Category: Clinical Rotations

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The Day To Day Schedule of a Third Year

An incoming first year medical student asked me, “what is the day to day schedule like in medical school?” To begin with, I want to differentiate the two halves of your medical school education. The first half is spent in the classroom and the second half is spent in clinical rotations. In this post I will be discussing the day to day schedule during your clinical years, specifically your third year (because fourth year is basically like senior year of college).  Now before you scroll down to see the day to day hourly schedule of a third year medical student I have a few caveats about your third year clinical rotations to reveal.

Everyone’s experience is different. 

During the first two years of medical school, regardless of what school you attend, everyone basically learns the same stuff. The information that you are eventually are tested on during your United States Licensing Exams (USMLE) is standardized regardless if you went to an Ivy League school or a Caribbean one like me. So the first two years of didactic lectures are pretty similar in every medical school. This standardized experience of your first two years of medical school is grossly different compared the second half of your schooling. You can be from the same school and be in the same rotation and have completely different experiences during your rotations, and there’s a number of reasons why. You works with different residents, different fellows, and different attending physicians and each one of them will share with you something unique. Not to mention that you end up seeing entirely different pateints. There is simply no way for everyone to have the same experience. Ultimately, although you might have the same schedule as your colleagues, your experience can be considerably different.

Each respective rotation is different

My third year core rotations consisted of the following: 6 weeks of pediatrics, OB/GYN, psychiatry, and family medicine, and 12 weeks of internal medicine and surgery and each rotation’s schedule was completely unique. Just think about how different the day to day life of a surgeon is compared to a psychiatrist. The same is true when it comes to your schedule. More so, each hospital’s respective rotation experience can vary widely between the hours you work, number of patients you see, balance between autonomy and supervision, and how much the residents and attending physicians are willing to teach. So take the following daily schedule with a grain of salt because it is mainly applicable to my internal medicine rotation that I completed in Brooklyn, New York.

Here’s my daily internal medicine schedule

  • 7:00am. Handoff from the night team. Pick up a new patient.
  • 7:00-9:00. See patient(s). Write note. Talk to the cute nurse. Look up how to treat my patient. Talk to my patient’s actual nurse. Present and discuss my patient with my resident. Prepare presentation for rounds.
  • 9:00-10:30. Round with my team. Present my patient. Discuss assessment and plan with the attending. Make updates to my patient’s treatment plan.
  • 10:30-10:35. Find that piece of paper that you wrote everything down on and then subseqently lost.
  • 10:35-10:40. Find your team that you lost while you were trying to find the piece of paper that you just found.
  • 10:40-11:30. Play it cool. They wouldn’t have noticed if you left altogether. Update my patient’s note. Call consults and check if lab-work results are back and interpret them if you can.
  • 11:15-12:00. Lunch. Attempt to resist drinking second cup of coffee.
  • 12:00-1:00. Lecture of some sort.
  • 1:00-1:15. Go get that second cup of coffee. Remind myself to stop trying to stop drinking coffee.
  • 1:15-4:00. Go say hello to my patient. Make sure labwork, radiology, and procedures were ordered. Call people to make sure it gets done. Eventually ask my resident, ‘if there is anything else I can help with’ and hope that they don’t need something faxed. God I hate fax machines. Seriously, why do they still exist?? I think its punishment for all the years of attitude I gave my parents when I wouldn’t help them find the ‘TV/VIDEO button’. Side note, when are TV/VIDEO buttons going to be a thing of the past?
  • 3:00-3:05. Complain about my research project.
  • 3:05-3:30. Work on my research project.
  • 3:30-4:00. Find someone to procrastinate with. Find someone to annoy if they won’t procrastinate with you.
  • 4:00-6:00. UWorld.
  • 6:00-7:30. Home, relax, gym, shower, eat.
  • 7:30-8:30. Review UWorld or watch Kaplan videos (Thank you Conrad Fischer and Online MedEd)
  • 8:30–midnight. Beer, Netflix, Xbox, read something non-medical, and lament over how little I got done today. Repeat tomorrow.
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How to Study for the Psych Clerkship Exam

Psych is generally regarded as the easiest of all the shelf exams. That doesn’t make studying for it any easier. Here’s how I approached it and what I would have done differently:

Overview: There is always overlap when it comes to clerkship exam content. On the psychiatry shelf you will be tested on neuro, pediatrics, OB/GYN, and some internal medicine along with psychiatry. It’s annoying but it makes sense if you think about it. For instance, if a patient comes in with increasing forgetfulness your differential list can be quite wide. This being your psych shelf you might be anchored to a diagnosis like pseudodementia secondary to depression but you also have to think about Alzheimer’s and hypothyroidism.

Psych Specific Tips: Know the timeline for psychiatric illnesses cold. You need to be able to differentiate brief psychotic disorder from schizophreniform from schizophrenia based on the timeline. And acute stress disorder from post-traumatic stress disorder. And both of those from adjustment disorder. It seems easy and it is. But the diagnostic criteria and various timelines can blend together quite easily when you are taking a two hour hour test and each question has the same differential diagnosis list. Also, psych meds are huge on this test so don’t neglect them.

Resources: First Aid for the Psychiatry Clerkship is gold. It has everything you need for both the clerkship exam and step two. My primary resource when I studied for step two was Master The Boards (MTB) by Conrad Fischer. It provides a good skeleton but leaves you dictating a lot of stuff that isn’t in the book. If you know everything in MTB then you will likely know all the high-yield stuff. But it is entirely comprehensive. That’s why I suggest the First Aid for Psych Clerkship. And as always, UWorld is the gold standard for practice questions.

Practice Questions: As I said, UWorld is the gold standard. Finishing the psych section is doable. I would also attack the neuro section while you’re at it. If you finish all of that then redo all the questions you got wrong. If you finish those questions and want more I would next use PreTest for pysch. PreTest presents a lot of good information that isn’t in any review books (FA, MTB included) or even in UWorld. Granted, some of these questions are beyond low-yield and you should always know the basics inside and out before you delve into the esoteric. That being said, PreTest is a good resource if you’re looking for a couple hundred more new practice questions before test day.

tl; dr: Use First Aid for the Psych Clerkship, annotate Master the Boards, finish the psych and neuro UWorld questions…and basically just know everything.

As always, this isn’t anything groundbreaking but I wish someone told me this when I started psych. Feel free to leave any follow-up questions you may have down below!

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OB/GYN: What To Expect

“I’m starting my third year with OB/GYN. Do you have any tips or tricks for that particular rotation? Anything I should expect working with those attendings? Or anything the attending like or expect from us? Just anything that could help before starting.”

Short answer: Expect vaginas, babies, long hours, and lots of vaginas.

Long answer: During my obstetrics and gynecology rotation I rotated through each aspect of the specialty. Obstetrics, gynecology, gynecological oncology, a week with a preceptor, a week in the outpatient clinic, one week on days, and one week on nights. Days and nights are the worst because they are literally twelve hour shifts. My surgery rotation wasn’t even this bad. In surgery you can at least steal away to the library to study. In OB/GYN, you are constantly doing something. It’s a lot of work and in my opinion the toughest third year rotation. Not to mention all of the vaginas.

For me, one of the most difficult aspects of pediatrics and OB/GYN is the fact that it feels like I’m studying a complete different species. For the most part, in internal medicine, family medicine, emergency medicine, surgery, and psychiatry you study the medicine involved with the adult human being. Pediatrics and OB/GYN are completely different entities. The steep learning curve in OB/GYN is a tough one to tackle. So grab a review book and start reading and, like every rotation, be present! Learn as much hands on medicine as you can. The OB/GYN residents I worked with went above and beyond to teach. They get a bad rap in my hospital for being…high-strung. Yes, let’s say high-strung. All joking aside, they are hard-working, intelligent, and willing to teach but you have to be willing to work. Just don’t get stuck doing SCUT work all day. Yes you are there to help but first and foremost you are there to learn. So be a part of the team, be willing to help out, ask questions, and learn! Of course, pick and choose your time to ask questions. There is a delicate balance between inquisitive med student and OMG STFU med student.

OB/GYN also sends you into the surgical realm. So learn how to scrub in properly and be nice to the scrub nurses. Also be warned- there are certain scrub nurses who will be rude, curt, and straight up nasty to you in surgery. Don’t take it personally and just roll with the punches. Introduce yourself when you enter an operating room and state your purpose. My friend got into the habit of literally walking in and saying “Hi my name is John Smith. I’m a medical student” because when you walk into an OR everyone will look to see who you are and it’s kind of awkward if you just scoot in without saying anything.

As for the attendings, I stopped trying to guess what they are thinking and what will make them happy. Just show up on time, work hard, study your medicine, be professional, be kind to your patients, and you will be fine.

Let me know if you have any follow up questions. And as always, happy studying!