3rd year med school

[Guest mamnrkr]

Hey guys,

 

I was wondering if any of the current people in med school could tell me what 3rd and 4th year are like at Dal?

 

I've heard all the horror stories about rotations and nasty residents and night calls and 36 hour work slots...

 

I was kinda hoping someone could tell me the real deal...

[Guest JewelLeigh]

I'm in 2nd year, so I cannot speak about clerkship from firsthand experience, but since the 3rd years are very busy and likely won't be able to reply for awhile, I'll tell ya what I know so far.

 

First, the basics:

 

3rd year

All students do mandatory rotations through all the major specialties. This includes:

- Obstetrics/Gynecology 6 weeks

- Pediatrics 6 weeks

- Surgery 9 weeks (3 weeks general surgery + two 3 week selectives within the surgical specialties)

- Emergency 3 weeks

- Family medicine 6 weeks

- Psychiatry 6 weeks

- Internal Medicine (4 weeks in the Medical Teaching unit, MTU, + two 4 week selectives within the medical specialties)

Rotations are often in Halifax, but also take place at other locations around the Maritimes. 1 of the two internal medicine selectives may take place at any academic centre in Canada.

 

4th year

Fall - 12 weeks for electives. These are rotations in any area of medicine desired, in any location desired (provided you have a licensed physician to supervise). Electives are preparation for residency, and as such, most students do their electives at the locations and in the area of medicine that they hope to do for residency.

Jan - for now there is 3 weeks or so off to fly around the country doing CaRMS interviews.

Feb-Apr - Continuing and Preventative Care - four 3 week rotations that must be more clinic/community-based than hospital-based. 1 of the rotations much be in Halifax and is called "Care of the Elderly." Also in Feb, find out residency program through CaRMS.

May - write licensing exam and graduate

July - begin residency

 

So, again, I have not yet experienced these rotations, so I can only say what I have been told by the upper year students going through it, and the administrators preparing my class for next year.

 

With respect to call:

My impression is that the maximum amount of call is 1 in 4. In other words, every 4th night, you're on call. This of course varies with the rotation you are on - family medicine may not have any call for example. When on call, it can be "in house" (you must be in the hospital or "home call" (you can go home but be ready to come in quickly). 36 hours shifts? Sounds unlikely I think. My understanding is that if you are on call 1 night, you are able to leave the next day by noon.

 

So suppose you're on call Thursday night. You work your regular day, say 8-5 (some specialties, surg for example, might begin earlier in the morning), begin call at 5pm, end call the next day at 8am, start your regular day again, but can leave by noon. So it seems like 27-29 hour shifts is the max? Again - current 3rd or 4th years will be able to comment on whether this "rule" is actually reality.

 

That being said, however, even when not on call, the days are long. A 3rd year friend of mine was in MTU (notorious for being one of the toughest rotations) told me that he got home at 6:30pm one day and that it was the earliest he had arrived home during that rotation. He likely started most mornings at 6:30 or 7am. So...while 36 hours shifts seem unlikely, 70+ hour weeks seem more than possible.

 

I am not certain how weekend day shifts work, but clerks definitely get them.

 

With respect to nasty residents:

While I am sure that the odd nasty (or really tired/grumpy from call) resident exists, my experience with residents during electives and other rotations we do in the hospital during 1st and 2nd year is that they are fantastic. Residents are fantastic teachers for several reasons - 1) They are still learning themselves, and thus understand the need for teaching those "below" themselves. 2) They are much closer to having been a clerk, thus they can remember what things were difficult and how they came to better understand them. I have found (and heard from others) that in a teaching centre, there truly is a spirit of teaching. The staff guy teaches the senior resident, the senior teaches the 3rd year resident, the 3rd year teaches the PGY1, the PGY1 teaches the clerks.... So, not sure where the "nasty residents" thing came from, and upper years can correct me if I'm wrong, but my impression is that residents are really awesome and understanding teachers.

 

To, to sum up my impression of what clerkship is like - lots and lots and lots of work resulting in lots and lots and lots of hands-on learning from generally fantastic teaching.

 

Hope that helps! (And hope that anyone with actual firsthand experience will correct me in anything I've said that's wrong!)

 

JL

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[Guest cassica]

Heya, its too bad you have heard horror stories about Dal's Clerkship. I am in my 3rd year now and it really isn't bad... I was scared out of my pants at first but if you are diligent in your work and eager to learn, they don't really expect that much more from you..of course knowledge of basic medicine is a plus.

 

I must admit that sometimes your hours are long. But I don't think I have ever worked 36 hours. The worst hours are in your surgery and Obstetrics blocks. My longest shift may have been 30 hours without sleeping. It may sound @#%$ but you learn alot, well I do, when you work up a patient at 2am. Plus you get the whole or part of next day off.

 

I feel that the residents have been awesome so far. With the exception of a few who didnt know anything, most residents are great at guiding you through the rotations. Just be sure to get to know them as people as well and ur rotation will go smoother. Here at dal, we even party with our residents on aregular basis. I don't know if it is like that at other schools.

 

One thing I don't like about Dal clerkhip is the amount of hands on experience. I really want to be proficient at all basic procedures ie:IVs, intubation etc...but there are just too many learners that prevent me from doing so. It may be like that at all schools but part of me is disappointed that half way through clerkship I still haven't done too many IVs on my own.

 

I hope that answers your question(s).

[Guest mamnrkr]

Hi JewelLeigh and cassica, thank you both for your replies.

 

They really helped set my mind at ease...to an extent...it doesn't sound as bad as I have heard.

 

Though I have to admit, putting in 30 hours without sleep scares me silly...I've never been able to stay awake beyond 18 hours and even then I'm mindless zombie-like creature by the end of it. The thought of trying to function 30 hours straight is a little daunting. Do you guys come up any strategies to deal with the long hours?

[Guest CaesarCornelius]

Hey

 

Thanks for the post jewelleigh. I can just say

 

See excellent note by med II above.

 

You pretty much summed it up. Cassica is right that surgery and obs have been the most time consuming, although MTU is pretty close. Check it out below:

 

OBS:

Signover at 8am. Work until 5pm. Call starts at 5pm. You will NOT sleep on OBS call. Then you are done at 8am the next day. So 24hrs and done. But honestly, NO sleep.

 

Surgery (gen surg)

6-630 start rounds. Operate/Clinic until 6pm. Call starts at 6pm. You will be awake and running around until 2-3am, likely will be up all night. Sometimes get to sleep. Have to return for rounds at 6am, then to the OR until noon.

 

MTU

Start at 8am. Deal with your patients (this can take until late in the evening, but you're supposed to be done at 5pm). call starts at 5pm. EMerg call - you won't get any sleep. Maybe 2 hours if its a tuesday..

 

With regards to weekend call, most services want you to do a friday/sunday call. So you are on friday night, have to round on your patients on saturday (until about noon), then you're on call all sunday until monday. Makes for a long weekend.

 

YEAH MTU. (thats what im on right now. On call in fact).

 

CC

 

p.s. MTU is tough because its the only service so far where my patients regularly die. I suppose ill get used to it, but so far its been difficult.

[Guest scooter]

Hey,

I just read in another forum that some schools pay during clerkship... any chance Dalhousie is one of them?? Probably not, but i figured i would ask

[Guest JewelLeigh]

Yes, Dalhousie does pay during clerkship...I believe it's a whopping $50/week. (And no, that is not a typo, hehe.)

 

Of course, we still have to pay regular tuition during clerkship...so I more just think of it as a very slight reduction in tuition as opposed to getting paid

[Guest scooter]

UBC pays 250! But 50 is better than a kick to the kidneys... and could definately pay for one night out a week.. provided you budget of course

Another question, are the rotations fixed, ie all 90 of us do the same order or are we in smaller groups with some starting in Xand some in Y and then switching?

Scooter

[Guest JewelLeigh]

There are 4 tracks and 4 subtracks within the 4 main tracks, so the class is divided into 4 large groups and 16 small groups for rotations. So, at all times throughout the year, there is a group doing each rotation.

 

Eg. I'm in track 4, so I'll start with peds/obs-gyne, then surgery, then family/psych, then internal. Within those tracks, I do smaller rotations in a different order from 3/4 of the other people in track 4 (eg. within surg there are 4 rotations - general surgery, 2 selectives within surg and ER). Someone in track 3, would start with surg, then peds/obs-gyne, internal and finally family/psych.

[Guest noncestvrai]

If you want to do IVs and intubation, I think an elective in anesthesia would be just what the doctor ordered...

 

noncestvrai

[Guest cassica]

NCV - you are totally right! I have four set up:p Hopefully by then I will be better at more than just IVs

[webshy]

4th year

Fall - 12 weeks for electives. These are rotations in any area of medicine desired, in any location desired (provided you have a licensed physician to supervise). Electives are preparation for residency, and as such, most students do their electives at the locations and in the area of medicine that they hope to do for residency.

Jan - for now there is 3 weeks or so off to fly around the country doing CaRMS interviews.

Feb-Apr - Continuing and Preventative Care - four 3 week rotations that must be more clinic/community-based than hospital-based. 1 of the rotations much be in Halifax and is called "Care of the Elderly." Also in Feb, find out residency program through CaRMS.

May - write licensing exam and graduate

July - begin residency

 

Has the 4th year schedule changed? When I looked at the Dalhousie curriculum website, I saw that there are 18 weeks of electives listed. However, I did not see "Continuing and Preventative Care" - just the three weeks for "Care of the Elderly".

 

http://undergraduate.medicine.dal.ca/curriculum/clerkship.htm

 

Do these changes mean that there are an additional 6 weeks of electives? Does Dal then have more electives than other medical schools?

 

With regard to your role as a clerk.... At Dal, are clerks first or second call? I'm trying to compare the clerkship of Dal to that of Western and Queen's. From what I can see, the schedule seems similar to that at Western, but perhaps there are more electives.

 

Also, how much experience did you gain as a clerk? One of the numbers I've often seen quoted on these forums is how many babies Western clerks deliver in London vs Windsor.

 

Thanks for your help!

Elaine

[JewelLeigh]

Hey Elaine,

 

You are correct that the fourth year schedule has changed. There is no more "Continuing and Preventative Care" officially...but in reality, it has simply been folded into electives. Previously CPCU rotations were essentially electives with some criteria that need to be met. Now they just say that 2 of your electives have to meet the same boundaries. All that has really changed is that there is more flexibility in the timing. As the schedule is currently, of your 18 weeks of electives, at least 3 have to be in a non-tertiary centre and 3 have to be in an Interdisciplinary setting (Eg. I am doing Palliative Care). So really, fourth year now looks like (schedule not exact, but this is how most people set it up):

- Fall - 12 weeks of electives geared towards each student's CaRMS goals

- Winter - 9 weeks of clinical rotations in which 3 must be Care of the Elderly and the other 6 are electives which must fulfill the "non-tertiary" and "interdisciplinary" categories IF your fall electives didn't do this already. Otherwise these are just normal electives. There are also 3 weeks set aside for CaRMS interviews as per usual (starting on Monday for this year actually). Early March usually includes CaRMS match day. (March 6 this year!)

- April - 1 week of an ACLS course (required for residency I think) and 2 weeks of review courses for the LMCC

- early May - write the LMCC

- late May - graduate

- July 1 - start residency

 

As a 3rd year clerk, your role on call varies depending on the service. For most services, you are called by the junior resident, who is first call. This is both good and bad. It is good in that the residents can kinda screen out the simple requests that have no learning value (Eg. just need a tylenol order which you as a clerk cannot write). It is bad in that when it comes time for you to be the resident, you second guess even these simple orders because you don't have any experience! However, that being said, on most services, the residents call you for anything other than those simple/boring things, and on Internal Medicine, you are first call, which was a great experience in my opinion.

 

I feel that I got a pretty good experience at Dal during clerkship. You have the opportunity to go outside of Halifax for many rotations, which only increases the amount of experience you can get. For example, my good friend did general internal medicine in Saint John, NB. It was just her and a first year family medicine resident managing their internal floor along with their attending. (Compare to in Halifax where each team had at least two residents and two students.)

 

For baby delivering experience, I did obstetrics in SJ and over the 6 week rotation, I was able to deliver 11 babies without the resident helping and probably 5 or so more with some help. I assisted on a further 15 or so deliveries by C-section and was present for probably 15-20 other vaginal deliveries. I think this was probably par for the course in SJ and the high end of average when comparing to those who did this rotation in Halifax.

 

However, I really think that clinical experience is closely related to enthusiasm. It's easy to avoid late night deliveries, for example, if you aren't interested. And on the contrary, if you're willing to stay up all night following any and every labouring lady who comes through the door, you're going to get more experience (with a little luck!) Similarly, "just ask" is a good philosophy when it came to doing procedures. At least at Dal, I found that if I expressed my desire to participate or do procedures (to nurses, residents, attendings, patients, anyone), I was much more likely to be called when something interesting/worth learning was happening.

[webshy]

So really, fourth year now looks like (schedule not exact, but this is how most people set it up):

- Fall - 12 weeks of electives geared towards each student's CaRMS goals

- Winter - 9 weeks of clinical rotations in which 3 must be Care of the Elderly and the other 6 are electives which must fulfill the "non-tertiary" and "interdisciplinary" categories IF your fall electives didn't do this already. Otherwise these are just normal electives. There are also 3 weeks set aside for CaRMS interviews as per usual (starting on Monday for this year actually). Early March usually includes CaRMS match day. (March 6 this year!)

- April - 1 week of an ACLS course (required for residency I think) and 2 weeks of review courses for the LMCC

- early May - write the LMCC

- late May - graduate

- July 1 - start residency

 

Thanks for the response JL!

 

Based on your description - does Dal have more electives than other medical schools in Canada? Most seem to have 16 weeks of electives; however, I count 21 weeks at Dalhousie. Do you get an "extra" five weeks of electives?

 

Thanks for your help!

Elaine

[JewelLeigh]

I think many schools have a longer "back-to-the-basics" course at the end of 4th year, so this might be why we get a few more weeks of electives.

 

Dal actually gets 18 weeks of electives. The other 3 during the 21 weeks of clinical rotations during fourth year are not elective - you must do a care of the elderly rotation.