How Should I Schedule My Clinical Rotations?

Daniel Egan, MD

Disclosures

January 07, 2009

Question

In what order should I schedule my clinical rotations? Does it depend on the specialty I am choosing?

Response from the Expert

Response from Daniel Egan, MD
Attending Physician, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York

Medical schools take varied approaches to scheduling students during the clinical years, with different amounts of elective time and mandatory rotations. For instance, one school may require a month in the intensive care unit or in the emergency department, while another may require a rotation in geriatrics.

Despite these variations, certain general principles do apply. If you are certain about the specialty you plan to pursue, you should avoid scheduling a rotation in that clinical area first. During your earliest rotations, you will be learning basic medical practices, how to pre-round and round, how to write a note, and how to use the computer system. The best place for you to experience that learning curve is not in the specialty you intend to enter. However, it may make sense to do a so-called "difficult" rotation first, such as surgery, if you are not going to pursue a residency in that clinical area. More difficult rotations can accelerate the process of learning the ways of the hospital as well as decreasing your anxiety level (and requirement for sleep) as the year moves forward.

Certain disciplines require special considerations. For example, students generally do not get formal exposure to specialties such as emergency medicine or ophthalmology until their fourth year. If you plan to enter one of these specialties, you should schedule a rotation during your third year so that you can meet people, possibly arrange an audition elective, and most importantly, make sure that you actually enjoy the specialty. Another unusual situation arises with specialties that require an early match. If you are considering one of these areas, you should schedule a subinternship rotation or "audition" early in the fourth year so that a potential residency program can see who you are and how you work.

Aside from these special cases, let's consider a student applying to one of the more generalized specialties, such as surgery or pediatrics. Most advisors and mentors would advocate doing an elective rotation at an away site early in your fourth year. Similarly, a subinternship at your home institution also should be scheduled early in the year. This will give you a chance to really perform like an intern, significantly integrate yourself into the team, and secure that letter of recommendation.

In fact, the role of the fourth year student is quite different from that of a third-year student. In a subinternship, you will get admissions from the emergency department. You will have direct patient care responsibilities. Residency programs will likely want to read your evaluation from the subinternship as part of your application packet. As a result, it may be advantageous to do this rotation at your home institution before doing an away elective. You already know the system at your home institution and won't struggle with mundane tasks that could detract from your performance, such as ordering tests, logging onto the computers, or finding the radiology department.

Finally, take full advantage of your last year of medical school. There are few times during the rest of your life when you will have the chance to learn something truly unique. Your residency will include some elective time, but at that point, you will already be focused on your specialty. So, during your fourth year, find something different to explore. Consider doing a rotation abroad. You might also want to schedule a rotation outside your chosen specialty at a hospital where you would like to do your residency. This would give you a chance to see the city and the hospital without having to worry about being at the top of your game 24 hours a day.

And don't forget to speak with classmates at your own school. Senior students can be a valuable resource and can tell you what worked well for them and what did not.

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