Electives planning

[StudentInMedicine]

Hey guys! Starting clerkship as a 3rd year student soon, and I had a few questions. Looking for advice from more experienced folks and also to just discuss with fellow students in the same boat. For context, I'm at McGill, where we are given 6 weeks of electives as a block in 3rd year.

1) I know what specialty I'm interested in, but I don't know whether I should save all 8 weeks for 4th year or do a few weeks in 3rd year. I got a little unlucky and will be starting my clerkship with all my 3rd year electives weeks right off the bat. I'm afraid I'll be a little too inexperienced at this stage, but I also want to show early interest. I'm also wondering whether it would put me at a disadvantage to do my specialty of choice so early just because, by the time we reach CaRMS in 4th year, I imagine a lot of the people I'll have worked with in early 3rd year would probably have forgotten about me.

2) Kind of connected to what I said above, when do you ask for LORs from the people you work with? Is it right after an elective, and they write it right then, even if CaRMS is like a year away? I feel like asking them for a letter a year letter is a little awkward, especially if they barely remember me. At the least, I imagine that would reduce the quality of the letter.

3) I have close to no clinical experience prior to clerkship because pretty much everything got cancelled due to COVID, and I was wondering what would be a good 2-week elective to start off with to get up to speed. I'm interested in neurology and IM. I want to check out GIM and ICU, but I think these might be too intense for someone who has no idea how a ward works or how to write an admission note. Would a subspecialty IM elective like cardiology or GI be more appropriate?

Thanks!

[shikimate]

1) starting your clerkship with electives puts you in a very difficult position because presumably you haven't had much exposure to the clinical side. On the flip side the sooner you do one in your specialty of choice, the sooner you can decide if it's right for you, and gain some experience in that specialty. I would advise doing perhaps 2 weeks in your specialty of choice at your home school to get a feel for it, and do more in 4th year.

2) clerkship is a big learning curve, and a lot of people struggle in the first half of it, but usually by the second half their performance is much better. I would advise against asking for LOR in the first half of clerkship unless it's your specialty of choice and you must, or you performed brilliantly, or you've worked with that person before. I would advise you to ask for LOR either near end of clerkship or during your 4th year electives. The best time is probably at end of rotation or whenever you are given your assessment. In person is probably the most effective.

3) I would consider rural family medicine, and be very keen during that time to get exposure to as much as possible in clinic, ER, hospital or whatever setting you can get your hands on. That way you get as much exposure to various patients as possible and learn general skills that can help with many rotations. I advise against starting clerkship on high octane subspecialty electives, because you don't even have the basics down yet. I remember the first day of clerkship, I didn't even know where I could find a consult form, and what they meant when they say don't forget to stamp it with the patient's card!

[Quark]

On 9/18/2020 at 7:47 PM, StudentInMedicine said:

1) I know what specialty I'm interested in, but I don't know whether I should save all 8 weeks for 4th year or do a few weeks in 3rd year. I got a little unlucky and will be starting my clerkship with all my 3rd year electives weeks right off the bat. I'm afraid I'll be a little too inexperienced at this stage, but I also want to show early interest. I'm also wondering whether it would put me at a disadvantage to do my specialty of choice so early just because, by the time we reach CaRMS in 4th year, I imagine a lot of the people I'll have worked with in early 3rd year would probably have forgotten about me.

2) Kind of connected to what I said above, when do you ask for LORs from the people you work with? Is it right after an elective, and they write it right then, even if CaRMS is like a year away? I feel like asking them for a letter a year letter is a little awkward, especially if they barely remember me. At the least, I imagine that would reduce the quality of the letter.

3) I have close to no clinical experience prior to clerkship because pretty much everything got cancelled due to COVID, and I was wondering what would be a good 2-week elective to start off with to get up to speed. I'm interested in neurology and IM. I want to check out GIM and ICU, but I think these might be too intense for someone who has no idea how a ward works or how to write an admission note. Would a subspecialty IM elective like cardiology or GI be more appropriate?

1) Agreed with the above comment. Would do maybe a 2 week elective in your third year to make yourself known to your home program and really decide whether or not you're committing to this specialty, but try to get most of your critical electives (i.e. the programs you really want to impress and want letters from) in the early part of 4th year. 

2) Yes, ask immediately before they forget you lol. I will actually provide a dissenting opinion here from Shikimate, above. Strongly disagree that clerks are automatically shit in the first half of the year and to not ask for letters... that is often simply not feasible & ill-advised. Good staff know to judge you by the level of your training, and the standards/expectations for a first month baby clerk are definitely not going to be the same as someone at the end of their clerkship. I got reference letters from my first two rotations and also some of my last few rotations; it truly does not make a difference unless you're performing significantly below average. 

3) IM CTU is a LOT but it's a good introduction to everything else. Neurology may be a good choice for a starting elective since it's also ward-based but definitely more chill than IM most of the time, although I realize that's your specialty of choice so you may not want to do it first; you could also consider a chill IM subspecialty like endo, rheum, ID, although that wouldn't give you the ward experience. 

[lolz3]

If you think you did well and it is a specialty you might end up applying to, then there is literally no downside to asking for a letter, no matter how early on. Worst thing is they say no and you feel bad for a bit. Getting a letter early means one less thing to necessarily worry about later on - what if you have a really off rotation during your electives or you go through something which impacts your ability to get enough reference letters? Having one in your back pocket can only be a good thing and it's ultimately up to you to decide which letters you want to use anyway.

Either way, if you're going to ask for a letter then ask for it right away and while they're still in front of you. You can get them to actually submit it to CaRMS way before your portal opens and that way you don't have to try and convince someone months later to remember you.