What do you actually do on rotations?

[idahoruralDO]

I know that I reveal my ignorance here but I have looked all over and all I can find is vague allusions to what students actually do on rotations. Some make it sound suspiciously similar to shadowing. Is that true and if so what is the value of shadowing 100+ hours a week in some rotations? Is there much "hands-on" at all? Just a glimpse of the typical day or week in the life of a MS3 or MS4 would help me out a lot.

Thanks!

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[strv04]

well for medicine a typical day on an in-patient service consisted of

6:00am wake up
6:45am arrive at hospital and begin pre-rounding on your patients usually 2-3
9:00am Rounds with attending and entire team see between 8-15 patients
12:00pm-100pm Rounds end get lunch
1:00pm-5:00pm Write notes, do the occasional procedure, help interns/residents then go home

Every 4 days you are on long call and admit new patients until 7pm or so which means you eventually leave around 9-10pm
Every 4 days you are on short call and admit until 1pm which means you usually end up leaving as late as 7pm

Add in lectures at noon time for students or the occasional PBL session and you end up being quite busy

and you do this 6 days a week

also you should be reading a lot and doing lots of practice questions

 

[SouthernSurgeon]

Depends largely on the hospital and the rotation. I rotated the largest hospital in the country that gets cases from virtually everywhere so i got to see a lot of weird stuff and people with really complicated diseases; but at the price of doing rather few procedures. As an MS-3 a classmate boasted at me how cool it was that a resident asked her to do an ECG on a patient while I just get so annoyed at doing these tests as an intern when i'm busy.

My schedule was more like this:

7:30 Show up at the hospital classrooms for class
8:30-9 am: Present yourself with the attending you will shadow. You'll either do rounds or visit the consult and watch the doctor do consult while you fill out lab test forms for the patient, take vital signs (scutwork anyone?) and fetch for charts and things. The attending sometimes asks you questions or asks you to interpret tests.
In some rotations all you had to do was choose a hospitalized patient and practise doing clinical charts. You write the notes in a notebook and write school essays about the case and a personal interpretation of the case for grades at the end of the rotation.
12:00 More classes which typically end at around 3 pm and go home.

I rotated in two hospitals that had call, all students had to complete call 4 times. At one hospital the class lasted 12 hours starting at 8 am or 8 pm where call was once every two weeks and you actually had to do a lot of real work, much more similar to the things you do as an intern. At the other hospital call was only for 6 hours and you didn't really do much of anything (bit of a waste of time in my opinion).

A lot of students that go to public universities do rotations that are more similar to the functions of an intern with much more paperwork and real procedures. Plus they had call at least once a week. I never did call in private hospitals. My hospital is a good place for students to rotate in because they are exposed to interns which is what they will be in a few semesters. What better advice about getting a good internship than hearing the real lifestyle of the job instead of basing on urban legends of poor treatment and false information about how hotrrible actually having real work and hands on experience is like.

Doctors will tend to let students do more procedures if they do seem mildly interested in the field. However people generally just ignore the students. It's not exactly the coolest experience really. Being an intern is way cooler despite the crappy hours.

Readers should keep in mind that all of this is describing the typical experience of a medical student in Mexico and is very different from the typical experience of a US medical student.

 

[swamprat]

so for example, surgical rotation you basically shadow surgeries for 12+ hrs a day and have class thrown in there where you learn about surgical stuff? do you even get to suture? (lets say for example in the ED) lol

 

[ACSurgeon]

so for example, surgical rotation you basically shadow surgeries for 12+ hrs a day and have class thrown in there where you learn about surgical stuff? do you even get to suture? (lets say for example in the ED) lol

You're not really shadowing. You actually have responsibilities. Will patients die if you didn't exist? NO!. Do you (or can you) make your resident's life much easier (or harder) YES! Shadowing implies you are there to watch and you are typically ignored for the most part (and have great limits to what you are allowed access to and what you can do). Being a 3rd/4th year student means you "pretend" to be a resident but have a bigger safety net (ie your work is replicated or closely observed). In 3rd year you learn how to manage different medical conditions. You get asked "what do you think this is" and "what do you want to do about it." If you are correct, the team will follow your opinion. If not, you get to learn the right answer and hopefully remember it for the next time you have a similar case. When you are shadowing you hardly get put into this decision making capacity.

I didn't do surgery yet so I can't speak to it, but I did OB/GYN which has some surgery. As a third year you might end up making the first incision, suctioning, suturing, stapiling, and assisting with laproscopic tools. You also catch babies independently (while being watched, obviously). You might insert a foley or change a surgical bandage. These are things that no one gets to do (or should get to do) while shadowing.

 

[SouthernSurgeon]

so for example, surgical rotation you basically shadow surgeries for 12+ hrs a day and have class thrown in there where you learn about surgical stuff? do you even get to suture? (lets say for example in the ED) lol

On a typical surgery rotation at my school:

4:30-5:00 - Arrive, gather data and see patients ("pre-round")
6:00 - Round with surgical team. Present your patients to the chief resident, including all relevant data and esp your assessment/plan
7:30 - First case of the day

In addition to your early morning duties on rounds, students typically run to and from the floor throughout the day/in between cases and help the interns with floor work (procedures, dressing changes, consults, admissions, discharges)

After all the daily cases, you will round again with your chief (sometimes joined by the attendings), complete any additional work, and then go home. Typical days ended ~6pm. Longer if you had big cases.

In the OR, the student involvement varies a lot from case to case and from attending to attending. You might be 1st assisting on some cases, and just holding retractors on another.

On top of all this, we have didactic lectures 2-3 times per week, as well as clinic time and mandatory call. At my school, there is NO "shadowing" as a medical student. You are actively involved and the expectations of the attendings and residents are high.

 

[howelljolly]

so for example, surgical rotation you basically shadow surgeries for 12+ hrs a day and have class thrown in there where you learn about surgical stuff? do you even get to suture? (lets say for example in the ED) lol

Quit with the "shadowing" talk. As others have said, you have responsibilities. As a third year, you will retract, retract, retract, make the opening incision, cut, tie, snap, retract some more, operate one of the laparoscopic instruments (usually the camera), suction suction suction. At the end, the attending might step away and have you finish the suturing, or staple, then you apply the dressings, connect drains etc. Shadowing has nothing to do with it. The ED has nothing to do with it.

You dont have a class thrown in where you learn surgical stuff. You will have a daily lecture in one form or another (lecture, discussion, journal club, M&M, grand rounds, tumor board), where you will learn the pathophysiology of surgical disease - compartment syndrome, appendicitis, cholecystitis, diverticulitis... etc, or specific techniques like laparoscopy, or complications of a type of surgery. Basically, stuff that has nothing to do with the technical aspects of operating, but everything to do with surgery.
You learn surgical stuff by reading up on how the cases you'll be in are done. You'll watch and remember what you read. Things will start to make sense. You might be taught tiny little principles of operative technique - like pulling tissue straight up while cutting. You might be shouted at for doing something opposite of what the surgeon is doing by second nature.

On a surgical rotation you spend a lot of time managing the patient on the floor, before and after surgery. The OR time seems small in comparison.

Anyway. No shadowing, No nothing thrown in. No shadowing.

 

[J ROD]

it's hands on!!

more like an apprenticeship!!

 

[howelljolly]

it's hands on!!

more like an apprenticeship!!

What the hells the matter with you?

 

[swamprat]

You're not really shadowing. You actually have responsibilities. Will patients die if you didn't exist? NO!. Do you (or can you) make your resident's life much easier (or harder) YES! Shadowing implies you are there to watch and you are typically ignored for the most part (and have great limits to what you are allowed access to and what you can do). Being a 3rd/4th year student means you "pretend" to be a resident but have a bigger safety net (ie your work is replicated or closely observed). In 3rd year you learn how to manage different medical conditions. You get asked "what do you think this is" and "what do you want to do about it." If you are correct, the team will follow your opinion. If not, you get to learn the right answer and hopefully remember it for the next time you have a similar case. When you are shadowing you hardly get put into this decision making capacity.

I didn't do surgery yet so I can't speak to it, but I did OB/GYN which has some surgery. As a third year you might end up making the first incision, suctioning, suturing, stapiling, and assisting with laproscopic tools. You also catch babies independently (while being watched, obviously). You might insert a foley or change a surgical bandage. These are things that no one gets to do (or should get to do) while shadowing.

On a typical surgery rotation at my school:

4:30-5:00 - Arrive, gather data and see patients ("pre-round")
6:00 - Round with surgical team. Present your patients to the chief resident, including all relevant data and esp your assessment/plan
7:30 - First case of the day

In addition to your early morning duties on rounds, students typically run to and from the floor throughout the day/in between cases and help the interns with floor work (procedures, dressing changes, consults, admissions, discharges)

After all the daily cases, you will round again with your chief (sometimes joined by the attendings), complete any additional work, and then go home. Typical days ended ~6pm. Longer if you had big cases.

In the OR, the student involvement varies a lot from case to case and from attending to attending. You might be 1st assisting on some cases, and just holding retractors on another.

On top of all this, we have didactic lectures 2-3 times per week, as well as clinic time and mandatory call. At my school, there is NO "shadowing" as a medical student. You are actively involved and the expectations of the attendings and residents are high.

Quit with the "shadowing" talk. As others have said, you have responsibilities. As a third year, you will retract, retract, retract, make the opening incision, cut, tie, snap, retract some more, operate one of the laparoscopic instruments (usually the camera), suction suction suction. At the end, the attending might step away and have you finish the suturing, or staple, then you apply the dressings, connect drains etc. Shadowing has nothing to do with it. The ED has nothing to do with it.

You dont have a class thrown in where you learn surgical stuff. You will have a daily lecture in one form or another (lecture, discussion, journal club, M&M, grand rounds, tumor board), where you will learn the pathophysiology of surgical disease - compartment syndrome, appendicitis, cholecystitis, diverticulitis... etc, or specific techniques like laparoscopy, or complications of a type of surgery. Basically, stuff that has nothing to do with the technical aspects of operating, but everything to do with surgery.
You learn surgical stuff by reading up on how the cases you'll be in are done. You'll watch and remember what you read. Things will start to make sense. You might be taught tiny little principles of operative technique - like pulling tissue straight up while cutting. You might be shouted at for doing something opposite of what the surgeon is doing by second nature.

On a surgical rotation you spend a lot of time managing the patient on the floor, before and after surgery. The OR time seems small in comparison.

Anyway. No shadowing, No nothing thrown in. No shadowing.

thanks for all the input.. i can't even imagine being asked what is wrong with a particular patient... seems like so much you have to learn before you can even come close to that level 😱

 

[howelljolly]

thanks for all the input.. i can't even imagine being asked what is wrong with a particular patient... seems like so much you have to learn before you can even come close to that level 😱

um. yeah.