3.23.2012

MS3: Choosing a Clinical Track

This week, my husband was given his first bit of information about his third year of medical school.  Third year is this mysterious, looming thing - I really am not sure what to expect with regards to how many hours a week to expect him to be at the hospital or even if it is Monday-Friday, or if weekends are included...Really, I'm clueless.  Everything is currently culminating in Step 1 and I just don't really know what to expect beyond that.

The third year of medical school is clinically-based, and consists of six clerkships, each lasting eight weeks.  There are six different tracks that students take (which is a fancy way of saying in which order they do their clerkships). Basically, my husband takes his boards, has a week off, and is then thrown into the hospital setting for the first time after a quick orientation.  

Broken down, this results in the following schedule for his entire year:
  • June 16: Step 1 boards
  • June 17-24: Summer Break!
  • June 25-28: Orientation
  • July 2-August 24: 1st clerkship
  • August 27-October 19: 2nd clerkship
  • October 22-December 14: 3rd clerkship
  • December 15-January 6: Winter Break!
  • January 7-March 1: 4th clerkship
  • March 4-April 26: 5th clerkship
  • April 27-May 5: Spring Break!
  • May 6-June 28: 6th clerkship
  • June 29-July 7: Summer Break! 

The clerkships are in the following areas: Jr. Surgery, Family Medicine, Ob/Gyn, Pediatrics, Psychiatry and Internal Medicine.

So here is where I come to you, you wiser med wives: is there a method to the madness to deciding in what order the clerkships should be completed?  Are we correct in assuming that the clerkships that my husband thinks he will like/might want to specialize in he should try to do first?  Which of the above mentioned rotations are considered to be the most difficult/time consuming/have more nights or weekends?  On the flip side, are any of them generally lighter or easier?  And just a couple of general questions about this whole "third year of medical school" thing - will my husband be gifted with a pager for next year, and if so, is he going to be called in at all hours of the night on a regular basis?  Is it possible to request "days off" during third year?  We've got quite a few weddings this year, and I'm just wondering if I will be truly beginning the time of my life when I'm the married-girl-with-no-date for most events.

Thanks everyone - this is why I love the blogging community of med wives! 

15 comments:

  1. my husband is just finishing his third year, but is at a DO school vs. MD, so it looks a bit different. For him, he changes rotations every single month and pretty much doesn't know until the first day of the month what his schedule regarding weekends, etc. Apart from his psych rotation, he has had at minimum 'office hours' (8-5) every weekday and weekends vary according to rotation. Usually if he is hospital based, he worked at minimum 1-2 weekends and in his experience, they were long days (6-6ish). Alot of it can depend on what hospital/clinic he is at as well as far as how busy/how long of hours he has. I am sure there is a method to the madness of choosing the order, but since the osteopathic schedule is different than the allopathic, it is hard for me to really give my thoughts. Good luck! For us, third year was better by far. Yes, he worked long hours and there is still lots of going to things by myself with our boys, but in general, he loves it more, he isn't glued to the books 24/7 and he allows himself to take time away and be 'present' with us more, if that makes sense. Good luck with Step 1, it is a huge load off to have that behind you!

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  3. I just posted a whole comment that wouldn't publish. Drat. Anyway, my husband went to USUHS (military med school) so many things were vastly different. They had no clerkships during the summer and instead did military training. Rotations were six weeks long instead of eight, and were all over the US, so lots of travel was involved. That being said, I can tell you that some rotations will be harder than others. Internal Medicine and Surgery will likely be the worst, hours-wise. Things like psychiatry and family medicine should be easier, office-type hours. I found that the hours that a med student works is based largerly on the Intern/Resident on his team. If you have rad doctors, they will send the students home early A LOT. If you are on a team with a jerk, he/she can make you stay late and ping the heck out of you. The med student is really at the mercy of the team Intern or Resident. My husband never had a pager during med school either (that I can remember!). The thing is, they are there largerly to observe and do some hands on learning. There's rarely an instance where the med student is required to the point of paging them in...which is good for you! Enjoy your free evenings while you can. The time flies, and before you know it, they have a pager stuck to their hip like Bill Cosby (only they aren't home nearly as much as he seemed to be). :)

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  4. Oh, I have tons of advice in this area! But first, I wanted to tell you that I'm jealous that your husband has a winter break. Andy's winter break was December 25-26 and December 29-January 1. Yes, we did have to come back to Detroit for 3 days before returning home for New Year's Eve. OK.

    Yes, he should DEFINITELY complete clerkships in areas where he might want to specialize first. Preferably, right away. I'm not sure if he's a DO or MD student, but I assume he will start applying for residency in the fall either way. That means he will need letters of recommendation from attendings. It's so important to get letters of recommendation for specialties to which he's applying EARLY so he can submit his applications for those specialties EARLY and get interviews EARLY! A lot of places won't look at your application until its complete - including having all your letters in.

    Clerkships include weekends. Not every clerkship, but some. Andy didn't have to go in on weekends for Family, Psych, and I think Peds. But otherwise, he had to go in on weekends.

    Clerkships where he will be at the hospital a lot, including weekends and evenings (and possibly nights) - Surgery, IM, Ob/Gyn

    Clerkships that are easy - Psych, Family

    Clerkships that are hard - Surgery

    Clerkships that are a lot of work - IM

    Clerkships where he will come home not hungry because drug reps shoved his face with Thai, pizza, and other unhealthy foods when you've cooked a delicious, low-cal spinach lasagna - Family.

    Yes, he will get a pager. No, he will probably not have to leave his bed in the middle of the night. Andy never had to. Sometimes there will be a slow day at the hospital and the attending or resident will send the student to the library to research a presentation or rare disease (meaning the student will go to the on-call room and catch up on sleep), and that is where the pager comes in.

    Yes, he will be able to take days off. Andy's hospital allowed 4 days a month for interviews in the fall, so if we had something extremely important to do (wedding, baptism, funeral) and we weren't full with interviews that month, we used one of those days. Otherwise, it's important to notify the attending and important residents that you're working with AS SOON as he knows he needs a day off. And the program coordinator at his hospital. Usually it will be fine. If he needs to be off for more than a day or two, he might need to come make it up on a night or weekend when he wasn't otherwise scheduled to work. Occasionally, he won't be approved for days off. It was very difficult for me to fly to California by myself for more than a week for my grandma's funeral, and I really wanted Andy there with me, but he just could not take off additional days because he had been on so many interviews that month. The key to taking days of is planning far, far ahead. For example, we're getting married in October, and he made that known that he would need a few days off for that when he interviewed. Once he matched, he reminded the program coordinator that he would need days off for the wedding, and he will tell the program director again during his orientation in June.

    All that said, it won't be as bad as you think.

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  5. Anything out-patient is going to have better hours. He might spend a few weeks of the medicine rotations on out-patient. I've already forgotten if my husband could request time off. All I remember is there was no winter or spring break 4th year. Usually people say try to get what you might want to do in the middle. Get some experience in something else first, then when you go to what you're really interested in, you won't be clueless and can get a good review :) Leave what you're least interested in for last.
    Yes, there will be times you'll have to go to weddings, family gatherings, holiday celebrations, etc. without hubby, but it's part of the territory. There's good stuff about being married to a Dr/Dr in training too, you just have to cherish the little nuggets of goodness!
    Good luck!

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  6. Now that I think about it, it really doesn't matter when you do your 3rd year rotations because you don't apply for residency til 4th year. Duh, Marisa. :)

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  7. Thank you thank you all so very much! This has been most helpful - I'm going to have my husband read all of your comments and suggestions when he needs a break from studying today. You are all so helpful!! :)

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  8. I follow your blog so thought I'd chime in .

    While not a med-wife, I've actually done the med school and residency thing and finally now done and enjoying the rewards of 8 years of suckitude. It all depends on the school. We didn't have breaks through the year but after Step 1, we had 1-2 months off (depending on when you took Step 1).

    As someone who knew an area but not exact specialty, I wanted to go into, I made sure to have my choices in the middle (not at the beginning as I didn't want to be too "fresh" to make these decisions and not at the end in case I changed my mind) but in the grand scheme, it doesn't really matter what order you take rotations.

    This is in contrast to what Marisa wrote. I HIGHLY ADVISE DOING ANY ROTATION YOU MIGHT VAGUELY BE INTERESTED IN DOING AT THE BEGINNING OF THIRD YEAR. You are just getting used to the hospital, rounds, doing patient care every day. It is not worth sacrificing your evaluation by being too fresh to do this rotation early. Reading what else she wrote, I think she's confusing 3rd year with 4th year (which I'll comment on below). So, planning areas in which you might be interested in for mid-way through the year gives someone a chance to learn how the hospital works, learn the computer system, learn how to do an iv, etc so that when they actually get to a rotation of interest, they have skills and more knowledge to more thoroughly impress their residents/attendings for their evaluations. YOU DO NOT INTERVIEW OR EVEN APPLY DURING THIRD YEAR AS YOUR APPLICATION TO EVEN SUBMIT DOES NOT EVEN OPEN UNTIL SEPTEMBER OF THE 4th YEAR.

    I was also getting married at the end of 3rd year so I made Psych and Family medicine at the end so I would have the most time for last minute prep.

    However, if you have a particular interest in a certain area, I wouldn't advise having that rotation last just in case you DON'T like it so you're not scrambling at the end of the year trying to pick something new and start your 4th year schedule from scratch.

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  9. Now for 4th year, which will start in July after 3rd year is over, YES, you do the specialty rotations you want to pick FIRST so you can line up your letters of recommendation and line up away rotations next, etc. The applications aren't even open for submission (because it's all electronic and done nationally by this ERAS system) until September of 4th year. But you want to have your application relatively complete before you formally submit. Yes, you do need your letters of recommendations submitted but again, this has nothing to do with the third year of med school. As someone who does review our applicants for interviews and interviews them, this wouldn't even take place until September-October of 4th year. We start granting interviews in mid-September and are usually full by mid-October.

    Hehe....days off during 3rd year. Um, I would say no unless it's based on the rotation below. You don't get days off and if you request them, keep in mind his evaluations during third year are a huge component of his Dean's letter which gets sent to every residency program he applies to.

    As someone who now interviews candidates and also evaluates med students, I can tell you that it doesn't look favorable to me when you schedule a routine 6 month appointment for your baby at 2pm in the afternoon during your rotation because as a mom myself, I schedule my own daughter's appointments on Saturdays, evenings, etc because missing work shows a lack of commitment and third year is a lot of self-sacrifice. Likewise, I missed many weddings/baptisms/parties of family/friends because I did not want to be that person who asked for a Saturday off (especially when the interns/residents/attendings well above me on the heirarchy would never get that day off and thus, those were the exact people evaluating me so third year is a lot of suck-it-up and deal). Enjoy the lighter rotations and suck it up for the longer, more challenging in life balance rotations.

    Again I think the previous poster is confusing 3rd year with 4th year, there is no reason to be interviewing as a third year med student and interviews aren't even granted until fall of the 4th year as you can't submit your application until then. As a 4th year med student, yes, my med school did grant the occasional interview day and most of us were on nice rotations that didn't matter by this point so we could take a good bit of time off....that's why most will affectionately refer to 4th year as a really expensive vacation).

    We had pagers. It was mostly for daytime so we could be gotten a hold of to go here, see x patient, do this, etc. I was rarely paged at home.

    However, the schedule varies by rotation and then varies based on your interns/residents/attendings. I can remember 2 drastically distinct months on medicine (ours was 3 months long) because 1 resident didn't let anyone leave early and the other wanted med students gone as soon as their work was done for the day so they could study.

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  10. Surgery: general idea for surgery is that it is long days. Usually in house around 5am to see patients before heading to see patients for OR (most start at 7-7:30am). Then round again in the afternoon. My days were usually 5am to anywhere from 5pm-7pm. We only did weekdays and 2 weekends per month that started around 6am and we only went to like noon. We took trauma call so usually once per week we were overnight.

    Family Medicine: all outpatient and the mercy of your attending. I was like 8am to 3pm at most. No weekends but that was my site.

    Ob/Gyn: varies widely but usually has similar hours to surgery when you're on the surgery side but had some nicer hours the rest of the rotation. On OB, we had some overnights and some daytimes.

    Pediatrics: usually in around 6-7am and long days until late afternoon. Ours was weekends (ie: our days off for the month were 4 random days) when we covered inpatients and similar to family medicine when we were on the outpatient side. We did have in-house call where we were overnight but my intern/resident only woke us up for important patients.

    Psychiatry: mine was 7am to like 4pm and Internal Medicine. No overnights, no weekends. It was glorious.

    Internal Medicine: to me, it was worse than surgery because we had 4 random days off per month instead of like surgery where we had 2 weekends/month off. Long days like 6am to 4pm on non-call days and then till 8pm or 10pm on our admitting/call days. There were no such things as weekends as every day was a work day and I had a random Tuesday or Wednesday or other random day in between

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  11. Wow, thank you so much Kristin! Tons of great advice here - I just read yours and everyone else's comments to my husband...we are loving all of these tips and tricks! Thank you all so much :)

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  12. My hubby isn't in medical school but he does work in the oilfield and many a night has gone by when he gets a call at 3am to go to work for an undisclosed amount of time, inevitably when we have an important appointment/event to go to the next day.

    He's on call 24/7, even on his days "off", so I can understand a little of what you feel.

    If you happen to go to a wedding this April and notice another married chick with no date, it's probably me cuz no doubt the Hubby will get called out to work the night before! Haha!

    Here's praying you will have a date for all your events! :-)

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  13. Kristin's comments are on the money. Specifically, I would emphasize her advice to plan the rotations in which you have possible interest around the middle of the year. My boyfriend made the mistake of planning it first. Don't do that! During the first rotation, you are drained from having just taken Step 1 and are getting adjusted to the hospital system. It shows on both your evaluations and your exam scores.

    Kristin's descriptions of the rotations were similar to our experiences as well (in terms of weekend shifts/time off/pagers). Surgery and ob/gyn were awful. We planned his surgery rotation during Nov and Dec so that he got a day off for Thanksgiving and had time to recover over winter break before the next rotation. That worked out really well for us.

    Overall, third year is rough. For both of you. Enjoy the easier rotations and bear through the hard ones. Try to keep perspective during the times where it seems you are merely trying to survive - it will pass (and come back again and pass again). I started counting down to the end of surgery on day 1. (I literally wrote the countdown on a note in his lunch every day.) BUT it is also a really great year. You finally see all of that studying come into practice and it's really very rewarding. Best of luck! - Michelle

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  14. My husband's advice, he's a MS3, is do internal medicine first. He'll have a broad amount of information for his next rotations and he'll look smarter. Plus it'll help with shelf exams in the future.
    We've had friends do the easier track first, Peds, psych, whatnot and it takes them a lot longer to get a hang of things. And they didn't score as well on their shelves (they're smart too).
    We highly recommend trying to do IM first. It helped my husband in leaps and bounds.
    Don't worry about what the schedules look like as far as this rotation has weekends off and this one doesn't do nights. None of them are fun. Third year is probably the worst no matter how you schedule. So do IM first!!

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  15. Oh my gosh -- I have been missing out. I JUST found this blog tonight as I was searching for more information on 3rd year! My DH is in the same exact spot and all of this information is SO helpful and positive!!!! Thank you for being open and sharing! There are so many people who benefit from this!

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