D is in MS2 and her clinical rotation schedules came out. The common IM, FM, OB/GYN, Ped, Psy and GS are on the schedule, 4 weeks each, in addition, there is 4 weeks of Orth and 4 months of Electives or Vacation.
Questions:
TIA
GS is intense. Ortho may or may not be. It really depends of the individual program she’ll be rotating through.
Vacation–does her schedule include dedicated study time for USMLE/COMLEX? If it doesn’t, she should use her vacation to study for boards. 3-4 weeks of dedicated study time is pretty common for Step 1/Level 1. If your D plans to apply to any ACGME (MD) residencies, she must take both exams.
If her schedule already includes dedicated study time, then your D has more options. A brief vacation (1-2 weeks) is pretty normal and nice way to break up her time, esp if she takes it between MS3 and MS4.
RE: slack time-- don’t assume that her rotations will begin and end in smooth lockstep. Since DO rotations are done at several different clinical sites, all running on different schedules, there may be a mismatch of when one end and the next starts. Her vacation time may get eaten up by a week lag here and a 2 week lag there between rotations.
What are your D’s areas of interest for specialties?
If she hasn’t rotated through all of her interest areas, then she needs to do at least one elective rotation in each during MS3. If she has a done a rotation through her area of interest, then she should consider doing a elective sub-I rotation in her potential specialty. She’ll need 1-2 specialty-specific LORs from supervisors/PDs for her residency applications.
She may also want to apply for away rotations (also called audition rotations) at any residency programs she has a strong interest in matching at. These are best done before she applies for residency next June/July. If your D wants to apply to ACGME residency programs, she really, really needs to do one or more aways in her future specialty at a ACGME residency program.
Some specialties (EM, for example) expect/require students to have completed one or more away rotations in the specialty before they apply to residencies. That’s something to consider also.
ERAS opens for DO residency applications in June with PDs receiving applications in mid-July. .
One more option for “vacation” time during MS3–a dedicated research block in her future specialty to gain a publication or presentation to enhance her CV for her residency application.
MS3 are expected to busy and productive. 4 months of vacation will not look good to PDs.
A little vacation is ok, but I recommend using elective time as much as possible for electives, especially if there’s any chance she wants to pursue a specialty not covered in her schedule already or if subspecializing might be on the horizon.
I will ask her take the electives instead of vacationing. She is taking Comlex and USmle step 1 in early June, just few days after the start of the Rotation, so we told her to pick a schedule that has the first month off/vacation.
I don’t know how rotation is being scored, but can she take an elective with a private clinic without school affiliation? In this past summer, I took D to an infertility clinic for shadowing she seemed like it. The clinic is run by my friend, so I had the inside track. Obviously, to practice in infertility requires a fellowship and not sure she should shadow/rotate in this sub-specialty that is 8 years from her MS2 status. Jokingly, my friend told me that D is welcome to take over her clinic, but she may not be able to wait that long before retirement.
No. Any clinical rotation site for MS3-4 must be an accredited GME site and meet all standards set out by the ACGME (allopathic) or AOA (osteopathic). A rotation site must also have an agreement with the medical school that allows students from that school to rotate through it. (There are massive insurance issues involved. I know that D1 had to provide proof she had $1M in malpractice coverage to rotate at a site NOT directly affiliated with her medical school.)
REI (fertility specialists) physicians are required to have completed a OB/GYN residency (4 years) plus an REI fellowship (3 years). There are only 2 osteopathic REI fellowship programs and each program accepts a single fellow each year.
See: http://opportunities.osteopathic.org/search/search.cfm
Clinical grades are largely subjective (students get graded and ranked based upon the perceptions of a student’s performance by the attendings and residents), though some programs factor into the grade the student’s performance/score on the shelf exam in that specialty.
Aoa and acgme are merging by 2020. So, residency and fellowship will be accredited by one gme organization. Perhaps that is the reason why DO schools have to abandon the grade replacement policy. And the recent up surge of admission standards for DO schools.
http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/default.aspx
S’s school had one elective rotation third year. If anything it confirmed in his mind that that particular specialty was not for him. Also on MSPE, the attending who oversaw this elective said some very nice things about S. He said things like S worked well with others, would make a great……., etc. Residency PDs are going to read this, so it could be a positive for D in gaining an interview. So I say take and use elective(s) as opportunity to further decide her future and also gain some additional positive comments from her attendings. I agree that a PD doesn’t want to see a lot of doing nothing time from an MS3. D is applying for a job after graduation and she doesn’t want to look like a slackard.
S did have two weeks off in his third year, I think at end of third year. He probably used time to help prep for Step 2CK…Shelf exams were included in S’s grades.
Whether or not a rotation will be difficult depends on where D is assigned, who are attendings, fellows, residents, what patients are at facility, with what needs. If D’s schedule just says something like she’ll be assigned at county hospital for surgery in November, it’s hard to know what will happen in March. If her schedule is more specific like Dr Pompous Arse will be her attending, then good luck to D.
Rotation and elective are not the same thing - but even then I’m not so sure it’s that black and white. At my school for example, as long as a physician affiliated with the school is supervising you, it is accepted. For example I was thinking of doing an elective with a surgeon who has operating privileges at my school’s hospital but whose practice is completely unaffiliated with the school. I would have been working both in the hospital and at the practice. For one of my required rotations even, my preceptor had admitting privileges and took call at the hospital but spent most of their time in a small, no-insurance, private practice in a wealthy part of town that I had to travel to. No residents or fellows ever set foot in the practice but I went there and would “see” patients on my own and present. By the end of the rotation they frequently didn’t do much more than ask if the patient had any questions for them. That’s been the setup for a few years so I doubt it’s against the rules.
100% this. Almost impossible to really predict what it’s going to be like for any given student.
If you want to read the boilerplate that LCME uses for the requirements imposed on med school programs for electives as well as required clinical rotations–you can go here:
Electives are required to have evaluation standards, to have a curriculum, must to allow for remediation of unsatisfactory performace, must have “sufficient resources and authority” to provide for adequate educational experience, must be monitored so it conforms to educational and curricular standards, must have a regional officer responsible for local oversight of geographically distant programs, must undergo periodic review for effectiveness, blah, blah, blah…
^And none of those things are mutually exclusive with “non-university/hospital affiliated private practice”
Oh, I agree it doesn’t rule out an elective at a private practice or clinic. The state med school sends its students out on mandatory rural medicine rotations twice during the course of their 4 years. (Once the summer between MS1-2 and once again as a MS4.) All are at private practices/clinics.
However, unless the preceptor routinely takes students (which is the case with rural rotations here), there’s an awful lot of hoops/paperwork to jump through to have a one-time-only rotation for a single student.
Plus, there’s still the whole malpractice insurance thing.
Let me ask questions from a different angle.
What a student do in a Rotation that is different from Dr. Shadowing? Or like D, during the MS1 summer, she went to a school sponsored overseas “intern” at a hospital for a month, she was rotating among 3 or 4 different departments and shadowing.
And why there is a malpractice insurance? Are they treating the patients?
I don’t think a student should “Rotate” in a sub-specialty, because they have not even learned the ropes from the specialty.
During the rotation, a student will be introduced to foundational concepts of the specialty. They will assigned readings & case studies. They will take a shelf (NBME) exam at the end of the rotation to test their knowledge of the field. (And fail the shelf = fail the rotation.) They will attend rounds. They will pre-round patients and be responsible for presenting patients to the residents and attending. They will be assigned patients to monitor and do work ups for. They will recommend/suggest treatments and tests and do follow-ups. (They can’t enter notes in the EMR or actually order treatments/tests, though–that’s outside their scope.) They will conduct physical exams. They take patient histories. They will perform minor procedures on patients.
A clinical rotation is much more active, in-depth and involved than shadowing. And yes, they actually do lay hands patients–so that requires malpractice coverage. (For example, on OBG rotations, med students will assist w/ surgical abortions, insert and remove IUDs, do breast, pelvic & rectal exams, assist w/C-sections and hysterectomies, suture incisions, do internal exams during active labor, catch babies as part of a vaginal delivery. )
Student are expected to rotate in a sub-specialty if it’s a field they have strong interest in, but only after they have completed a rotation in the basic field. IOW, if a med student is interested in CT surgery (or trauma, or abdominal or ortho or ENT or anesthesia or Opthal), they will do a sub-I in that field after they’ve finished GS. Or if a student is interested in cardiology (or oncology or GI or ID or pulm/CC, etc) , they should do a sub-specialty sub-I after they’ve completed IM. Ditto for OBG, EM, Peds sub-specialties.
Students will do rotations in sub-specialties to help them decide to pursue or not pursue certain fields.
I will also mention that at least at D1 and D2’s med school, each basic 3rd year rotations last 6 weeks and students rotate through several departments in each specialty. Then they get to pick 1 or 2 subspecialties to spend a full week in. During her GS rotation, D1 spent a week in trauma surgery. During her OBG rotation, D1 did a week in uro-gyn and another in well women/family planning. In IM, she did CC/pulm and something I can’t remember. D2 did MFM and gyn onc during OBG, ortho during GS, and med onc and cardiology during IM.
At my school students can write notes and place orders in the EMR. The notes appear as “unsigned” and then require consigning by the resident or attending to be considered official. Notewriting is expected in certain specialties and it’s a badge of honor for the note to get signed with just “agree with excellent med student note” (one MD/PhD resident once wrote “agree with note from Dr. IWBB, MS3”). Orders require a cosign from a resident or attending to become actionable. Usually we don’t bother because it doesn’t save the residents time to sign our order vs place one themselves. As a sub-I it is expected that you will place all necessary orders for your patients and the senior resident will sign them.
Examples of things I have done beyond shadowing:
Interview and examine patients. (Attendings may or may not repeat things when they see the patient.) On a busy consult service the attending once had me go see all new consults initially and determine if they needed to be seen ASAP or could wait until after seeing everyone we were already following.
Draw blood (including arterial blood gas) start IVs, remove IUD, vaginal delivery, Pap smears, make first incision and dissect down to muscle, operate camera during laparoscopic procedures, position patients for surgery, insert/remove foleys, intubate patients. Bag mask patients, CPR on a newborn, ligate a Fallopian tube, morcellate and remove a uterus, psychotherapy, run family meetings during psych, wound dressing changes, write initial reports on radiology and pathology, assist in an autopsy, ultrasound pregnant women, ultrasound to look for pneumothorax, administer cognitive tests, draw up a safety contract with a patient, suture wounds, remove sutures, and I’m probably forgetting things