What's it like being MS3 and MS4? How are clinical rotations?

[giraffesuptop]

I've heard it's hell bc of the clinical rotations but I've also heard it described as a semi-vacation and easier than years 1 and 2.

How would any attendings/residents/current MS3 or MS4 describe it? Can you give as thorough an explanation of the schedule/workload/commitments/stress of years 3 and 4?

Please no opinions from premeds.

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[Cheetah13]

I've heard it's hell bc of the clinical rotations but I've also heard it described as a semi-vacation and easier than years 1 and 2.

How would any attendings/residents/current MS3 or MS4 describe it? Can you give as thorough an explanation of the schedule/workload/commitments/stress of years 3 and 4?

Please no opinions from premeds.

Lol at bolded
I would like to know the answer to this as well, esp. In terms of balancing a social life

 

[Elevencents]

Please no opinions from premeds.

And yet posts in pre-med forum. Nice one.

 

[KnuxNole]

I've heard it's hell bc of the clinical rotations but I've also heard it described as a semi-vacation and easier than years 1 and 2.

How would any attendings/residents/current MS3 or MS4 describe it? Can you give as thorough an explanation of the schedule/workload/commitments/stress of years 3 and 4?

Please no opinions from premeds.

MS3 varies by rotation. Some are notorious for long hours and waking up before the crack of dawn, such as OB/GYN and Surgery. 3rd year has for the most part, the same core rotations(Surgery, IM, OB/GYN, Peds, Psych, FM, Neurology) with shelf exams. The workload varies by rotation. Most of the cores have an inpatient portion as well as an outpatient portion. Clinic portions have easier hours, and you usually see patients before the attending/residents, present to them, and get feedback. The ward portions expect the med student to pre-round on patients they are following, then formal rounds, and doing admissions/going to OR/doing consults/assisting deliveries. Med students usually take call which can simply mean staying later, or staying overnight with the next day off. Also, weekends on occasion. Shelf exams are at the end of the rotation, and with daily reading, are manageable. Some can seem daunting(IM with the broad spectrum, OB with the bundles of new information) but if you start reading from the first day, it'll be all good.

MS4 is more or less the "semi vacation and easier than years 1 and 2". For the most part, it's electives with easier hours, no exams, no calls, and more laid back. Near the beginning, people like to do sub-intern rotations which can be brutal, but at the same time, a key way to get a strong LOR. There were several weeknights where I was able to go to happy hours after getting off work as an MS4 😛

 

[Aerus]

And yet posts in pre-med forum. Nice one.

If OP is a premed, even if their questions are addressed to residents or attendings, they MUST post in the pre-allo forum, unless there is a better, more relevant forum. For this question, there is not.

 

[KnuxNole]

I also want to know. Based on people's explanations, I have an image of it being like an advanced shadowing gig but there has to be way more to it than that, since you also have to take step 2 of the boards.

Yes, advanced in that it's taking you away from passive and more into active. Shadowing is a horrible way to learn for a 3rd/4th year rotation. Seeing patients on your own, formulation a differential/plan, organizing the information you gathered into a presentation, being involved in patient care, etc. etc. Watching a resident talk to patients for a month is boring as hell compared to seeing them yourself, presenting, and then seeing the patient together with an attending.

 

[giraffesuptop]

MS3 varies by rotation. Some are notorious for long hours and waking up before the crack of dawn, such as OB/GYN and Surgery. 3rd year has for the most part, the same core rotations(Surgery, IM, OB/GYN, Peds, Psych, FM, Neurology) with shelf exams. The workload varies by rotation. Most of the cores have an inpatient portion as well as an outpatient portion. Clinic portions have easier hours, and you usually see patients before the attending/residents, present to them, and get feedback. The ward portions expect the med student to pre-round on patients they are following, then formal rounds, and doing admissions/going to OR/doing consults/assisting deliveries. Med students usually take call which can simply mean staying later, or staying overnight with the next day off. Also, weekends on occasion. Shelf exams are at the end of the rotation, and with daily reading, are manageable. Some can seem daunting(IM with the broad spectrum, OB with the bundles of new information) but if you start reading from the first day, it'll be all good.

MS4 is more or less the "semi vacation and easier than years 1 and 2". For the most part, it's electives with easier hours, no exams, no calls, and more laid back. Near the beginning, people like to do sub-intern rotations which can be brutal, but at the same time, a key way to get a strong LOR. There were several weeknights where I was able to go to happy hours after getting off work as an MS4 😛

Thanks for that info. I never knew about shelf exams before. Are they basically final exams at the end of each clinical rotation? Are they written and do they include a practical aspect? Are the grades for each rotation based off of the evaluation of the attending physician, the shelf exam score, other assignments, or a combination of all those?

Do MS3's and MS4's assist/perform procedures on patients?

Is there a classroom component to years 3 and 4 similar to didactics in residency?

Are the MS4 electives just clinical rotations in specialties that weren't already performed in year 3?

And how does studying for Step 2 fit in to the busy rotations schedule?

 

[KnuxNole]

1) Yes. They are standardized multiple choice exams given at the end of the rotation. Grades are based on evaluations from attendings and shelf exams. The breakdown is variable by school, which at this point, just remember to do your best and try to do the best you can on the shelf. Some rotations have a observed clinical exam, where someone watches you take a patient history, do a physical exam for a grade. Some also have an oral exam, where a preceptor may ask you questions about a certain topic(ex: Third trimester vaginal bleeding. Differentials, workup, treatment). Those two can factor into the final grade as well.

2) Yes, MS3/MS4 assist in procedures. For minor procedures(suture, joint injections), an attending might let you do it under supervision. Surgery rotations, ICU rotations, and EM rotations give students a good opportunity with doing many procedures such as incising and draining abscesses, chest tubes, central lines. In the OR, you can assist in operations. Although everyone jokes that you are basically the retractor monkey, there are times where you can do a little more than that 😛

3) There are didactics. Usually there are lectures specifically for students, given by attendings, or senior residents. Students also go to Grand Rounds and other resident conferences too, depending on the site/program.

4) 4th year electives are usually specialties that weren't in 3rd year, sub-specialties of Surgery/IM, or extra rotations. I knew one girl wanted more OB rotations, and did that.

5) Studying for shelves = Step 2 prep. How does that fit into it? Well...there are two key times to read. At home, and during downtime on your rotation. There were countless times where I would read in the hospital while waiting for things to happen, and can come home and relax. And countless times where the day is busy with 0 downtime, and come home after a 12 hour day, take a quick break, buck up and do some reading. Basically, you have to make time, which is doable. However, it is distinctly different from the first half of med school where YOU control your time. Now, the rotation schedule controls your time.

 

[smarts1]

@KnuxNole, could you give a sample of a schedule during the day during a surgery rotation vs something like IM?

 

[obgyny]

MS3 is definitely not a semi-vacation, you have much less free time in 3rd year than MS1/MS2. 4th year is supposed to be another story.

The easier rotations are the outpatient rotations: the hours are typically 8-5, 5 days a week. You see the patients on your own and then present to a resident/attending.

The longest hours are typically on inpatient rotations: my worst one so far was a minimum of 12 hours a day, 6 days a week (though I often went over 12 hrs, sometimes up to 16) for 2 months straight (internal medicine). You'll pre-round and see the patients on your own early in the AM, then present to your team on rounds later in the AM. You'll then spent the rest of the day making sure things get done for all your patients, admitting new patients, in the OR, etc., depending on what rotation you're on. You might have to do night shifts or be on call. You fit in studying whenever you have downtime on rotation (which sometimes is a lot or none at all), or when you get home unfortunately.

On top of studying for shelf exams and your duties on rotation, you'll have assignments to do for your school, lectures to attend, and occasionally OSCE's for some of the rotations (in which they test your clinical skills with standardized patients). All of these things and of course evaluations from attendings and residents will make up your grade. There is a lot of BS in 3rd year.

As KnuxNole mentioned, shadowing is not a great way for us to learn at this stage, so there's not as much of it. It's a lot more hands-on, do-it-yourself kind of learning, which I really love doing.

As much as I miss the free time of preclinical years and am annoyed by all the BS comes with 3rd year, I do enjoy it 🙂.

 

[KnuxNole]

IM day:
6am - Wake up, shower, eat breakfast, and drive to hospital
7am - Pre rounding on 2-3 patients, which entails talking to the patient, doing a physical exam, writing a progress note, talking to my intern about my patients, helping the intern/senior with any work that needs to get done.
9am - Rounds with the attending. Walk around to each patient room, with extensive discussion about the patients. When he/she gets to my patient, I present the patient, with the intern adding extra info if needed, with the attending giving feedback, quizzing me on the condition.
12pm - Lunch
1pm - Helping out with floorwork, following up with labs/tests done on my patient. If there is an admission to the medical floor, I would go down to the ED to do the admission history and physical, work on the note, present to the resident and follow that patient throughout the hospital stay. If the floor is slow, I get some reading time in.
4pm - On certain days, there might be a lecture from an attending.
5-7pm - Residents let me go home.

Surgery Day:
4:30 - Wake up, hit snooze button, go back to sleep
4:40 - Wake up, moan, take shower, grab a granola bar and drive to hospital
5:15- Show up to hospital to pre-round. Same as above with IM, except notes are way quicker, and more patients to see.
6:30ish - Round with senior resident. Head to morning report.
7:30ish - Head to OR for first procedure of the day. Most standard gen surg procedures are around 2 hours give or take. Usually, on an OR day I scrubbed into 2 cases in the morning. Patients I was following got priority, same with other students. Pro tip: Never steal a case from another student!
12ish - Resident tells me to grab lunch. If I'm back in the OR, I grab some soup, then head back to OR. If I'm in the surg floors or clinic, I just have lunch with other students.
1ish - Branches into 3 segments:
OR afternoon: 1pm-whenever they tell me to go home(5-7pm). Scrub into more cases.
Floor afternoon: 1pm-whenever they tell me to go home(5-7pm) Help out with floor work, see a surgery consult
Clinic afternoon: 1pm-4-5pm. see surgery patients in the clinic.

 

[Wordead]

@KnuxNole, could you give a sample of a schedule during the day during a surgery rotation vs something like IM?

My IM schedule was the same as knux's.

My surgery rotation was a bit different:
7-8 am didactics
9-7 pm surgery all day continuously. No time for lunch.
1 day a week was clinic, a glorious 9-3 pm affair.

 

[smarts1]

Thanks for all of that! So then how exactly is a rotation split between in-patient and outpatient work? Like is it the first half, you do inpatient and then move to outpatient in the second half?

@Wordead... No Lunch!? Then do you eat snack in between?

 

[obgyny]

Yes. For example, at my school Peds is split: the first 3 weeks are outpatient, last 3 weeks are inpatient. Or they're sometimes separate rotations: inpatient medicine rotation is 8 weeks, ambulatory medicine (outpatient) is a separate 4 weeks, etc.

Oh, and I forgot all the notes you'll be writing in the clinical years: history & physicals, progress notes, discharge summaries... lots and lots of notes.

 

[EMDO2018]

This is good info. What do med students do in the OR? Do you first assist, retract, or just shadow from afar?

 

[No Limits]

Surgery Day:
4:30 - Wake up, hit snooze button, go back to sleep
4:40 - Wake up, moan, take shower, grab a granola bar and drive to hospital
5:15- Show up to hospital to pre-round. Same as above with IM, except notes are way quicker, and more patients to see.
6:30ish - Round with senior resident. Head to morning report.
7:30ish - Head to OR for first procedure of the day. Most standard gen surg procedures are around 2 hours give or take. Usually, on an OR day I scrubbed into 2 cases in the morning. Patients I was following got priority, same with other students. Pro tip: Never steal a case from another student!
12ish - Resident tells me to grab lunch. If I'm back in the OR, I grab some soup, then head back to OR. If I'm in the surg floors or clinic, I just have lunch with other students.
1ish - Branches into 3 segments:
OR afternoon: 1pm-whenever they tell me to go home(5-7pm). Scrub into more cases.
Floor afternoon: 1pm-whenever they tell me to go home(5-7pm) Help out with floor work, see a surgery consult
Clinic afternoon: 1pm-4-5pm. see surgery patients in the clinic.

@KnuxNole




So this is pretty accurate? lol

 

[alpinism]

You still have grand rounds, conferences, and lectures (aka didactics) every week in most rotations.

Some rotations also have quizzes, assignments, journal club, and med student case presentations.

 

[mauberley]

This is good info. What do med students do in the OR? Do you first assist, retract, or just shadow from afar?

Going to depend on your attending, and also the amount of interest you display. If you show a lot of interest or desire to do a lot in the OR, you'll get to do a lot more. If you don't, then you just basically do whatever you're told... retracting, suctioning, repositioning the lights, cutting sutures... although there's usually a minimum of what you're expected to do -- like assisting in prepping the patient (SCDs, Foley, positioning, shaving...) or in helping to close up (wound closure, staples).

 

[mauberley]

So let me see if I have this right. Grades are based on evaluations from attendings and shelf exams. You go to your rotations and at the end, they will tell you how you did, and that's half of your grade. The other half comes from doing the shelf exams, which are after every rotation. You study for them by reading a prep book whenever you have time? No classes to help prepare you or anything like that?

Generally, yes. No one really has a good handle on what the shelf exams will test you on, even though various faculty will take the exams to see what the general gist is going to be and try to pass on their experience on to you to guide your studies.

Theoretically, what you learn on rotations and in required lectures/conferences/whatever will help you prep for the shelf, but that may or may not have any bearing in reality.

The actual contributions of evaluations and shelf scores to your clerkship grades will vary by clerkship and by school. There will likely be other assignments you'll have to do that also contribute to your grade. However, it's very likely that everyone receives pretty much the same scores on those assignments, and also that your evaluations will be a crapshoot (depending on your draw of residents/attendings and whether they like you), so the only thing under your control is your shelf score.

 

[KnuxNole]

@KnuxNole




So this is pretty accurate? lol

Yes 😛

Part 2 works as well...except I've never had to eat lunch in the potty. Also, I totally watched Spongebob after being tired out from surgery 😀

 

[Wordead]

Thanks for all of that! So then how exactly is a rotation split between in-patient and outpatient work? Like is it the first half, you do inpatient and then move to outpatient in the second half?

@Wordead... No Lunch!? Then do you eat snack in between?

Yeah. Kept granola bars in my white coat, or just sucked it up sometimes. It will depend on your service; mine had 5 attendings that operated a lot and they expected you to be in the OR if someone was operating at all times. And I'm going into surgery, so I had to just suck it up and just chug along. Old school surgeons have no sympathy for being tired or hungry.

So let me see if I have this right. Grades are based on evaluations from attendings and shelf exams. You go to your rotations and at the end, they will tell you how you did, and that's half of your grade. The other half comes from doing the shelf exams, which are after every rotation. You study for them by reading a prep book whenever you have time? No classes to help prepare you or anything like that?

No. Study on your own time. It can be really, really tough to generate motivation after a full day, but that's life.

This is good info. What do med students do in the OR? Do you first assist, retract, or just shadow from afar?

Depends on your hospital. You'll probably get to do more at community hospitals (no residents or fellows). But it'll be harder to get in contact with people you need for residency if you apply to that field. So there's always a trade off.

 

[The Buff OP]

Please no opinions from premeds.

Well, as a pre-medical student who has seen all the seasons of Grey's Anatomy and Scrubs, I can say it's a dramatic and a funny life.