Advice for MS3: Clinical rotations, LOR, scheduling electives, etc.
Congrats! Half of the journey is done. Now, onto the great unknown. In my opinion (and this whole blog is only my opinion), 3rd year is so much better than basic sciences. It presents its own challenges. I’m definitely more tired, but it was so much easier to keep going because I could see where I wanted to be.
Logistics
There’s a similar section in my first clinical rotations post, but here is my 4th year medical student updates!
On budgeting
I’m in the January class so budgeting was even more on my mind. In the January class, the loan disbursement that we received in August is to last us until our clinical rotations start the following May/June! I know a fair amount of people working during their dedication. On top of that, I probably missed some financial aid meetings but I wasn’t aware of the costs for Step! Because SGU students go through ECFMG, we had to pay a certification fee of $165 + an exam fee of $985. Also if you don’t have any locations near you, you might have to pay for hotel costs. In addition, if you plan on taking more than one NBME (practice exams, SGU will give you a voucher for one) each will be $60! So be smarter than me and save some money for this!
3rd year schedule
As someone who loves routine, loves plans, loves pretending I have some control over my life. Clinical rotations are unpredictable. So I think when you get your 3rd-year placements likely a couple weeks ahead of time, it’s representative of this part of life.
I was emailed my 3rd-year placements about 3 weeks before the start date. It included the start and end dates for internal medicine, surgery, OBGYN, Family Medicine (this was canceled about 3 weeks before I started), Pediatrics, and Psychiatry. About 3 days before each rotation, I usually had to reach out for my schedule and reporting instructions. Most of the time, the clinical coordinator would give me the start time and location for the first day. Then when I was actually onsite, I’d get a better idea of what the rest of the rotation would be like. Some rotations were incredibly structured. One attending made a month-long schedule which included which physician I’d follow and what days I had off. Other rotations, I’d know what days I had off as went went - like a couple days before I got the day off. Some rotations would have students come in only Monday through Friday. Some asked students to go 7 days in a row or night shifts. So it really depends. Once you’re at a site, it’s a good idea to ask around about what the schedule has been like and if you can meet anyone with rotations you’ll have in the future.
What to wear
For most rotations, I’ve worn scrubs. So when I scrambled to buy a couple of business outfits before rotations started, it was mostly in vain. But I’d suggest at least getting one outfit, just in case.
Scrubs:
Mandala: I’ve converted to all Mandala. I really love the jogger style and they have so many pockets so I can horde all my notes and pens. They’re actually on the cheaper side of scrubs and really easy returns. You can use this link to get $5 off which is already a third of the price. The only thing is no free shipping which Amazon has ruined for all my other shopping experiences.
Amazon (the Adar brand has been comfortable)
If you’re really in a pinch, there are always second-hand stores that have scrubs though I don’t want to imagine what they’ve gone through.
Shoes: Since you’ll be in hospital/inpatient settings and outpatient/clinic settings, it can be helpful to have comfortable sneakers and a business casual pair. What you’re looking for is comfort. I’ve stood for hours. My feet hurt.
New Balance x Figs: I just purchased these for $98 which is reasonable. So far if you like a stiffer shoe like I learned I liked, this is really supportive.
Addidas ultra boosts: I got mine on sale for about $80 around Black Friday. They were very plushy, but not the right support for me, and hurt after a couple of hours. Some people get orthotic inserts that I heard can help, but they were just too clunky for me.
Rothy’s knockoffs for business casual
If you have the money, Dansko Clogs! People I’ve met who have them absolutely love them, especially the surgery peeps. I wish I went full send and got them.
Compression socks: An absolute must!
Student white coat: SGU gave my class the long attending size one. I didn’t even know that was a thing. So I had to purchase a short coat before rotations. I couldn’t find a definite answer on what is considered short, but I’ve been using this one. Some rotations want you to wear them, some are less strict.
Stethoscope: I tried using the one SGU gave us. Maybe it was my ears, but it was really heavy and hard to hear. I got this one and it’s been durable and great.
Women’s light jacket: In many of my rotations, white coats were not required. Sometimes no one even wore them. I get cold easily so a light athletic jacket like this was helpful when inpatient
What I bring every day
In my scrubs, I usually carry pens, masks, and eventually too many notes. In my white coat, I have carried:
H&P notebook: This was so helpful for IM and my first rotation. I didn’t have a routine yet of what information to collect. It’s a great training wheel and comes with a 100 note templates. It was my reminder of things to ask, physical exam maneuvers to do, a place to write my presentations, and updates on the plan when we round. It’s my crutch and I loved it. Eventually, I learned what things to ask and my residents taught me a cheaper way to prechart.
(Alternative) Foldable clipboard: I’ve seen residents and nurses use these which seem super handy. Some even have lab values and random helpful facts. This might be better and more lightweight if you plan on just using loose paper.
Badge reel: My location doesn’t give students badges and requires me to display my school ID. I bought some cute motivational ones to compensate for my anxiety.
Pocket medicine: My PCP recommended this when I was getting my health clearance. It’s like an ultra condensed version of First Aid for IM. A resident told me if anything it makes you look smart haha!
How to study
Keep it simple. Make it a template. Every rotation can be very different. From the schedule, to the demand, to the state of your endurance - you want to be able to rely on a tried and trusted routine. For me, generally for a 6 week rotation was:
1st week: learn how to be helpful. Casually glance at what videos to watch on OnlineMeded. Take the total amount of Uworld questions and divide among study days so I know how many to tackle a day. I usually took Sundays off.
2nd week: listen to the comprehensive reviews (Emma Holiday, Divine Intervention, or Dr. High Yield) casually to get a lay of land. Understand where my adventure better take me
3rd-4th week: Take a baseline NBME, how well has this adventure been going? Usually it lights a fire under me, to be honest.
4th-5th week: Take NBME weekly and finish Uworld. Start seriously watching comprehensive reviews.
6th week: Exam time!
And for the 12 week rotations, you can just add more space in between things.
Studying in clinical years has been more simple mostly out of necessity. There’s no time to question how many qbanks or textbooks you should get into. Just get into what you can. At the very least do the Uworld.
Helpful Apps & Resources
Up To Date: Please! If you sign-up for Up To Date in some hospitals, the membership is free. Another option is to ask a classmate who has this option, to make you an account. It is incredibly helpful in knowing the presentation, diagnosis, treatment, and all the good stuff about diseases. And flowcharts!
Dynamed: If that’s not an option, you can sign-up for a limited membership of Dynamed by becoming a member of the American College of Physicians (free for medical students). I do like Dynamed. It’s a more paired-down version of Up To Date. It’s helpful for prepping before interviewing patients to know what to ask and look for the physical exams.
MDCalc: For IM and FM. Great way to quickly calculate things like FENa, CHADSVASC, and blah blah if you don’t have the brain power
USPSTF App: For FM. It’s great because you can input your patient’s demographics and history and the screening recommendations pop up
Outside resources I used
The list is much smaller compared to basic sciences which has been great for my wallet. Though it felt like the wild west in feeling confident that I covered all my necessities.
Anki: I learned most of my Anki knowledge from the Anking on YT and this SGU student’s video. I used the latest free Anking deck. I didn’t go through every possible card like in basic sciences.
Uworld: SGU gives you a 720-day membership for Step 2 qbank. The Qbank has Shelf exam sections and Step 2 sections. Is it all you need? Probably. And it’s already paid for, plus plus!
Firecracker: SGU requires you to utilize Firecracker. They map out study plans, have flashcards, and weekly quizzes.
Sketchy IM/Peds/Surgery/OBGYN: The sketches are much longer and they don’t quite hit like the other ones. I still used it because I am a visual learner and it paired nicely with the Anking deck. During my rotations, it felt like too much information. Looking back now in dedicated, if I had only learned what they were trying to give me!
Question banks
UWorld
Amboss
I ended up getting Amboss during my third rotation, OBGYN. I felt like there wasn’t enough practice. Amboss was helpful because it has the wiki section. They also had “study plans” for each core and step. It was impossible to do completely with Uworld. However, if you’re seeking really high grades or 260+ on step - I’d say it can be helpful because it was very challenging. After completing the Uworld qbank, doing amboss, then going back to Uworld- Amboss was actually more particular. Not a necessity though!
NBME’s
NBME’s are practice tests. Each core has 2-4 online NBME’s that you can purchase off their website. They’re usually 50 questions. In 2023, they were about $20 each.
Step 2
I’ve got a blog coming up for this soon. Big tips:
It’s doable!
Compared to Step 1:
It’s easier because you learn every day on clinical rotation. These things actually translate to helping you with questions so don’t discount your experience
It’s harder because there is more to know, the questions aren’t as clear, and mental weight of knowing how important Step 2 is now that Step 1 is P/F
Set yourself up for success.
Have a home for your notes. There were many times I had to relearn something, but could not find where I wrote it down because I studied differently for every core. For basic sciences, that was First Aid for me. First Aid Step 2 is not that great. I tried Master the Boards, First Aid Step 2, Step Up To Medicine. None of those were complete. I ended up putting my notes in Anki because the information would return and was searchable.
Clinical Rotations
Everyone’s order of rotations differs. There are many clinical sites with different start days. I’m a visual person, so I made myself a timeline. I started clinical rotations in May 2022 and Term 1 was in January 2020. I really liked starting in May. It seems to have the most space. The later you start, the more condensed the timeline gets. So MS3 includes IM, Surgery, OBGYN, Psych, and Pediatrics. Sometimes a 6 week rotation of Family Medicine is included in 3rd year as well. I was originally scheduled for one, but it was canceled due to staffing. If you do Family Medicine in 4th year. It’s only a 4 week rotation. In my third year, most of my rotations were back to back. There was 2 weeks off after IM and the last 2 weeks of the year off. 4 of my core rotations were in the same hospital, but pediatrics and psychiatry were at a different hospital. I heard SGU attempts to place your cores in the same hospital. And they aren’t very amendable to changes to the 3rd year schedule.
The daily routine is site/attending/and resident specific. Some rotations, I worked weekends. Some wanted students to do night shifts and call shifts. Some didn’t. Sometimes I knew my schedule for the whole month. Some told me week by week. Getting holidays off is also variable.
So how do you even do this?
Your daily tasks will differ with each rotation. However, there are some skills that you will use in most rotations. Most of the time in the hospital, you’ll pick up a couple patients. For me, I’ve followed anywhere from 1 to 6 patients. You’ll arrive early to prechart (review their charts and what’s new with them), then you’ll see your patients, then round with everyone. Later in the day, you’re often finishing notes or waiting for new admissions or new patients to be sent to your team.
In the outpatient or clinic setting, it’s very similar. You can be expected to prechart the patients, see the patients, present to your attending/resident, go back in together, and then write the note.
So generally expect to:
Present your patients
This video by Dirty Medicine can be helpful in what that means. A resident told me, when you work with new attendings it’s best to give a full presentation and then have them taper your presentation down because everyone has different preferences.
A note for my fellow “shy” people
Medicine often benefits extraverted people. It’s easier for them to connect with people including attendings and residents. Many attendings have told me, from their perspective if you don’t interject - it can seem like you’re not interested. That was hard for me to hear. I would put so much work in, but other people were more inclined to jump right into conversations. So if this is the case for you, here’s some tips:
Talk to your resident. In groups situations, especially where a resident jumps in to present, I’m very hesitant to interrupt and can be timid. I consulted my resident about how I’m working on being shy and they were more than happy to help. Of course, use your judgement. I know not all residents can provide this.
Ask for feedback from your attendings.
One attending instructed me to write 3 goals I had for this rotation. By goals, she said tangible, measurable goals. I found this so helpful. Going forward I could tell residents or attendings what I’m specifically working on like presentations or creating better plans and it makes it easier for them to involved. Plus I do much better in small groups or 1-on-1, so it was another way to signal that I’m engaged, avoid surprises on my evals, and get them involved in my learning.
Commit to saying one thing. A resident wisely told me to just say anything, even if it’s so wrong. Most attendings will value the participation over the work needed to be done in knowledge. Of course, use your best judgement. Sometimes just getting by is the best move.
Planning 4th year electives
In the midst of everything wild in 3rd year, you get to choose how your 4th year will look like! The school advises you meet with your advisor ASAP. I waited until after I took 2 shelves, because you can’t schedule anything until after that. The advisor’s job doesn’t seem to help you plan this, but more make suggestions.
So let’s break it down (as far as I know). You need 80 weeks of clinical rotations to graduate. It has to include
Of course your cores, FM
IM subspeciality (think GI, heme-onc, etc)
SUB-I which is related to your cores (so EM and FM Sub-I’s don’t count to this)
Everything else is up to you! I choose to do 3 audition rotations.
I choose to do electives in things I was interested in learning like ENT, Radiology, PM&R, Infectious Disease, Cardiology, 2 weeks of EM. I really wanted to try Pathology, but they were full everywhere near me!
How to get elective rotations
Most of the electives have to be through an affiliate site which can be found here with their elective lists here. The best way I’ve found is to email the coordinator to understand their process. Some sites you can do this through email and other hospitals have have online portals or pdf applications that need to be filled out. I started applying for electives in March and finally finished the process in July. I just want this off my list! But I know many students who were able to schedule a couple weeks before starting. However, if you have a highly desired hospital or rotation I would do some research about their elective process early.
Out of network rotations
12 weeks of rotation can be out-of-network AKA not part of the SGU network. I would recommend to use these for places you might want to audition for. Out of network rotations have a lengthy process. First the site has to be ACGME accredited. Then there’s two processes to deal with. Applying for the rotation through the rotation’s specific process and then doing all the SGU things. SGU requires paperwork to be completed 90 days prior to start date. SGU does not participate in VSLO which is a popular way hospitals have students apply for rotations. You can apply for rotations via Clinical Nexus and it’s free! Of note, out of network costs aren’t covered by SGU.
Asking for LOR
I would recommended talking to the attending you want to write a LOR early. I ask specifically if they’d be comfortable writing a good or excellent LOR. Use your gauge, you don’t have to send them the request if you’re not confident. I ask for their email and send them my CV with my photo and my personal statement.
If you don’t have an ERAS token open to store your LOR, you can ask the onsite student coordinator if they hold LORs (because you’re not supposed to read them), ask your LOR writer if they can write it now and you reach out to them later, or use systems like Interfolio which store them.
Making a CV & ERAS
Lastly, SGU asks you to make a CV. A CV is super helpful to give to LOR writers but use to get ahead on your ERAS applications. You will have to input all this information on the ERAS application. I’ll be making another post about that.
Warmly, Rainee
Rooting for you all! See you in 4th year <3