I'm an MS-1 as one of the new osteopathic schools, and as such have no upper classmen or anything to ask about this. So far, all I know is class work like anatomy, some physical diagnosis, biochem, etc. I know MS-3/4 are extremely time consuming, you do rotations in all the different fields, and a few other very general things about them.
What kind of educational experience are the clinical years? Are you expected to go buy books and just learn everything on your own? Is there any classroom instruction at all or is it all following around physicians and getting grilled with questions? Are you at the hospitals for the same amount of hours as a typical intern/resident? Do you actually interact with the patients themselves or are you not allowed to touch any of the fancy equipment? I have many similar, general questions but you get the idea of where I'm going with this.
If anyone could give me an overview or point me in the right direction with some links I'd be grateful. Thanks in advance.
Hi there,
This is a perfectly legit question, but I fear that some of my fellow posters may have been too vague in terms of answering. My guess is that you want some picture of what day-to-day life is like on the rotations. The truth is it varies a lot by rotation, but I've done 3 of the cores (OB/Gyn, Psych, and Medicine) so I will give you an idea of the breakdown based of course on my personal experience. Your mileage may vary, but I think they're pretty similar in most places.
OB/GYN
As you might have guessed, this is a divided rotation with 3 parts: OB, inpatient Gyn (Read: gyn surgery) and outpatient OB/Gyn.
Typical OB day:
Arrive at 5 am to pre-round on your postpartum patients (i.e. those whose deliveries/c-sections you scrubbed in on) ask like 5 questions to make sure they're ok, waking the poor women up at 5 am. You will write a note in the chart indicating that they are ok and any pertinent lab values. At 6:30 is board check-out where you and the other students divide up the laboring patients to follow. In between waiting for laboring women to deliver (you can't miss their deliveries/c-sections) you will periodically check on OB triage to assess and admit women who are in labor. Those that you admit will become your patients and if they deliver on your shift, you are expected to be there, and to follow them for their postpartum day the next morning. Basically you will do as described above until 5 pm, where you'll go through board check-out with the night team, who will take over. This takes about an hour, and you leave at 6 pm. At my school, you also do a week of night float team in which you have the reverse schedule, arriving at 5 pm and leaving at 6:30 am.
Typical Gyn Inpatient day:
You will arrive at 5:30 am and see all your post-op patients to make sure that they're doing ok. You will again write a note in the patient's chart, noting any pertinent lab values or imaging. Usually gyn notes (and ob notes) are very short and don't take long to write unless the pt. has a complication. After you pre-round (write all these notes on your patient), you go to rounds at 6:30 where the Gyn team with residents, interns, etc. rounds on ALL gyn patients (yours, those of other students, and those not assigned as student cases). Usually by 7:30 or 8 they divide up the surgeries between you and the other student(s), and the rest of the day is spent in the OR. If you scrub in on a patient's surgery, then you will follow her post-operatively, usually from 2-5 days. This means that you'll see the pt every morning and write a note as described above. Gyn surgeries are pretty straightforward: Hysterectomy, myomectomy, occasional gyn onc and incontinence surgeries (at 6 hrs a piece, yikes!) and of course D&C's, ovarian cyst removals, and other laparoscopic surgeries. These last patients sometimes go home the day of surgery, so lucky you you don't have to follow them or write notes! usually by 4 pm we were out of the OR and ready to go home for the day.
Typical OB/Gyn clinic day
Get to the clinic at 8 am, and see two kinds of patients. Gyn patients will be there for STD sx, pap smears, abnormal bleeding, etc. On these patients you usually do a speculum exam, bimanual exam, pap smear, and STD culture swabs. Now, a lot of people don't get as much experience as I did b/c my school sends you to the local jail to do outpatient gyn (i.e. pts don't really complain about med students doing this stuff...i even did an endometrial biopsy, with lots of guidance from the attending of course). The outpatient OB patients will be there for prenatal visits, in which you ask them a few basic questions to assess the baby's well-being, and then look for the baby's heartbeat with a special doppler. You also measure the height of the uterus to look for gestational size (roughly). Occasionally you may also assist on or even perform ultrasounds (with guidance of course). This is the easiest week of OB/Gyn, as you usually get out around 4 pm (after having arrived at 8).
Psych is usually also divided into inpatient and outpatient. I don't know much about outpatient psych since I by some fluke ended up with the whole thing being inpatient. So I can only talk about that aspect of it.
Typical inpatient psych day
Generally I arrived at 7:00-7:30 to pre-round on all the patients before the attending arrived at 9:00-9:30 (psych attendings have a sweet gig). Anyways, pre-rounds are very different here, they involve asking crazy people mostly schizophrenic and bipolar, some very specific questions. i.e. "any trouble with thoughts about wanting to hurt yourself or anyone else?" "do you see things other people can't see, hear things other people can't hear, or get any special messages from the television or radio?", and also typical mood questions: "Do you have trouble with feeling down or depressed a lot of the time? Feel anxious or nervous? Feel paranoid, as though people are out to get you?" In general, unless someone specifically complains about a physical symptom, you wont' do any sort of physical exam. Sometimes we did brief physicals on those patients that were new, although psych inpatients are rocks, and there is little turnover. You record the answers to these questions as thought content, thought process, mood, affect, etc. Also note compliance with medication, and copy the nursing report describing your patients' behavior overnight. You must be prepared for patients to refuse to speak with you, curse you out, develop delusions about you, insist that they are in love with you, etc. All of these happened to me at one point or another. Just speak with the attending and (s)he will decide whether you should ride it out (some people are like this to everyone) or drop the patient (if their behavior is wildly inappropriate or threatening). All in all, psych is interesting but bizarre. At 9 or 9:30 we would round with the resident and attending on all the patients, and we were usually ready to go by 12:30 pm. Some days we were just done at 12:30 and 3 days a week we had psych lectures until 4 or 5 pm. It just varies by school. Overall this rotation was my favorite so far.
Typical Internal Medicine (inpatient) day
I think that some schools have an outpatient component to their IM rotation, but the bulk of it is always inpatient. I think outpatient IM exposure is left to the family practice rotation (which is all outpatient) at most places. Anyways, IM day begins with prerounding between 6 and 7 depending on how many patients you're carrying. Unlike OB/Gyn notes or Psych notes, IM notes are not short. This is because you're now dealing with multiple organ systems, and IM inpatients generally have a million problems (COPD, HTN, DM, and CHF are almost givens, plus 2 or 3 other major issues that are unique to that particular patient). So it can take a good 45 minutes to see, examine, and write a note. This also includes writing down labs and imaging (and IM inpatients have TONS of labs and imaging studies), in addition to writing down the 20+ meds that the patient is currently on. At 8 am is morning report, a boring lecture on an esoteric topic that is usually over your head unless it's in an area of your specific interest (which hardly ever happens). Rarely, some pharm company will give you breakfast. At 9 or 10 the attending arrives and you round on all your team's patients. This usually takes 2-3 hours. On most IM teams there are 2-4 med students and you can sort of turn your mind off while the other students are presenting their patients, as in general the attending only talks to the student presenting that patient. At 12 pm there is another required boring talk that will be over your head. About 50% of the time someone will feed you lunch. At 1 pm you will report to your team and the resident and interns will inform you of what scut work needs to be done on your patients (i.e. calling hospitals for medical records, calling pt's family members to arrange placement, negotiating with insurance companies and clinics to arrange outpatient follow-up for the patient, etc.) Above all the name of the game is to do whatever it takes to get your pts discharged ASAP. Why? Because every fourth day your team will take call and admit all new medicine patients that are sent up from the ER or ICU. This is when you acquire new patients and perform full H&P's and workups, which takes 2-3 hrs per patient. You do NOT want to go into call with 4 patients, because you may end up with 6 or 7 and that's a nightmare. So the idea is to clear your slate every 3 days before call. Another lovely aspect of call is that it's 30 hrs. You arrive at 6 am on day 1 of call and leave at 12 pm on day 2. You get 2 'normal' days before you have to do it again. At most places you will get 1 day off per week on IM rotation. Overall the work isn't as intense as OB/Gyn but this schedule is really horrible. In addition, a lot of the patients are senior citizens with nowhere else to go, so once you've acutely stabilized them it's a lot of babysitting and social work, which can get frustrating. Overall, I find IM to be less stressful than OB/Gyn but definitely not as nice or interesting as psych.
There you have it, the day-to-day guide to 3 of the 7 core rotations! hopefully this will answer some of your questions (and hopefully it won't make you dread third year. lol)
Oh and you also have to take a shelf exam at the end of every rotation. This is a standardized test in that field written by the national board of medical examiners. At my school you get one day off to study for it, so you will need to study on your off time while you're working on that rotation. Kind of a bummer, but you will get good at making use of small 30 min-1 hr study times when there is downtime throughout the day. Obviously this gets more intense approaching the exam, but most people do fine. You've been hands-on exposed to the specialty by the time the exam rolls around, and also you only have to learn one thing at a time, as opposed to those crazy 'blocks' in MS1 and MS2 where you have tests in like five subjects in one week.
