What do you do M3, M4????

[TOMFighter]

Well, M1 and M2 is all the sciences, but what about M3, M4? What's the typical schedule like? Is there more or less studying involved??

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[Law2Doc]

Well, M1 and M2 is all the sciences, but what about M3, M4? What's the typical schedule like? Is there more or less studying involved??

In year 3 you generally have your core clerkships. These are usually IM, Surgery, OBGYN, Peds, Psych, and at most places FM and Neurology. Hours vary, but you may find yourself pulling 70-80 hour weeks in inpatient parts of IM, Surgery and OBGYN, and much more reasonable hours in the rest. IM, Surgery and OBGYN (and sometimes Peds or Psych) will also often have overnight calls, where you work 24-30 hours in a row, sometimes every 3rd or 4th day, which is something to get used to. Fortunately it's not usually for that many weeks in a row, so you only get a small flavor of what it must be like as a resident. You can expect to have to get up really early in third year. In non-surgical things, you usually have rounds around 7ish, so you will need to preround on your patients before that. In surgery it's not uncommon for you to have to be there by 5-6am. And yes, there will still be studying involved, because all the core electives have a test (usually the NBME shelf exam) at the end which will play some role in your grade (10-30%). And you will have topic presentations to make and will be pimped on topics you are supposed to read up on if you get things wrong. So I would plan on an hour or two a night of studying even after that 11-13 hour day. It's a lot of work, harder than the first two years, but most people think it's better as it's more "real life".

In year 4 you have elective rotations (note that some schools move some electives to 3rd year), and usually will take a couple of things you are most interested in early in the year (both to get good LORs and to help your decision). In fall and winter of 4th year you will be interviewing for residency positions, and in March you will hopefully match someplace. So the electives from, say, February, on won't count. At some point in the 3rd-4th year you also have to take the two parts of step 2 (one of which will involve travel for most). Hope this helps.

 

[MrBurns10]

I agree with everything L2D said and will add that some rotations have significant downtime during the day (in pieces) and if you use that time wisely and always read when there's nothing else to do, that means less time you'll have to spend studying when you get home. I always thought I'd be running all over the place every minute I was in the hospital and that's usually not how it works.

 

[DoctorPardi]

In year 3 you generally have your core clerkships. These are usually IM, Surgery, OBGYN, Peds, Psych, and at most places FM and Neurology. Hours vary, but you may find yourself pulling 70-80 hour weeks in inpatient parts of IM, Surgery and OBGYN, and much more reasonable hours in the rest. IM, Surgery and OBGYN (and sometimes Peds or Psych) will also often have overnight calls, where you work 24-30 hours in a row, sometimes every 3rd or 4th day, which is something to get used to. Fortunately it's not usually for that many weeks in a row, so you only get a small flavor of what it must be like as a resident. You can expect to have to get up really early in third year. In non-surgical things, you usually have rounds around 7ish, so you will need to preround on your patients before that. In surgery it's not uncommon for you to have to be there by 5-6am. And yes, there will still be studying involved, because all the core electives have a test (usually the NBME shelf exam) at the end which will play some role in your grade (10-30%). And you will have topic presentations to make and will be pimped on topics you are supposed to read up on if you get things wrong. So I would plan on an hour or two a night of studying even after that 11-13 hour day. It's a lot of work, harder than the first two years, but most people think it's better as it's more "real life".

In year 4 you have elective rotations (note that some schools move some electives to 3rd year), and usually will take a couple of things you are most interested in early in the year (both to get good LORs and to help your decision). In fall and winter of 4th year you will be interviewing for residency positions, and in March you will hopefully match someplace. So the electives from, say, February, on won't count. At some point in the 3rd-4th year you also have to take the two parts of step 2 (one of which will involve travel for most). Hope this helps.

Nice description L2D, while I had a good idea of what 3rd and 4th year will be like, this sums it up nicely.

 

[TOMFighter]

In year 3 you generally have your core clerkships. These are usually IM, Surgery, OBGYN, Peds, Psych, and at most places FM and Neurology. Hours vary, but you may find yourself pulling 70-80 hour weeks in inpatient parts of IM, Surgery and OBGYN, and much more reasonable hours in the rest. IM, Surgery and OBGYN (and sometimes Peds or Psych) will also often have overnight calls, where you work 24-30 hours in a row, sometimes every 3rd or 4th day, which is something to get used to. Fortunately it's not usually for that many weeks in a row, so you only get a small flavor of what it must be like as a resident. You can expect to have to get up really early in third year. In non-surgical things, you usually have rounds around 7ish, so you will need to preround on your patients before that. In surgery it's not uncommon for you to have to be there by 5-6am. And yes, there will still be studying involved, because all the core electives have a test (usually the NBME shelf exam) at the end which will play some role in your grade (10-30%). And you will have topic presentations to make and will be pimped on topics you are supposed to read up on if you get things wrong. So I would plan on an hour or two a night of studying even after that 11-13 hour day. It's a lot of work, harder than the first two years, but most people think it's better as it's more "real life".

In year 4 you have elective rotations (note that some schools move some electives to 3rd year), and usually will take a couple of things you are most interested in early in the year (both to get good LORs and to help your decision). In fall and winter of 4th year you will be interviewing for residency positions, and in March you will hopefully match someplace. So the electives from, say, February, on won't count. At some point in the 3rd-4th year you also have to take the two parts of step 2 (one of which will involve travel for most). Hope this helps.

Thanks for the thorough response.

Hmmm, I see. What sort of material do you study? Does this material have a link to the basic sciences of M1/M2?

For example, if you're in IM, do you review microbio-type stuff and pharm stuff?

What about surgery? OBGYN? Peds?

Or is it more of how to examine a patient properly-type stuff??

 

[Hole Dweller]

Thanks for the thorough response.

Hmmm, I see. What sort of material do you study? Does this material have a link to the basic sciences of M1/M2?

For example, if you're in IM, do you review microbio-type stuff and pharm stuff?

What about surgery? OBGYN? Peds?

Or is it more of how to examine a patient properly-type stuff??

The material in M3/M4 definitely has a link to the basic sciences, especially pathology/micro/physiology. But in addition, exams start to focus on differentials, diagnosis, and management, and attendings and residents are looking for students to apply their basic science knowledge to the clinical realm. Typically, you review what your patient presents with. For example, if your patient has a CHF exacerbation, you'll review relevant cardiovascular physiology, pathophys of CHF, relevant diagnostic criteria, and management strategy based on the patient's clinical presentation.

But the basic sciences learned in 1st + 2nd year remain at the core of what you'll do in the clinical years, so master them early. Hope this helps.

 

[vtucci]

The material in M3/M4 definitely has a link to the basic sciences, especially pathology/micro/physiology. But in addition, exams start to focus on differentials, diagnosis, and management, and attendings and residents are looking for students to apply their basic science knowledge to the clinical realm. Typically, you review what your patient presents with. For example, if your patient has a CHF exacerbation, you'll review relevant cardiovascular physiology, pathophys of CHF, relevant diagnostic criteria, and management strategy based on the patient's clinical presentation.

But the basic sciences learned in 1st + 2nd year remain at the core of what you'll do in the clinical years, so master them early. Hope this helps.

I do not entirely agree with this statement. The basic sciences applied in a clinical manner are important but not all basic sciences are created equal and not all schools teach the material in a way that translates well to the wards.

I can say that I rarely use biochemistry or cell bio. Regular anatomy also not so much except on surgery. Pathology (when combined with physical diagnosis)- highest yield of preclinical subjects followed by micro/immuno and pharm.

3rd and 4th year are about the intracacies of management and diagnosis. Regurgitating the mechanism of action of a drug is meaningless if you can;t put a group of symptoms together into a clinical syndrome and chose the appropriate meds.

 

[TheRealMD]

I do not entirely agree with this statement. The basic sciences applied in a clinical manner are important but not all basic sciences are created equal and not all schools teach the material in a way that translates well to the wards.

I can say that I rarely use biochemistry or cell bio. Regular anatomy also not so much except on surgery. Pathology (when combined with physical diagnosis)- highest yield of preclinical subjects followed by micro/immuno and pharm.

3rd and 4th year are about the intracacies of management and diagnosis. Regurgitating the mechanism of action of a drug is meaningless if you can;t put a group of symptoms together into a clinical syndrome and chose the appropriate meds.

So in other words, that first rotation is really tough eh?

 

[njbmd]

Moving to Clinical Rotations forum where issues related to MS-III and MS-IV are discussed.

 

[vtucci]

So in other words, that first rotation is really tough eh?

There is always anxiety associated with starting something new. Even the "Easiest" rotation of the year can seem a little daunting.

Here are some basic rules to third year:

1. Approach the first rotation (indeed every rotation) with a good attitude and strong work ethic.

2. Ask for feedback early and often from the attendings and residents.

3. Read as much as you can on your patients

 

[Law2Doc]

Thanks for the thorough response.

Hmmm, I see. What sort of material do you study? Does this material have a link to the basic sciences of M1/M2?

For example, if you're in IM, do you review microbio-type stuff and pharm stuff?

What about surgery? OBGYN? Peds?

Or is it more of how to examine a patient properly-type stuff??

As mentioned, the linkage to basic sciences will tend to be clinical and indirect. A lot of the material you focus on for the Step 1 exam will be fodder for pimping questions throughout the core rotations. Surgery is anatomy heavy. Medicine will be micro and pharm heavy. Psych will be pharm heavy. And so on. But you probably won't use the old books. Most people use up-to-date, e-medicine, or other online options for their daily "read up on the patient" knowledge. And there are lots of things like Case Files, Blueprints, Recall, Pre-Test, subject specific First Aid, etc which are geared toward the shelf exams which folks tend to rely on for each subject. If you can read a couple of those during each rotation, you probably have a decent foundation for the shelves.

 

[DrDre311]

As mentioned, the linkage to basic sciences will tend to be clinical and indirect. A lot of the material you focus on for the Step 1 exam will be fodder for pimping questions throughout the core rotations. Surgery is anatomy heavy. Medicine will be micro and pharm heavy. Psych will be pharm heavy. And so on. But you probably won't use the old books. Most people use up-to-date, e-medicine, or other online options for their daily "read up on the patient" knowledge. And there are lots of things like Case Files, Blueprints, Recall, Pre-Test, subject specific First Aid, etc which are geared toward the shelf exams which folks tend to rely on for each subject. If you can read a couple of those during each rotation, you probably have a decent foundation for the shelves.

The best shelf book ever is NMS Surgery. Questions in that book were invaluable. I would also recommend Surgical Recall before cases because it has common pimp questions in it, but it won't really help you with the shelf. A lot of people like CaseFiles, but I hated those books and never finished one--I favored First Aid for most of my rotations, and USMLEWorld has great practice questions (especially for internal medicine/OBGYN).