3rd Year Clerkships

IMF

Internal Medicine Foundations was an 8-week rotation that was a requirement for all students before starting core rotations. RUSM has recently made some changes to the curriculum and IMF is no longer present. I won’t be going through all the details of what needed to be completed in order to start IMF but, I will be talking about what we did for those 8 weeks.

Virtual: Due to the pandemic, many changes had been made and students were no longer allowed on the RUSM campus in Miramar, FL. Instead, all of our OSCE sessions were virtual along with some other online lectures and patient encounters. OSCE sessions were once a week for 4 hours. We would interview the patient, verbally explain what physical exams we would perform, and then type out the SOAP note with a 10-minute timer. The purpose of the OSCE sessions was to prepare us for clinical clerkships as well as USMLE Step 2.

In person: Actual patient encounters were done at Cleveland Clinic Hospital in Weston, FL. We went into the hospital approximately 3-4x/week. Some days, we were given a patient to work with and other days, we were working at the entrance for COVID screening. We were required to write H&Ps on the patients we saw along with presenting some of these patients to one attending/resident each week. Although all of the reports and presentations were participation grades, they were requirements in order to make us better equipped for rotations.

ACLS/BLS/PALS: All students were required to complete CPR certification at the University of Miami during IMF. It was a one-day course that was completed in-person with hands-on training. This was one of my favorite parts during IMF because they simulated the events and allowed us to practice on the dummies as if it were the real deal. There were some online courses that needed to be completed beforehand.

Evaluations/exams: We had to perform a physical exam on our partner to an attending/resident twice throughout the entire 8-weeks. The final exam was multiple choice and all online. It was fairly straightforward and based on the weekly quizzes we had at the hospital. The final H&P was part of our final grade. We were given a virtual patient encounter and had one week to write up the report.

Overall experience: although it was really nice to be in a hospital setting and have some sort of patient encounter, I did not find IMF as useful as I thought I would have. What helped me the most was learning how to write H&Ps and SOAP notes along with presenting them to an attending. But, the few patient-encounters I had were not enough for that hands-on experience I was looking for. I wish IMF had provided more of that so that I could be more prepared for rotations. I know they used to teach a lot more before the pandemic hit so I’m assuming that is why our cohort was unable to do all those things.

Psychiatry

My first core rotation of third year. 6 weeks flew by in the blink of an eye. The schedule was pretty consistent throughout the 6 weeks. We had a total of 8 students that were split into two groups. The two groups alternated each week on starting at 6:30am. For the weeks that I started earlier in the morning, I rounded on psych patients with the rest of the group and the attending. After that, we would see any consults the attending might have. On Monday, Wednesday, and Friday we also observed Electroconvulsive Therapy (ECT) procedures. The procedure lasted anywhere from 15-30 minutes per patient. Once all the ECT’s were completed, all 8 of the students would meet with the doctor around 8:45am and discuss psych topics. After that, we individually rounded with our assigned patients.

There wasn’t any additional work that was required by the attending besides two patient write-ups. The attending was extremely helpful in giving feedback along with being a great teacher.

Psychiatry was definitely a lot lighter on the workload and I had a lot of free time to do other things outside of studying. I think it was a great first rotation that allowed me to become more familiar with the hospital and adjusting to seeing real patients.

Study resources: I completed all of the UWorld psych questions and then redid all of the incorrects. I also took notes on all the Online Med Ed videos for psychiatry. I used these notes to review and wrote in any additional notes from UWorld. I used Case Files to review in a case format and I thought it was helpful in learning how a patient would present. First Aid for Psychiatry was another resource I used. It was a fairly short textbook and was an easy read. The last resource I used was USMLE Step 2 Secrets. I used this as a quick review on the main topics of psychiatry. It’s a small book that consists of high yield topics.

The shelf exam was decent overall but there were a few questions that were unexpected.

Family Medicine

For family medicine, I ended up being placed at two different clinics. For the first 3 weeks I was at a small family practice. The hours were from 9AM to approximately 4:30-5PM. It seemed like a lot at the beginning, but I had a couple hours of study time during the day around lunch time. These 3 weeks were the most memorable for me during my family medicine core. The doctor had been seeing these patients for an extended period of time and I got to witness the connection he had with his patients. I gained a lot of insight on how far patient care can go when there is a good understanding and relationship between the patient and doctor. At this clinic I got to have one-on-one interactions with majority of the patients. I would see the patients, do a history & physical, and then go back in with the doctor. The doctor was great in teaching me during the patient encounters and ‘pop-quizzing’ me randomly. The workload was perfect as a student because I did not feel rushed in trying to see all the patients. There were usually about 26 patients on the schedule. The other student and I would split the patients in half and there was adequate time to interact with the patients. The last 3 weeks were spent at a different clinic that was much larger with multiple providers. We started at 7:30AM and went till 5PM. The days were much longer at this clinic with not a lot of free time. I was also the only student working with this doctor, so I ended up seeing about 25-27 patients each day. It was mentally and physically more draining, but I did have Mondays and Fridays off to compensate for that. The EMR was the same as the one used at SJMO and it really helped me learn more about it throughout the 3 weeks. The downside of the second clinic was that I did not learn as much as I had expected. I felt more like a scribe who was filling in all the gaps on the EMR but there wasn’t much interaction between the doctor and I. Overall, family medicine was a mix of good and bad moments. It does get repetitive after some time with a lot of physicals and common disease managements such as hypertension, diabetes mellitus, and hyperlipidemia. But, I think it does a great job in teaching you about long-term patient care and building a healthy relationship with your patients.

Study resources: Family medicine was a tough shelf to study for due to such a broad range of questions. UWorld had about 800 questions if you completed both the Family Medicine and Ambulatory sections. This was a lot of questions to complete in 6 weeks. Although UWorld was the only resource I was using to study for the shelf, I still felt like I was constantly falling behind. I struggled to retain the information because I felt like I was rushing through UWorld to finish all the questions. I completed two NBMEs as well. The first did not go well at all and it was extremely disappointing. The shelf had a lot of management and “what’s next?” questions and it was difficult to change my way of thinking because we’re so accustomed to answering questions based on treatment alone. I felt relieved being done with the shelf and it did not go as bad as I had thought but the entire study process was overwhelming. There is a lot of material on UWorld that has never been covered throughout basic sciences and you will feel like you’re like things for the very first time. I recommend slowing down with questions and trying to retain the information compared to rushing through them just for the satisfaction of being done with it.

Internal Medicine

Finally finished the 12-week IM rotation and all I can say is that I am left with a bunch of mixed emotions. At the beginning, it seemed as if the days were passing by very slowly and everything was dragging on. But, the pace started to pick up after the first month. 12 weeks seems like more than enough time to study, and it is, if you use your time wisely. It’s easy to push back studying when you know you have all this extra time. But, trust me, it is better to get started from day one. This rotation is all about medicine in addition to a little bit of information from each of the other core rotations. That being said, there is lots of material to go through and learn about. I got to a point where it was overwhelming to learn new material on top of the old material that I needed to continuously review. The good thing about rotations though is that you also learn while working with your patients. You get to a point where remembering a real patient case is more helpful than reading 20 pages out of a textbook. It really is important to be able to take your clinical knowledge and combine it with your basic sciences knowledge.

What my schedule looked like:

4 weeks of inpatient floors

2 weeks of Heme/Onc elective

2 weeks of ICU

2 weeks of outpatient clinic

2 weeks of inpatient floors

Floors & ICU were pretty similar in the sense that you meet with the residents in the morning and are assigned a patient or two. You then get an hour or two to chart review these patients and to go see them, do a H&P, etc. Once this is done, we meet up with the team and do rounds. Majority of the time, after rounds, the students were done for the day and we used this time to attend our afternoon lectures and study. The only days we needed to stick around was for on call days. During on call days, we would be at the hospital until about 6:30pm and helped out with new admissions.

Heme/Onc and outpatient clinic were the most beneficial for me because I got to work one-on-one with the doctor and got more hands-on experience. During outpatient, I learned how to put in orders and referrals. This seems very minor for now, but it actually reinforced which labs/tests/medications are associated with the common diseases we see on a daily basis in IM. Not only that but I think the extra knowledge I gained about Epic will be helpful when it comes to starting residency.

Study resources: UWorld was my main study resource due to the extensive amount of questions provided. It took me about 6 weeks to get through all the questions. Around week 6, I started using Anki as well and this really helped solidify the material through the repetition. I took 3 practice NBMEs during the last three weeks and used those additional questions to learn from as well. The NBMEs went really well but unfortunately the shelf questions were nothing like UWorld or NBME. I felt as if I was breezing through the questions and randomly selecting answers because I felt clueless for majority of the exam. Overall, there is a lot to learn during IM and all I can say is that make sure you get a head start as soon as IM begins.

Pediatrics

And that’s a wrap on Peds! I am officially more than half way done with 3^rd year and I cannot express how great it feels to be that much closer to my end goal. I spent the first 3 weeks at an outpatient clinic and although this seems to be the most boring for students, I absolutely loved it. I got to interact with a wide variety of patients, all the way from newborns to 18-year-olds. And this taught me a lot about the importance of adapting and adjusting to your patient population. I got lots of practice on doing H&Ps and became really comfortable in doing physicals in younger children. After outpatient, I had 1 week of inpatient and 2 weeks of NICU. Inpatient was interesting with the fact that it was similar to outpatient but in a hospital setting. And on top of that, we also saw the newborns and got to interact with the mothers. NICU was my least favorite of the whole rotation due to the fact that you cannot exactly communicate with the newborns. Although I admire the entire NICU team and all the effort they put into making sure these babies get to go home and be with their families, I realized that this was not for me. I adore kids and I like being able to interact with them and talk to them. I think that communication helps you build a strong patient-doctor relationship and that’s what I am looking for in the future.

Study resources: As we all know, UWorld is always the number one resource for shelf exams. Outside of that, Anki was great for spaced repetition and I even came across some things on Anki that were not on UWorld. I completed all 4 NBMEs although I think that not all 4 were necessary now that I look back on it. I would definitely recommend taking at least 2 and reviewing through them efficiently. Towards the last couple weeks, I reviewed through Emma Holliday’s Pediatrics Review, Dr. High Yield’s Review, & Divine Interventions Pediatrics Review. Since I did not fall behind on my studying, I seemed to have a lot more time to go through those last 3 resources and focusing on the high-yield material.

Ob/Gyn

ObGyn is officially done, and this rotation flew by the fastest for me. With a few extra days off for the holidays, this rotation did not drag on at all. Although Ob/Gyn is not the specialty I want to do in the future, it definitely kept me interested for the past few weeks. From delivering babies to watching gynecology surgeries/procedures, I would say this rotation has offered a broader range of learning than what I have experienced before. People usually think that Ob/Gyn is all about pregnant women and giving birth but there is so much more to this specialty. I got to have multiple different learning experiences from both a clinical and hospital environment. On top of that, we had 1 week of night shift, and this was definitely something new for me. I have been a morning person for as long as I can remember so it was a challenge to adapt to this change but it was worthwhile in the end.

Surgery

These 12 weeks of surgery were some of the longest weeks for 3^rd year. With the early mornings and long hours, this rotation felt the most dreadful of them all. Although I am not interested in surgery, I did get to see some intriguing things and with some great partners by my side, it all made the rotation more doable.

What did the 12 weeks consist of?

1 week of trauma
1 week of nights
5 weeks of general surgery
1 week of cardiothoracic surgery
2 weeks of colorectal subspecialty
2 weeks of breast subspecialty

Out of the 12 weeks, the breast subspecialty was my favorite. For someone who is interested in primary care, these two weeks allowed me to interact with patients in a clinic setting and there was more continuity of care. I was able to see some patients in the clinic before and after their surgery, which helped bring everything together for me. In addition to that, my preceptor was extremely patient when it came to teaching me and I enjoyed being able to connect what I learned in the clinic/surgeries to what I studied outside of the hospital.

Study resources: As always, UWorld was my go-to for this rotation. Since this was my last core rotation, having completed all the previous rotations helped a lot. The surgery shelf consisted of a good mix of all the core rotations and was especially heavy in Internal Medicine. I would say that it is beneficial to review through all the material in addition to surgery for the shelf exam. Another tip would be to become familiar with trauma management since this was one of the main ways that NBME asked about surgery on the exam.

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