Internal electives

[hemogoblin]

Sort of narrowed things down to internal vs. family. I've got a bunch of pre-clerkship internal electives. Between those, some research, and my core medicine, I've got 5 good letters for internal. For my fourth year electives, I am debating doing, in order:

-2 weeks family

-2 weeks MTU

-3 weeks emerg

-2 weeks sports med.

Those would be pre-CaRMS apps being due, then:

-3 weeks family (with someone who does emerg)

-2 weeks peds emerg

-2 weeks cardiology

-then finally, post interviews, 2 weeks ICU.

 

I think my electives are fine for family, but I am a bit concerned about internal. Wondering if people think this is sufficient given that I've got some relevant conferences, already have plenty of IM letters, and did pre-clerkship electives in GIM and internal subspecialties. Waddya think?

[samy]

As an aside, what do you mean by "pre-clerkship electives" , observerships?

[hemogoblin]

As an aside, what do you mean by "pre-clerkship electives" , observerships?

 

My school lets us do electives as pre-clerks. They show up on our transcript in the same fashion as clerkship ones.

We are required to do them a half day a week during years 1 and 2 (either as full year or half year electives), and then can do some in the summer if we so choose. I did my required ones in medicine subspecialties, and some summer ones in GIM and anesthesia.

 

Edit: I also wouldn't call them observerships. Some pre clerks didn't get allowed to do much, but I intubated, put in art lines, saw patients on my own, wrote notes, dictated, etc. Not too dissimilar to what I am doing as a clerk, I just maybe wasn't expected to be as fast.

[A-Stark]

Conferences don't really matter unless you're presenting.

 

I would strongly recommend against the sports med elective - this is not at all relevant to IM and is sort of a wash otherwise. Better off doing an IM subspecialty (all of which are relevant to family), ICU, cardio, etc. Similarly, I would focus more on doing 3 weeks of GIM/CTU rather than 3 weeks of emerg. It doesn't matter that much, but it's easier to get a good letter from 3 weeks than two.

[bloh]

I would drop peds emerg, sports medicine and even perhaps emerg. They add no value to your IM application.

 

Just do 4-6 weeks in family and the rest in internal. Your pre-clerkship electives are useless and quite frankly I wouldn't even use those letters. You need to beef up your IM application if you'd like to be competitive.

 

Edit: Just saw your comment about the pre-clerkship electives. That sounds pretty unique. What school? In either case, whenever someone says preclerkship elective, it's synonymous with useless. Half a day a week is just dumb when it comes to patient continuity and I'm not sure anyone reading your application would take it seriously. The letters would have to go into extraordinary length at explaining the experience to give you the credit that you are looking for.

[A-Stark]

Probably Dal from what I can gather. I did those pre-clerkship electives too and they don't really give you a good sense of what a speciality is all about. Or what it's like to be on-service everyday. You also don't know very much before clerkship, and even there having a clerk isn't always that helpful.

 

When I was a clerk on gen surg, we worked 6-6 most days, though sometimes we got to sleep in a bit and start at 6:30. One day a first-year doing an "elective" appeared in the OR in the afternoon (who was saying, among other things, that only trauma surgery would be interesting as a career since everything else would be too "routine" or "repetitive"). I was a bit annoyed since now there was a fourth person scrubbed in, and at that time I still wanted to do gen surg. After the case was done, the first-year asked me what we were doing next and I told him we were going to go round on the patients. His expression changed, and he announced that maybe he was just going to take off.

 

He ended up in family med. If I have any point to this story it's that swooping on in one afternoon or morning a week isn't really a substitute for performance in clerkship. It's how you perform everyday for a month or a few weeks that matters. Don't get me wrong - I think the early elective program is a really good thing for getting a sense of different specialties early on, but it's never indepth, and rarely comes with any kind of responsibilities.

[hemogoblin]

Yeah I agree the half day a week isn't ideal for knowing what the job is like. The summer ones were better; I'd do the full work day for a couple weeks at a time...

 

As an aside, when I mentioned relevant conferences, I should clarify that I was indeed presentation or at least had posters at these.

 

Anyhow, I guess I have got some thinking to do electives-wise...thanks for the input (and I'd welcome any additional comments).

[bloh]

A-stark definetely put it much better into words than I. I'd just like to caution you once again against using the pre-clerkship letters for CARMS. People reading them understand well the difference between performance in full clerkship and glorified shadowing pre-clerkship. To that end, I'd highly recommend you beef up your IM application with more electives.

[hemogoblin]

A-stark definetely put it much better into words than I. I'd just like to caution you once again against using the pre-clerkship letters for CARMS. People reading them understand well the difference between performance in full clerkship and glorified shadowing pre-clerkship. To that end, I'd highly recommend you beef up your IM application with more electives.

 

Oh, I think I was unclear. Only one letter will be from a preclerkship elective. I also did research with them, and presented our work at some good conferences. Then other letters are ones obtained during my core IM rotation from MTU, Cardio, and ICU staff.

[epicfail]

Be careful.

 

Referees are obligated to say in the letter how long they have worked with you and under what circumstances.

 

For you personally, if you asked the pre-clerkship guy to write you a letter, make sure to clarify with him to write the letter as your "research supervisor".

 

Letters from research supervisors tend not be as useful as clinical supervisors, but there are schools/programs asking like 5 letters, so you can toss that one for such programs for variety.

[Lactic Folly]

Research letters aren't necessarily worse than clinical ones. They often have the advantage of knowing the candidate over a longer period of time, with more insight into their personality and ability to deal with challenges that come up in research.

[Totenmesse]

When I was a clerk on gen surg, we worked 6-6 most days, though sometimes we got to sleep in a bit and start at 6:30. One day a first-year doing an "elective" appeared in the OR in the afternoon (who was saying, among other things, that only trauma surgery would be interesting as a career since everything else would be too "routine" or "repetitive"). I was a bit annoyed since now there was a fourth person scrubbed in, and at that time I still wanted to do gen surg. After the case was done, the first-year asked me what we were doing next and I told him we were going to go round on the patients. His expression changed, and he announced that maybe he was just going to take off.

 

He ended up in family med. If I have any point to this story it's that swooping on in one afternoon or morning a week isn't really a substitute for performance in clerkship. It's how you perform everyday for a month or a few weeks that matters. Don't get me wrong - I think the early elective program is a really good thing for getting a sense of different specialties early on, but it's never indepth, and rarely comes with any kind of responsibilities.

 

I've gotta quote this for emphasis. I hadn't realized how true this was until clerkship.

 

Shadowing has a place, and it's nice to experience different areas and work 1on1 with attendings and find mentors. But in terms of career scouting it's largely irrelevant as you don't come close to experiencing the true nature of the specialty.

 

I was in the OR on the last day of my surg rotation and we had no residents so I was pretty stoked but this first year came in for a few cases so I was like well, whatever, it's my last day so I'll teach him whatever he wants to know. So I ask him any interest in what you wanna do? He's like well I tell ppl I'm keeping options open but it's 100% surgery. And I just laughed at him. He showed up at 9am and left at 11am to go to "skills" and "eat lunch" and came back for another case at 1pm. I was like, oh that's nice, but don't forget you didn't come in for 630 to preround on 30(!) patients, see consults inbetween OR and round after the ORs. He just kinda stared at me.

[Gimp Face]

I've gotta quote this for emphasis. I hadn't realized how true this was until clerkship.

 

Shadowing has a place, and it's nice to experience different areas and work 1on1 with attendings and find mentors. But in terms of career scouting it's largely irrelevant as you don't come close to experiencing the true nature of the specialty.

 

I was in the OR on the last day of my surg rotation and we had no residents so I was pretty stoked but this first year came in for a few cases so I was like well, whatever, it's my last day so I'll teach him whatever he wants to know. So I ask him any interest in what you wanna do? He's like well I tell ppl I'm keeping options open but it's 100% surgery. And I just laughed at him. He showed up at 9am and left at 11am to go to "skills" and "eat lunch" and came back for another case at 1pm. I was like, oh that's nice, but don't forget you didn't come in for 630 to preround on 30(!) patients, see consults inbetween OR and round after the ORs. He just kinda stared at me.

 

To be fair, as an MSI1-2, they can't really do that much on the ward and it's good to see a bit of the OR early. We all get our 05:00 rounding and scut eventually. I remember scrubbing for several MVR on cardiac surg as an MSI2 without any rounding; we were assigned to show up at a certain time and not round. That being said, openly saying that one is lying to their classmates about their goals is not the wisest course from a pragmatic perspective: you could well be in a position to influence his career later on. That type of ignorance is worrisome. If you going to lie, at least do it well.

[ellorie]

I mean, a lot of times if you tell people that you know what you want to do pre-clerkship, they just kind of laugh at you and tell you to keep your options open. So sometimes it's easier just to say that you are, even if you're pretty sure on the inside.

 

I knew what I wanted to do, but sometimes I would tell people I was still considering, when I was a pre-clerk, just because it saved my having to listen to them tell me I was going to change my mind (I didn't )