Choosing a rotation order

[mattg]

I'm not sure if this is unique to UofT (my guess would be that it is not), but we have to choose clerkship rotation orders soon (mid-2nd year). The way it is set up at UofT is there are two different sets of rotations: (1) Family/Psych/OGBYN/Peds (2) Medicine/Surgery/a group of others (i.e. ER/optho/anesthesia, etc.)... you are able to pick which set you want in the fall/winter, and which set you want in the following spring/summer.. also, you rank the order you would like to take the specialties within each set

 

anyways... my question is, for all of the clerks (or preclerks), what is the best 'strategy' to consider when choosing your rotation order?

 

I have heard multiple things:

- that if you know what you want to go into, you want to have it last, so that you will have a year of experience for the rotation in order to perform well and impress to a greater degree (for better evaluations, LORs, etc.)... also it will be fresh in your mind heading into electives (presumably in that specialty)

- that if you are interested in a speciality, to do it early so that you can make sure you want to go into it (since you have to apply for electives relatively early)

- to get the intense ones (surgery/medicine) out of the way first - i.e. baptism by fire, so everything following will be 'easier' to get through

- not to leave the intense ones (surg/med) for last, because then you will have no time to start your CARMS apps in the summer before 4th year

- not to leave the intense ones for last, because then you will be burned out heading into electives, which is where you need to be at your best more than ever

- to start with the lighter ones (psych/family) to ease into clerkship

- to start with Medicine (or Family) because it somewhat overlaps with/applies to all of the other specialties

 

Can any clerks (or residents if there are any on this site) give some insight into their thoughts, based on experience... or if any preclerks would like to share their thoughts

 

it probably isn't overly important, but the order does seem to matter somewhat, especially with respect to the first 2 points above

[alanine]

I would like to read these replies as well as I am in a similar situation!

[igotacookie]

I have the same problem.

 

I'm going with #1 as my ranking strategy.

There are a couple rotations I know I want to do well on and impress my preceptors so I am ranking them last.

[nephrolithiasis]

Some people do well starting with intense rotations (like surgery and internal medicine). Personally, I prefer easing into clerkship starting with psychiatry, family medicine, etc and 'building up' to internal medicine which is very knowledge intensive.

 

Its probably not worth spending a lot of time on. After all, you may not get your top choice. Most of the time, you have to work around the order you get.

[psychoswim]

I've heard good and bad about both orders. Here we have 4 electives that are placed anywhere within our 2 years so some people actually end up starting with an elective. It's not necessarily the best, but expectations are also different.

[Lactic Folly]

anyways... my question is, for all of the clerks (or preclerks), what is the best 'strategy' to consider when choosing your rotation order?

 

First of all, no matter what you rank (and people tend to prefer similar tracks), you may end up with something else - but it'll still work out fine.

 

I have heard multiple things:

- that if you know what you want to go into, you want to have it last, so that you will have a year of experience for the rotation in order to perform well and impress to a greater degree (for better evaluations, LORs, etc.)... also it will be fresh in your mind heading into electives (presumably in that specialty)

 

The conventional wisdom is that doing your preferred specialty first gives you the advantage of being fresh and enthusiastic, as well as the leeway of telling people this is your first rotation. As you said, doing your preferred rotation last does allow you to head in with greater experience.

 

Ideally, I would be doing electives (in either your preferred specialty or in related areas) during the summer between 2nd and 3rd year in order to hit the ground running. In practice, seasoned preceptors are aware of your level of experience and will evaluate you in comparison to others at the same level. Besides, a lot of the material in evaluations and LORs is about personal qualities such as work ethic, initiative, people skills, etc.

 

- that if you are interested in a speciality, to do it early so that you can make sure you want to go into it (since you have to apply for electives relatively early)

 

People do change their minds late in the game, but again, ideally you should be trying to get exposure to your most likely career choices earlier on (summers are nice for this).

 

- to get the intense ones (surgery/medicine) out of the way first - i.e. baptism by fire, so everything following will be 'easier' to get through

 

Not sure how much this matters. The "easier" rotations will be the ones that you enjoy, or the ones where you enjoy the team you work with. One thing I might suggest is to consider not scheduling hard rotations (e.g. surg + OB if you are not a surgical type) back to back.

 

- not to leave the intense ones (surg/med) for last, because then you will have no time to start your CARMS apps in the summer before 4th year

 

Some truth to this. You do want to leave yourself adequate time for CaRMS, but can get around a less ideal schedule by planning ahead.

 

- not to leave the intense ones for last, because then you will be burned out heading into electives, which is where you need to be at your best more than ever

 

Unless these are your passion in life.

 

- to start with the lighter ones (psych/family) to ease into clerkship

 

I had a schedule like this. There wasn't enough overlap to truly offset the steep learning curve into ward medicine afterwards though.

 

- to start with Medicine (or Family) because it somewhat overlaps with/applies to all of the other specialties

 

I've heard this about medicine but cannot attest to this. Outpatient family will give you practice in doing H+P on relatively well patients, but again, it's not inpatient medicine.

 

Can any clerks (or residents if there are any on this site) give some insight into their thoughts, based on experience... or if any preclerks would like to share their thoughts

 

My experience above.. hope that helps..

[Jochi1543]

I'm on a track that starts with family med, electives, and psych, with everything intense after, and it's working well so far. At least by the time I roll into a hardcore rotation (my next one is obs-gyne), I am familiar with some basic meds, basic diagnostic work-ups, and the seldom mentioned but rather stressful logistics of hospital living such as how to dictate a discharge summary, how to write admissions orders, navigate the ER computer feed, etc. Last thing I'd want to worry about during a 16-hr workday on internal med is how I'm gonna spend 3 hours afterwards dictating and then get criticized for the final product.

[leviathan]

I started with IM. I have used that knowledge in surgery, OBGYN and even a bit now in psych so it helps you impress your attendings. Of course you will do better in IM if you do it last and are familiar with charting, H+Ps, meds, dictating and that kind of stuff so you can focus on the medicine. So it's a personal choice on how you want to do it.

[NewfieMike]

^very likely a spambot. Will keep an eye out

[brooksbane]

^very likely a spambot. Will keep an eye out

 

I'd say definitely. There's a link to some garbage site in his sig, and his english makes absolutely zero sense. Heck I'd ban him for the meaningless sentence structure alone!

[medaholic]

I want to start by saying at the end of all your rotations, it doesn't matter what order you did them in, and more on how well you did in them.

 

Several things to think about. The first question is do you know what you want to do? Is it surgical or medical? If you don't know, using your first few rotations to expose you to different specialties is a good idea.

 

Second: When do you want your electives (that is if you have any in 3rd year). Do you want to use them to explore different specialties, or do you want to use them to impress people and get LORs.

 

Few thoughts: Starting with Gen. Surg or Internal Medicine will be a steep learning curve, but will best prepare you for the rest of the year. If you're pretty sure you don't want to do either of these specialties, doing them first is a great idea as it really familiarizes you with sicker patients and working in a hospital and on a team.

 

If you kind of know what you want to do, schedule it for the middle of the year or later on in the year, so you'll be more comfortable and competent by then.

 

Try not to schedule all your "heavier" rotations back to back, ie Surgery-IM-ObsGyn. Space family, psych and peds in between. similarly, don't line up electives where you know you'll be working hard with your other busier rotations.

 

For me: It was good to do some surgery rotations/electives right off the bat as I was still undecided. Once I made the decision to pursue a non-surgical specialty, I didn't feel bad for not excelling in those earlier rotations.

[rogerroger]

Good question. It can make a significant difference to your clerkship experience.

 

In hindsight I see two realistic schools of thought on this.

 

1) Gradual build up

 

Personally I did this. I started with FM and Psych and finished with IM and Sx.

 

FM was a nice place to learn the ropes of clerkship. There was a lot of one on one attention and a diverse array of cases. Would I have done better on this rotation if I did FM later in clerkship? Yes, certainly. I did a FM elective after all my cores and it was a very different experience. But I feel as though this was a trade off for having a gentler transition into my other rotations. Having FM first helped me feel more comfortable with psych, gyne, paediatric patients prior to these rotation. However, with this said I only had my first true ward based rotation until several weeks into clerkship. If you are interested in a speciality that will have you on a medicine ward I would try start with another ward based speciality first in order to learn the little nuances associated with this setting.

 

 

2) Jump in the deep end

 

I have talked a lot with classmates who did clerkship in the opposite direction. Personally, for me I think it would have been overwhelming and possibly detracted from my learning. I don't think I would have been ready for what IM/Sx would have presented me with on my first day of clerkship. With that said, if you are the type of person who loves the trial by fire approach I can see you learning a ton. I know classmates who loved this approach. But again, this probably comes at a price of being more fresh on the rotation and greater overall stress. I do think that you may be more prepared for other ward and surgical based specialities such as ob/gyn, paediatrics etc. with this approach. But, I don't think everyone learns best by the being "tossed in the deep end".

 

 

 

One thing I would not do is put your primary interest speciality first. You won't be at your best on your first rotation. You can't be, you are just starting a whole new way of learning and working. I also would not place your primary interest speciality last. So many people switched interests over their cores. I never measured it, but I would estimate that about 1/2 of those I know changed their mind, even the ones who were speciality X "gunners" during pre-clerkship. Don't wait until late in clerkship to try your main interest. You might be surprised and change your mind. This is kinda anxiety provoking when CaRMS looms over the horizon. Ideally I suggest placing your key interests in your third or fourth block. At UT this means around or after Christmas of 3rd year.

 

That's my two cents.

[AtomSmasher6]

Take the one you don't care about first - this will be your practice run. That way when it comes to evaluations on the one you want, you have some familiarity, and you'll know how to look competent.

 

And if you haven't decided what you want to do by third year, you're going to have a harder time getting in to anything competitive.

[rogerroger]

 

And if you haven't decided what you want to do by third year, you're going to have a harder time getting in to anything competitive.

 

If competitive = derm , optho, plastics etc. Then I really don't know, I never really pursued any of those. I can't say. But if by competitive we are talking about stuff like anaesthesiology, emergency, urology, ENT etc. I think you certainly have a reasonable opportunity if you decide during third year.

 

It is always nice to know what you want to do early. Many a clerk changes their goal numerous times. I bet someone somewhere has done a study on it but I am too lazy to look it up. But I would not be surprised if a majority or near majority of clerks don't end up pursuing their first choice speciality mentioned at the start of clerkship.

 

Take home message, don't stress too much if you don't know and you are starting clerkship.

[A-Stark]

If competitive = derm , optho, plastics etc. Then I really don't know, I never really pursued any of those. I can't say. But if by competitive we are talking about stuff like anaesthesiology, emergency, urology, ENT etc. I think you certainly have a reasonable opportunity if you decide during third year.

 

Agreed, though anaesthesia is actually considerably less competitive than emerg, urology, or ENT if you look at the numbers. It's also - apparently - easier to sell yourself as discovering anesthesia late since some schools don't have core rotations (like Dal...).

 

It is always nice to know what you want to do early. Many a clerk changes their goal numerous times. I bet someone somewhere has done a study on it but I am too lazy to look it up. But I would not be surprised if a majority or near majority of clerks don't end up pursuing their first choice speciality mentioned at the start of clerkship.

 

Take home message, don't stress too much if you don't know and you are starting clerkship.

 

It's also a good idea to make sure that staff know whether you're near the beginning of clerkship or, indeed, the end. There is - and should be - a big difference between a CC4 and a CC3, especially when the latter is just starting.

 

In any case, I started with peds, and it was initially a bit of a rocky start - at least for the first two weeks. After that, though, things changed dramatically, and I even got a "strong" letter out of the rotation.