what are 3rd year rotations like?

[theonlytycrane]

I realize that this is a very open-ended question, but I was just wondering what a typical day is like? Is there a lot to learn in a structured way or is it more about being proactive? What are your highlights?

Thanks!

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[alpinism]

Highly depends on the rotation. Also whether its inpatient vs. outpatient.

Either way aside from required conferences and lectures there isn't much structured learning beyond studying for the shelf. Some attendings may teach if they have the time but there aren't any hard and fast requirements.

 

[Gambler 101]

You learn how to exist in the hospital as a third year medical student. Then, you learn how to think like a doctor. The knowledge for Step 2 and shelf exams is something you learn in your "spare time".

 

[Ismet]

I realize that this is a very open-ended question, but I was just wondering what a typical day is like? Is there a lot to learn in a structured way or is it more about being proactive? What are your highlights?

Thanks!

As has been said, a "typical day" will vary by rotation and by institution. For instance, our pediatric rotation is 4 weeks of inpatient pediatrics and the day starts at 6am. Other places may have more outpatient peds in their peds rotation or their day may be structured differently.

All of our rotations had some form of dedicated didactics for us. Some were formal lectures at the medical school, some were small groups where we just went over cases, some were simulation sessions at our sim center. But that stuff is in no way the bulk of your learning, you have to be proactive and always be reading. First priority is reading about your patients, knowing about their diagnoses and management, which should in turn help you for your shelf exam. Also UWorld questions.

For a general inpatient day, you get in around 6 or 7am and pre-round on your patients. Check their morning labs, read any consult notes that were written since you left, talk to the nurse to find out if anything happened overnight, and go see and examine the patients. Then rounds with the attending, going to each patient room and presenting the patient to the team including the plan for the day. Rounds typically take all morning but again depends on where you are and the census. Then lunch, maybe some kind of conference/lecture (we always went to whatever lectures were given for the residents). Then the afternoon was for calling consults, admitting new patients, maybe some teaching, etc until signing out to the night team around 6 or 7pm. We had 1 afternoon of teaching each week with a dedicated teaching attending, we would just go through a case someone had and then pick out learning points.

Outpatient is just outpatient. Almost always the attending would have us go in first and do the visit then present to them, unless they were super busy or backed up and then we would see the patients together. Good hours.

Surgery - usually have to get in really early because OR cases start early and the residents round on the patients before cases start. I had to be in around 4:30am to help update the patient list and then go see post-op patients. Then I went to the OR all day. Depending on the case and how many residents were there, I either scrubbed in and assisted or grabbed a stool and observed. Hours depend on what service you're on.

 

[DrDarce]

As has been said, a "typical day" will vary by rotation and by institution. For instance, our pediatric rotation is 4 weeks of inpatient pediatrics and the day starts at 6am. Other places may have more outpatient peds in their peds rotation or their day may be structured differently.

All of our rotations had some form of dedicated didactics for us. Some were formal lectures at the medical school, some were small groups where we just went over cases, some were simulation sessions at our sim center. But that stuff is in no way the bulk of your learning, you have to be proactive and always be reading. First priority is reading about your patients, knowing about their diagnoses and management, which should in turn help you for your shelf exam. Also UWorld questions.

For a general inpatient day, you get in around 6 or 7am and pre-round on your patients. Check their morning labs, read any consult notes that were written since you left, talk to the nurse to find out if anything happened overnight, and go see and examine the patients. Then rounds with the attending, going to each patient room and presenting the patient to the team including the plan for the day. Rounds typically take all morning but again depends on where you are and the census. Then lunch, maybe some kind of conference/lecture (we always went to whatever lectures were given for the residents). Then the afternoon was for calling consults, admitting new patients, maybe some teaching, etc until signing out to the night team around 6 or 7pm. We had 1 afternoon of teaching each week with a dedicated teaching attending, we would just go through a case someone had and then pick out learning points.

Outpatient is just outpatient. Almost always the attending would have us go in first and do the visit then present to them, unless they were super busy or backed up and then we would see the patients together. Good hours.

Surgery - usually have to get in really early because OR cases start early and the residents round on the patients before cases start. I had to be in around 4:30am to help update the patient list and then go see post-op patients. Then I went to the OR all day. Depending on the case and how many residents were there, I either scrubbed in and assisted or grabbed a stool and observed. Hours depend on what service you're on.

That actually sounds like fun though a little tiring. I'm an MS1, do you like it better than the preclinical years?

 

[Ismet]

That actually sounds like fun though a little tiring. I'm an MS1, do you like it better than the preclinical years?

I certainly did. I did miss having more free time and making my own schedule, in 3rd year your schedule isn't your own, some rotations you work 6 days per week and the way the weekend works you might work 7 days in a row (sunday to saturday, off following sunday). And there's no end to the amount of stuff you can learn, as opposed to MS1/MS2 where if you know what's in the lectures you're pretty much set for the exam. But it's pretty cool applying your knowledge to actual patient care, and then seeing how you progress throughout 3rd year.

 

[theonlytycrane]

thanks for the thoughtful post @Ismet It sounds like there is a lot of interaction with members of the healthcare team from nurses to attendings. It also sounds like long days! Is it typically 5 days a week?

 

[Ismet]

thanks for the thoughtful post @Ismet It sounds like there is a lot of interaction with members of the healthcare team from nurses to attendings. It also sounds like long days! Is it typically 5 days a week?

Some rotations are 6 days per week.

 

[SasquatchEM]

Third year rotations are like being at a high school party where you have no friends and no one wants you there.

 

[Dekkard]

Third year rotations are like being at a high school party where you have no friends and no one wants you there.

This is incredible and so true

 

[NickNaylor]

That actually sounds like fun though a little tiring. I'm an MS1, do you like it better than the preclinical years?

It is fun initially, but the novelty quickly wears off. I would agree, though, that the clinical years are far better (if far busier and tiring) than the pre-clinical years. Residency is even better with a concomitant increase in business and fatigue.

 

[The Knife & Gun Club]

I recently overheard a 3rd year telling a group of shadowing pre-med students how most of his rotations 3rd year were based on five to six 16 hour shifts per week.

Just curious, is that the norm in terms of hours spent in the hospital? I'd be a little worried trying to work 80+ hours per week + study for shelf, read up on patients, etc.

Seems like that has to be an exageration given even interns are supposed to max out at 80.

 

[Señor S]

I'm an MS1, do you like it better than the preclinical years?

Speaking purely for myself, no. Certain elements of it are very cool (way better than anything from the first 2 years) but most of the time it just feels like a combination of your first few days at a new job + a blind date.

 

[Ismet]

I recently overheard a 3rd year telling a group of shadowing pre-med students how most of his rotations 3rd year were based on five to six 16 hour shifts per week.

Just curious, is that the norm in terms of hours spent in the hospital? I'd be a little worried trying to work 80+ hours per week + study for shelf, read up on patients, etc.

Seems like that has to be an exageration given even interns are supposed to max out at 80.

There's no official duty hours for medical students. My school's "rule" is that we should follow the same duty hours as the interns but no med student who is trying to get an honors eval is going to say "I've been here for 16 hours and 1 minute, I need my 8 hours off now!" Generally though, we often get sent home when most of the work is done for the day. But sometimes you get super unlucky and it's your turn to pick up a new admission that comes 5 minutes before sign out (I was always that unlucky one). Then you have to stay and admit the patient, do the H&P and write the note.

For inpatient rotations I was there for at least 10 hours per day, 6 days per week. Sometimes 12 and a couple times even 16. For surgery I was on a service with really long cases (I'm talking like 8 am to midnight cases) and I would often be there for 16 hours. But on my other service, I got in around 5 and usually left by 3 because cases didn't get scheduled that late.

I think the person you overheard was exaggerating but that's not to say those kinds of days/weeks don't happen. They do. It's just not happening all of 3rd year.

 

[Señor S]

I recently overheard a 3rd year telling a group of shadowing pre-med students how most of his rotations 3rd year were based on five to six 16 hour shifts per week.

Just curious, is that the norm in terms of hours spent in the hospital? I'd be a little worried trying to work 80+ hours per week + study for shelf, read up on patients, etc.

Seems like that has to be an exageration given even interns are supposed to max out at 80.

It's possible, but students do have a tendency to exaggerate. Also there can potentially be quite a lot of down time during third year so "in the hospital" might mean "in the hospital library doing UWorld." But work hour restrictions don't apply to medical students unless the school says that they do AFAIK.

 

[midwestm2]

How does anyone fit in anything else (research, being in student interest groups, volunteering) let alone the necessities like eating/showering/looking at SDN?

 

[Ismet]

How does anyone fit in anything else (research, being in student interest groups, volunteering) let alone the necessities like eating/showering/looking at SDN?

You do less. At least at my school, all of the club leadership is MS2. 3rd years don't have time and 4th years are busy applying/interviewing/vacationing.

You have time to shower. If you don't, you're doing something wrong.

Learn how to cook in bulk, make a couple recipes over the weekend and eat from that during the week.

You'll also have lighter rotations with more free time. Stuff like family medicine, psychiatry. I heard peds is pretty chill at some schools, for me it was pretty time intensive.

If you need to do research (we have required research) you can take dedicated research electives.

 

[The Knife & Gun Club]

There's no official duty hours for medical students. My school's "rule" is that we should follow the same duty hours as the interns but no med student who is trying to get an honors eval is going to say "I've been here for 16 hours and 1 minute, I need my 8 hours off now!" Generally though, we often get sent home when most of the work is done for the day. But sometimes you get super unlucky and it's your turn to pick up a new admission that comes 5 minutes before sign out (I was always that unlucky one). Then you have to stay and admit the patient, do the H&P and write the note.

For inpatient rotations I was there for at least 10 hours per day, 6 days per week. Sometimes 12 and a couple times even 16. For surgery I was on a service with really long cases (I'm talking like 8 am to midnight cases) and I would often be there for 16 hours. But on my other service, I got in around 5 and usually left by 3 because cases didn't get scheduled that late.

I think the person you overheard was exaggerating but that's not to say those kinds of days/weeks don't happen. They do. It's just not happening all of 3rd year.

Thanks for the reassurance! I'm sure if everyone else seems to be able to do it I will too.


Not meaning to hijack the thread but, if you could choose between a relatively nice private hospital vs a massive, sh*tshow, county hospital to do rotations at, which would you choose?

 

[Ismet]

Thanks for the reassurance! I'm sure if everyone else seems to be able to do it I will too.


Not meaning to hijack the thread but, if you could choose between a relatively nice private hospital vs a massive, sh*tshow, county hospital to do rotations at, which would you choose?

Both have their pros and cons. I had the opportunity to do both as well as one "in between" so that was great. If you have the chance to do both, take it.

Everyone here does 1 month of IM at the main tertiary hospital in the city. I saw a lot of "zebra" cases and turnover was fairly low because the sickest people get admitted there. Most of my patients had liver or GI diagnoses so I became relatively comfortable with those. Then we do 1 month at another hospital and mine was more of a community hospital where we saw mostly "bread and butter" medicine and there was a high turnover so I saw a lot of patients. I think to be well rounded it's good to have both.

I also did a more rural rotation so I got to see the types of patients that get managed there vs the ones that get transferred to the city.

 

[alpinism]

I recently overheard a 3rd year telling a group of shadowing pre-med students how most of his rotations 3rd year were based on five to six 16 hour shifts per week.

Just curious, is that the norm in terms of hours spent in the hospital? I'd be a little worried trying to work 80+ hours per week + study for shelf, read up on patients, etc.

Seems like that has to be an exageration given even interns are supposed to max out at 80.

Unless you're at a horribly malignant hospital the only rotation where you come close to 80 hrs per week is Surgery.
Most med schools average 12hrs x 6 days per week = 72 hrs per week.

Keep in mind that other rotations such as family medicine and psychiatry are usually around 40 to 50 hrs per week.

 

[SasquatchEM]

5 or 6 16 hour shifts? Umm no. Maybe for a couple weeks on OB, but overall this is a huge exaggeration.

 

[Akali]

That actually sounds like fun though a little tiring. I'm an MS1, do you like it better than the preclinical years?

It's usually very much so not fun and is very much so tiring, at least in my and my group's experiences. Inpatient rotations are such a pain for so many reasons. I only liked inpatient psych. And that's because I never had to preround/round on patients, started late (like 9), just got to sit around talking to patients about their feelings all day, and psych patients are interesting (I actually get a rush when dealing with patients going crazy on the ward), and residents/attendings were mostly chill. Outpatient is better imo. For one, don't have to wake seriously sick hospitalized pts up at the buttcrack of dawn everyday just to redundantly exam and ask the same questions the residents also already has/will do.

I would choose preclinical years over clinical years in a heartbeat. Why would I not want to instead be staying at home most days, studying in the comfort of my own home, and not really having to start studying for real until the week before the exam? Also don't have to deal with the interpersonal social nightmare that is being an MS3 on the team.