal

Yup this is my biggest worry and it’s making me not even care about the order of my rotations because I feel like I’ll have no chance of honoring any of them due to quality of students I’m rotating with. I’m trying to weigh the pros and cons of rotation order vs rotating with all of AOA.

And people have noted that just because people are top of the class preclinically does not mean they will be during clinical. I get that, but most of these people aren’t the socially inept nerds, but pretty sharp, normal people who are good Med students hoping for competitive specialties

 

[longhaul3]

This is such absolute bull****. I'm not endorsing cuthroat backstabbing but being compaired daily with a cohort 260s is obviously less-than-ideal.


?????? Then who cares ?????
You can't just throw in "oh they might match well but...". There is no but. They win.

Your knee jerked so hard to say something inflammatory that you missed the point. Since you seem rather passionate about your view that this is a zero-sum game, I will explain. You're not directly competing with your group for match results. You're competing for good evaluations at the margin. If you are a normal person and rotate with a group of socially inept, self-absorbed donkeys, your evaluators will not know or care how good their board scores are; your subjective evaluations will probably be better. They will be fine because they test well, and you will be fine because you have good evaluations (and hopefully reasonable exam scores).

Since they are all gunning for surgery and you are going into IM, it doesn't matter to you how they match. They don't "win" unless you later decide to go into ortho and they beat you out for your top programs.

 

[afib123]

Sdn likes to talk about socially inept gunners but I personally never met one. All the top students in my class end up shining on wards because the fund of knowledge from pre-clinical years is good allowing them to answer all the pimp questions. Most attendings are not looking to be best friends with you. They are evaluating you on your communication skills while presenting and fund of knowledge on pimp questions and proactiveness about reading on your patients and coming up with differentials.

Thinking about your concerns more, I would actually say if you think you are truly average and your fund of knowledge is average, don't rotate with the 260s. For example, someone like me, I am not the charismatic but I answer all the pimp questions and it does reflect well in my evals. I am not sure if the evals of the students rotating with me would get affected, but I think if I am answering everything and they don't answer a single questions, I would think it would. If you don't think you are prepared to work hard to look good on rounds, I would rotate with the other students like you.

I am not trying to say you can't do it, but just be prepared to work hard if you are going to rotate with the 260s that have a strong fund of knowledge to start with.

 

[Eyeronic]

My school got our third year schedules a couple of weeks ago and I have a couple of questions.

1. My cohort of students I am rotating with seem to be a lot of the top students in our class (all the students interested in surgical subspecialty students vs the FM crowd). Does this matter much in terms of how I will be perceived as a student? I have heard mixed things as in it will be harder to standout if all the med students are strong to it doesnt matter at all when it comes to third year since it is so subjective.

2. I am interesting in IM and my rotation is last. I have the option to switch it to my first rotation. Do you think this would be smart so that I can rule it in/out early, or should I do it closer to the end where I will have more rotations under my belt.

TLDR; Do I switch my rotations to have IM first and avoid all the gunners

Keep it as your last rotation. It's likely your best shot at nailing it and getting strong letters.

If in the end IM is not a good fit, you will have clues from your other rotations, trust me.
If in the end IM is the one for you, you will have clues from your other rotations, trust me.
If there's another specialty that's meant for you... You will figure that out.

There's considerable overlap in the rotations. Especially with rotations like OB-GYN, ER, etc. you'll figure out the way your brain works.

P.S. The perceived abilities of your classmates should have no influence on your decisions. There were quite a few students in my class after M1-M2 who wanted you to believe they were "Future AOA" and well... let's just say that appearances can be deceiving.

 

[ciestar]

How does your school evaluate you OP?
At my school, clinical knowledge is only a small part of the evaluation while clinical skills (hx taking, PE, bedside manner, teamwork, etc) makes up the bulk of it.

 

[Frogger27]

Thank you everyone for the replies. I understand this could come off as being neurotic, annoying, etc but it is a real concern of mine. I appreciate everyone giving real feedback

Sdn likes to talk about socially inept gunners but I personally never met one. All the top students in my class end up shining on wards because the fund of knowledge from pre-clinical years is good allowing them to answer all the pimp questions. Most attendings are not looking to be best friends with you. They are evaluating you on your communication skills while presenting and fund of knowledge on pimp questions and proactiveness about reading on your patients and coming up with differentials.

Thinking about your concerns more, I would actually say if you think you are truly average and your fund of knowledge is average, don't rotate with the 260s. For example, someone like me, I am not the charismatic but I answer all the pimp questions and it does reflect well in my evals. I am not sure if the evals of the students rotating with me would get affected, but I think if I am answering everything and they don't answer a single questions, I would think it would. If you don't think you are prepared to work hard to look good on rounds, I would rotate with the other students like you.

I am not trying to say you can't do it, but just be prepared to work hard if you are going to rotate with the 260s that have a strong fund of knowledge to start with.

I am an below average student when it comes to pre clinical grades (usually do about 3-5% below). It has nothing to do with hardwork/anything like that. I study a lot, it just seems a lot of my peers are more bright/better test takers than I am.

I am easy to get along with and a hardworking person. This is why I thought (and I have been told by residents, attendings, etc) that I will do well in third year. Compared to the average student in my class, I am confident in my abilities to stand out; however, I got put in a cohort where I feel like this will be much harder. This is not due to lack of confidence, but due to having self awareness.

How does your school evaluate you OP?
At my school, clinical knowledge is only a small part of the evaluation while clinical skills (hx taking, PE, bedside manner, teamwork, etc) makes up the bulk of it.

I have no idea- all I heard is it is subjective lol. I think evals are 50-60% of our grade

 

[afib123]

Thank you everyone for the replies. I understand this could come off as being neurotic, annoying, etc but it is a real concern of mine. I appreciate everyone giving real feedback



I am an below average student when it comes to pre clinical grades (usually do about 3-5% below). It has nothing to do with hardwork/anything like that. I study a lot, it just seems a lot of my peers are more bright/better test takers than I am.

I am easy to get along with and a hardworking person. This is why I thought (and I have been told by residents, attendings, etc) that I will do well in third year. Compared to the average student in my class, I am confident in my abilities to stand out; however, I got put in a cohort where I feel like this will be much harder. This is not due to lack of confidence, but due to having self awareness.




I have no idea- all I heard is it is subjective lol. I think evals are 50-60% of our grade

That is the thing I am trying to say. Easy to get along is pretty much majority of the people in third year than the rare jerks. To be honest, no one even cares about being socially awkward as long as you are smart and convey your thoughts. Few of the doctors I met this year are socially awkward.

If you are hardworking and willing to work hard (this translates to reading your patients conditions every night to answer pimp questions on them and look smart the next day on rounds, I don't anticipate there being a problem.

 

[libertyyne]

OP do you have an option to be in another cohort?
If the answer is no , stop worrying about it , it is out of your control . Sometimes life gives you a **** sandwich and you have to smile and eat it with a grin on your face.
Focus on things that are in your control.

 

[Frogger27]

OP do you have an option to be in another cohort?
If the answer is no , stop worrying about it , it is out of your control . Sometimes life gives you a **** sandwich and you have to smile and eat it with a grin on your face.
Focus on things that are in your control.

Yes I could switch, but it would be to a much less favorable rotation schedule.

I’m thinking of just eating that **** sanwich with a grin on my face, but wanted to hear some feedback on how much it truly matters the specific students you rotate with

 

[libertyyne]

Yes I could switch, but it would be to a much less favorable rotation schedule.

I’m thinking of just eating that **** sanwich with a grin on my face, but wanted to hear some feedback on how much it truly matters the specific students you rotate with

here is another thought. If you are gunning for something competitive. Maybe use this as fodder for improving and showing to yourself that you can compete with the best of them considering you will be up against these people come residency time.
And there is a possibility the next group will be just as top heavy.

 

[Newyawk]

It is common discussion among preclinical students that those who do superbly well during those years will likely not do well in the next 2 bc they must lack the social skills requisite. This is not true enough of the time for it to be a “rule” of any kind. I know people who succeeded in both, failed at both, and were somewhere in between.
My experience (n=1) also has led me to believe that top med schools have the pickings of students who do well academically and are almost always personable as well.

 

[bananafish94]

When I was starting M3 I noticed that in many of my rotations there were a lot of people who were notorious for being really smart and working really hard. Admittedly, I did have concerns that I was going to have difficulty standing out or that I was going to get “gunned.” But these fears turned out to be totally unfounded. I’ve really never had an issue with any of the students in any of my rotations and I haven’t had difficulty putting my best foot forward. What you have to remember is that this is a completely different skillset than pre-clinical/Step 1 is. As corny as it is, half the job is just showing up, being reliable and pleasant to work with, and putting forth a good faith effort. As for the questions and knowledge base, they’re generally not just quizzing you on random trivia that you need to be a genius to know, it’s a lot of stuff you can anticipate by reading around the patients and becoming familiar with the disease processes (e.g., what do you think we should do next? Explain why the patient has this finding, what medication is best, or asking about relevant anatomy during surgeries, etc.) I’ll echo that when the people around you are good, everyone looks better, even if you’re not the smartest person in the room by a mile. I was an average pre-clinical student and did a hair above average on Step 1 but I’ve managed to get a couple of Honors (top 10-20%) in M3 just doing what I described above.

As for having IM last, I don’t think it’s a huge issue. It’s probably ideal to have the thing you want to go into in the middle somewhere, but alas. IM isn’t huge on miscellaneous stuff like aways so you won’t be scrambling at the last second to arrange things if you finish M3 and confirm that you want to go into IM. I’m fact, you may even be at an advantage because if you realize you like something else you’ll have time to switch gears without a mad dash to the finish line!

 

[Frogger27]

When I was starting M3 I noticed that in many of my rotations there were a lot of people who were notorious for being really smart and working really hard. Admittedly, I did have concerns that I was going to have difficulty standing out or that I was going to get “gunned.” But these fears turned out to be totally unfounded. I’ve really never had an issue with any of the students in any of my rotations and I haven’t had difficulty putting my best foot forward. What you have to remember is that this is a completely different skillset than pre-clinical/Step 1 is. As corny as it is, half the job is just showing up, being reliable and pleasant to work with, and putting forth a good faith effort. As for the questions and knowledge base, they’re generally not just quizzing you on random trivia that you need to be a genius to know, it’s a lot of stuff you can anticipate by reading around the patients and becoming familiar with the disease processes (e.g., what do you think we should do next? Explain why the patient has this finding, what medication is best, or asking about relevant anatomy during surgeries, etc.) I’ll echo that when the people around you are good, everyone looks better, even if you’re not the smartest person in the room by a mile. I was an average pre-clinical student and did a hair above average on Step 1 but I’ve managed to get a couple of Honors (top 10-20%) in M3 just doing what I described above.

As for having IM last, I don’t think it’s a huge issue. It’s probably ideal to have the thing you want to go into in the middle somewhere, but alas. IM isn’t huge on miscellaneous stuff like aways so you won’t be scrambling at the last second to arrange things if you finish M3 and confirm that you want to go into IM. I’m fact, you may even be at an advantage because if you realize you like something else you’ll have time to switch gears without a mad dash to the finish line!

This was a great post, thank you!

 

[Treebeard]

I've been watching my classmates go ballistic over their rotation schedule all week (M2 here as well). I've come to the conclusion that it doesn't matter at all, if we just show up and work hard we will get the grades and match well.

 

[Newyawk]

I've been watching my classmates go ballistic over their rotation schedule all week (M2 here as well). I've come to the conclusion that it doesn't matter at all, if we just show up and work hard we will get the grades and match well.

It does matter in terms of expectations. My performance on my first rotation earned me an honors despite poorer performance whereas i high passed a later clerkship due to poorer performance. I also honored a later rotation due to good performance despite very high expectations.

 

[Treebeard]

It does matter in terms of expectations. My performance on my first rotation earned me an honors despite poorer performance whereas i high passed a later clerkship due to poorer performance. I also honored a later rotation due to good performance despite very high expectations.

This is pretty much the exact argument for why the order does NOT matter.

 

[watermelon master]

It does matter in terms of expectations. My performance on my first rotation earned me an honors despite poorer performance whereas i high passed a later clerkship due to poorer performance. I also honored a later rotation due to good performance despite very high expectations.

What does this even mean?

 

[Newyawk]

Maybe i wasnt clear. The earlier a rotation is the lower the expectations. Therefore, you get cut some slack for not being as great. The later in the year the less they will be forgiving of error. Hence you have to perform better to do well. Its not that difficult to understand.

 

[Treebeard]

Maybe i wasnt clear. The earlier a rotation is the lower the expectations. Therefore, you get cut some slack for not being as great. The later in the year the less they will be forgiving of error. Hence you have to perform better to do well. Its not that difficult to understand.

This is true regardless of which rotations you have when.

 

[Newyawk]

This is true regardless of which rotations you have when.

Of course. But then some may want to rearrange based on how confident they are about their skills atm.

 

[theonlytycrane]

@Newyawk which rotation has been the most challenging so far?

 

[Newyawk]

@Newyawk which rotation has been the most challenging so far?

Not sure how to respond. Different people thrive in different rotations. I high passed psych (usually an easy rotation) despite acing the shelf, while i honored others that are notoriously hard to honor as well. I just stunk at psych. Still, I didnt think it was difficult. Just didnt honor it.

 

[Lawpy]

Maybe i wasnt clear. The earlier a rotation is the lower the expectations. Therefore, you get cut some slack for not being as great. The later in the year the less they will be forgiving of error. Hence you have to perform better to do well. Its not that difficult to understand.

This is true regardless of which rotations you have when.

Of course. But then some may want to rearrange based on how confident they are about their skills atm.

So could front loading difficult rotations be a good idea? Especially with Step 1/preclinical knowledge still fresh in the mind. It could be easier to ace harder rotations at the start of the year, and by working really hard from the beginning, it would also be possible to crush through easier rotations with higher expectations in the end.

It'd be something of a nightmare to have a difficult rotation like surgery at the end of 3rd year.

 

[Newyawk]

So could front loading difficult rotations be a good idea? Especially with Step 1/preclinical knowledge still fresh in the mind. It could be easier to ace harder rotations at the start of the year, and by working really hard from the beginning, it would also be possible to crush through easier rotations with higher expectations in the end.

It'd be something of a nightmare to have a difficult rotation like surgery at the end of 3rd year.

Most people would say it doesnt make a difference. In my experience, i frontloaded and it worked out for me.
A major factor for many people is burning out. Most people i know were very much done with clerkships by the 4th quarter. I could not imagine starting medicine or surgery during that time.
If youre the type to hit the ground running, as i am, it may benefit you to frontload.

 

[bananafish94]

I could not imagine starting medicine or surgery during that time.

That’s me right now. It’s about as fun as you’d expect.