Doing Electives at Larger Sites

[Confluence]

I've applied to do electives at larger centres in cities like Vancouver and Toronto. I have heard some say that it is not great for med students to be at these larger sites where there are so many other leaners and residents because you don't get much interaction with your assigned preceptor. From those who have done electives at larger sites, what are your thoughts on this? Thanks!

[garlic]

Depends on which specialty and what your goals are (e.g. get a letter from a big-name staff vs. network with residents vs. have as much hands-on time in OR as possible). You are right, it is tough to stand out/do much, but going to the main hospitals gives you great opportunities to meet people who are on the committee or otherwise may have a say. If it is a competitive specialty, I personally would not go to a community hospital even if it means more consistent time with one or two staff - but again, that is just my preference/comfort level.

I've done some year 4 electives in both cities. General Surgery at VGH is as you described, many fellows and senior residents who take priority in OR. A lot of my work was doing consults with the R1 and ward management. Nonetheless an enjoyable rotation. The staff do take notice if you're an M3 vs M4, and you have to be proactive (no one will go out of their way to offer you a letter lol)

ID at SMH was quite good, a fair amount of face time with my assigned preceptor, though more interaction with the fellow. 

[Scorbix]

I did rotations in both Toronto and Vancouver in a surgical sub-specialty and certainly working in these larger centres can be challenging, particularly in the ORs, as you've already mentioned. Where your opportunities are greatest to stand out is 1) being helpful and eager during rounds in the morning, and helping out the residents whenever possible (without being an annoyance or a hinderance); and 2) showing your stuff in clinic. Most of my time with quite nationally "well-known" staff has come primarily from working with them in clinic without residents. This is your prime opportunity to show them you can take a history, do an appropriate physical exam, write strong notes, and communicate your history and physical exam appropriate and precisely. Knowing your surgical anatomy and being strong at procedures is what residency is for. Show staff that you're personable, hard-working, and just an all-around kind human being will, in my experience, get them approaching you with offers to write letters of reference than showing that you've memorized anatomy for xyz. Lastly, I will say that in my opinion, regardless of how much exposure to staff you get, going to a centre where you are seriously considering doing residency trumps all. Seeing how the hospital runs, how happy the residents are, what the service is like is very important.