Timing of clerkships

[Dany]

hey people,

as a newbie heading towards clerckship this fall, I have a question regarding the timing of different rotations:

what are the advantages and/or disadvantages of taking those "comprehensive" rotations (fam, IM etc...) at the beginning of the clerckship, or, should I wait till later in the year?

some told me that beginning clerckships with those rotations may not be as effective, given that we don't have much medical knowledge at the beginning.

 

thanks in advance!!

[Melisende]

The advantage of taking something like IM early on is when you go to your later rotations, you are already used to the hospital system and you have medical knowledge that will make you look like a star. The downside of taking IM early is, you are learning how to be a clerk, how the hospitals work, and a LOT of new knowledge at the same time. If IM is what you are going for, you want to get reference letters and you don't want to look dumb.

The best thing to do is do a "comprehensive" rotation early, but in a discipline that you are not aiming for. If you know for sure what you want to, do that rotation in the middle. Even if you start with what you are interested in, it is not the end of the world. You can always do electives and get letters that way.

[crush]

I don't know what school you're from (for timing of electives), but other things to keep in mind:

- ideally, you want to complete the core rotation in whatever you're aiming for at your school before going on electives. That doesn't impact things like at UWO where all of core clerkship is first, but my friends at Queen's (for now anyway before the rotation schedule changes) have electives in February/March, and it is popular to start clerkship with the rotation that they are most interested in, so that they have some experience under their belt.

- you might be burnt out by the end of 3rd year, so you might not want to do your most favoured rotation at that time. Consequently at UWO, it is most popular to do your favoured core rotation 2nd (December-Feb of 3rd yr) or 3rd (Mar-May of 3rd year).

 

I also agree with what Melisende said. And by "comprehensive" rotation - I would define it as Medicine or Surgery (not family medicine) because that gets you used to being in hospital, writing orders, dictations, being on call, etc. I started Surgery even though I would never in a million years want to be a surgeon - but I ended up doing well and having fun because since it was my first rotation, my keen-ness was at a high and I was really motivated to learn.

 

There are also tons of people who have started (and ended) with the specialty they ended up matching to, though, so no worries if you don't know exactly what you want yet- you'll figure it out!

[Lactic Folly]

We were assigned our clerkship tracks through a lottery system. The order of your rotations will not make or break you - many people did clinical electives during the summer between 2nd and 3rd year to hit the ground running for the start of 3rd year.

 

I agree that you want to figure out if you're interested in something competitive earlier on if possible, and set up electives as soon as you have your schedule for the following year. However, I disagree that you can relax on any rotation and make a ton of mistakes. All written comments from our rotations and electives were included with our Dean's letter, and it would be quite stressful to have a lukewarm or worse, negative, evaluation for a core rotation on your CaRMS application.

 

Also, preceptors have different expectations for students at the start of 3rd year as compared to those further along in clerkship. It is still possible to do well and gain strong letters of references based on personal qualities, even if one's clinical skills are 'evolving.'

[Dongzhuo]

Hey brooksbane, what do you mean by finish your work and dissapear ASAP? I thought we will have to stay for the entire shift and then more?

 

Here comes the realism train, and you're the next passenger.

 

I will preface my rant with the fact that the clinical phase of medical school is a mostly worthless waste of time. Learning how to "function" on the wards is pointless monkey-work that any moron could learn given a week or two. There's very little medicine to be learned on any of these inpatient rotations.

 

That being said, the timing of your clerkship rotations is extremely important.

 

Do you know what you want to go into? If you don't, I suggest something really competitive like rads ophtho or derm. It's easier to aim high and change your mind later than to aim low and be stuck.

 

Now, order: do obgyn first if you can. It takes a certain type of person to want to do obgyn. Most know they want to do it, or have considered it, before they get there. I'll assume you are not one of those people. On obgyn, you'll learn all the monkey-work of inpatient medicine but not have to worry about impressing people. In other words, you can make your mistakes here and look like an idiot and nobody will really care.

 

I advise against doing inpatient medicine first. The wards are bogged down with social work, gomers, and extremely pathologic personalities(I'm talking the hospital staff, not the patients) and guess what!? You as a student will be the one to be filling out the scut forms! You'll get grilled on physical exam findings that are completely useless! Your goal here is to finish your work and disappear ASAP if you don't want to do medicine. If you do want to do medicine, then it is to take more of a leadership role and move the meat. Remember, quantity over quality. If you start out with medicine, you will be bogged down with the paperwork and administrative crap and take forever to do anything so you will fail on both counts: you'll be in the hospital forever AND you won't impress anyone because you'll be slow.

 

If you're going for something competitive and you want to shine, do these rotations midway through. You'll become accustomed to hospital politicking, have a bit more of an idea about what doctors think is important, and you'll have enough time to set electives up for the next year if you want. WARNING: if you're going for derm or rads or something hard to get, set your electives up ONE YEAR IN ADVANCE. That's right: for all you pre-clinical people, set your electives up THE MINUTE YOU START CLERKSHIP. It's easier to cancel an elective than to get one.

[Dany]

thanks everyone, your answers really help alot!

actually I'm from a French university in QC, and I am only aiming (for now) IM as:

first, my preclinical grades are mediocre

--- btw, how much do they count for CaRMs evaluations?

2nd, IM looks like a wide "stem" where I still have a variety of further choices like general IM, cardio, GI, etc

--- so is it "misleading" for someone who isn't sure about his preference to make that move?

3rd. I don't feel (for now) have any interest for Sx, ENT, though I like imagery medicine

--- again, considering my preclinical grades... I ain't very confident of getting Rads after all, and don't know whether I should take the chance of applying for Rads...

[Dany]

for brooksbane:

I advise against doing inpatient medicine first. (...) If you do want to do medicine, then it is to take more of a leadership role and move the meat. Remember, quantity over quality. (...)

 

1. "inpatient med", "medicine", do you mean IM here?

 

2. "If you do want to do medicine, then it is to take more of a leadership role and move the meat"

I don't quite get it here...

 

thanks!

[thebouque]

for brooksbane:

 

 

1. "inpatient med", "medicine", do you mean IM here?

 

2. "If you do want to do medicine, then it is to take more of a leadership role and move the meat"

I don't quite get it here...

 

thanks!

 

He probably means IM

 

Preclinical grades are not worth that much for Carms, especially if you're aiming for IM. Keep in mind that the 1st 2 years are pass or fail (somtimes honours pass fail) at the English schools (we,re not lucky in quebec...).

 

peace

[regular]

My school had a lottery for order too, but I am glad I ended up doing peds/IM/surg last even though I initially wanted the big ones first.

 

The reason is that according to books such as Iserson's guide to residency, the rotations that hold the most weight are IM/surgery so you have a better of getting better grades. Secondly, by doing the smaller ones first, I can tell what I liked and could choose electives in those earlier- I was initially gunning for IM/EM but quickly changed my mind when I found what I enjoyed more.

 

Finally I knew I had no interest in psych/obs so doing those first got me familiarized with the way things work in hospital for my later rotations.

[Dany]

Most people should pick obs/gyn or psych first,

 

 

I am now hesitating bwteen starting with obs/gyn, psych and fam med,

 

I am abit afraid of starting with psych, as I consider it being pretty relaxing which might "mislead" me in my further clerckship

 

I'm considerting familiy med, because I know I won't go for FP, also, it'll be a good chance to acquire a comprehensive basis for further rotations. However, I have to confront the risk of "scewing" this rotation, as I being unexperienced at first, starting with a relatively "important" rotation --- btw is family med considered a core rotation?

 

thanks A LOT for your replies!!!

[Melisende]

Family medicine is a core rotation. Most preceptors are understanding that as a brand new clerk, you are not used to the system and you will need some time to adjust into your new role. They are more forgiving in September than they are in June. Ultimately, to succeed as a clerk, you need to look keen, try to learn, be willing to do scut work, never complain, and be around when they are looking for you. You might not know a lot, but as long as you do those things, your evaluation will be fine. People get converted during clerkship and some people end up going into the discipline they started their clerkship in. The order of the clerkship rotations is not as important. It is just nice not to have to learn the system when you are in the discipline that you want to do.

[justletmein]

I dont think it's the worst thing in the world to start with a tough rotation. I have IM first and even though it is a potential career choice for me, I figure they will be far more forgiving in the first rotation than they would later on. The last thing I need is a mediocre-bad eval from my IM rotation at the end of 3rd year. Also, I figure the "comprehensive" nature of the rotation and the long hours will help me get in a good head space for the rest of clerkship.

 

In the end, I think people stress WAY too much about the order of their rotations. Just work hard, and schedule your electives far in advance.. and everything will work out. Nobody I know has gone unmatched in their discipline of choice because of the order of their core rotations.