3rd year in review

So now that I’m finally at the end of my 3rd year of medical school, I thought I’d do a little “year in review summary” -

At Ohio State, 3rd year is composed of 6 two month blocks. We do 8 weeks of surgery, 8 weeks of pediatrics, 8 weeks of internal medicine, 4 weeks neurology/4 weeks psychiatry, 4 weeks ambulatory (family practice)/4 weeks elective, 6.5 weeks ob/gyn/1.5 weeks Clinical skills. We set our general third year schedule (that is, what order we are doing the clerkships in) using a combination of preferencing/computer randomization. Then, prior to each block, we preference for specific rotations/sites for that rotation which are assigned by the departments. At the end of each block, we have to take the NBME Shelf exams for that subject area. For the psych/neuro block, that means two exams at the end of the two months.

I started out the year on surgery. They try to break the surgery rotation down into one general surgery month and one specialty month. Options include pancreatic/liver/small bowel surgery, colorectal surgery, trauma, vascular, thoracic, cardiac, plastics, endoscopy, surgical oncology, burns, transplant, and general surgery rotations at outside hospitals. My first month was on pancreatic/liver/small bowel - widely considered to be one of the most difficult services in the hospital. I was fortunate to have an awesome 4th year student on my team as well as great interns/residents. We did some really interesting cases - lots of Whipple procedures (for pancreatic cancer), small bowel resections, cholescystectomys, nissen procedures, splenectomys, exploratory laparotomys, both open and laparoscopic procedures.

My second month was thoracic surgery (also a very difficult service). I didn’t enjoy this service nearly as much, partly because there wasn’t much variety - lots and lots of video assisted thoracoscopys, lung resections, bronchoscopys. There wasn’t much for students to do in these procedures, which made the long hours seem extremely unsatisfying.

I did surgery first for a variety of reasons - one of which being that I thought I would hate it, so I wanted to get it out of the way. Much to my surprise, I LOVED surgery, other than the hours. If I were a little younger and didn’t have a family, I would strongly consider general surgery as a career.

Hours on this rotation were by far the worst of the year - I usually got to the hospital between 4- 4:30 to preround. Work rounds with the residents started around 5:30 followed by either clinic or starting the day’s cases. Going home before 5 was an early day and I was there until 7 or later on a regular basis. We had to do 4 overnight calls on trauma as well. Didn’t leave a lot of time to study, so I took to carrying around my books and sitting in a corner of the OR and reading between cases.

2nd rotation: OB/gyn

I got exactly where I wanted for this rotation which was good and bad. I was assigned to a smaller hospital where OSU ob/gyn residents also train, as well as family practice residents. Hours were better than surgery - 7 to 5:30, usually, but we had to do 7 calls in the 6.5 weeks. (Calls varied by hospital - students at OSU only had to do 4 calls). We spent time doing gyn surgery, labor and delivery, high risk clinic, and ob clinic. The plusses of this location was that we generally got to deliver a lot more babies than students at OSU get to deliver, and there was a good amount of general gyn surgery. Downside - clinic was primarily pre-natal care only, so there really wasn’t much exposure to routine gyn issues. They also didn’t do a lot of gyn/onc procedures here. Students really didn’t do anything during clinic (which made it extremely boring).

During deliveries, once the baby was delivered, I found myself much more interested in the baby than the mother which I took as a sign that ob/gyn probably wasn’t in my future. As much as I really WANTED to like OB/gyn, it just didn’t happen.

This rotation was followed by a clinical skills experience. It wasn’t bad, but the downside for me was that I really would have found it more beneficial before doing surgery and ob/gyn. We got lots of practice suturing, ACLS practice, learned about vents, practiced central lines, LPs, paracentesis, thoracentesis, putting in chest tubes, I/o lines, etc.

3rd rotation: Ambulatory

For this block, I chose to do my elective month working on a research project for my MPH. There are lots of options for the elective month. A lot of people do anesthesia, radiology, derm, EM. Some people choose to do another month in something that is one of the core rotations - one of my friends did an elective month in neurosurgery, another did her month on ob/gyn.

My second month was my ambulatory month. Hour wise, this was the best month of the year. I actually did not do a family practice month - my preceptor was general internal medicine. Lots and lots of diabetes, hypertension, COPD. I enjoyed the month, learned a lot and my preceptor was great, but I’m not a big fan of being in the office setting. One downside was that I did this month in december, so between required lectures and the christmas holiday, this ended up being a very, very short month.

4th rotation Psych/Neuro:

1st month for me was inpatient adult psychiatry. This was an interesting month. We had quite a variety of patients. Each “team” in the inpatient setting has 8 patients. Every team had it’s own social worker to work on outpatient housing, follow-up, meds, disability, etc. Quite a few bipolar and schizophrenia, depression, suicidal ideation, etc. I had a pretty good idea prior to this rotation that mental health services were severely short changed, and this rotation only solidified this. Lots of genuinely ill people on this rotation and a few people who were working the system.

The second month of this rotation was neurology. I was assigned to inpatient neurology. This was a much better month than I was expecting. We saw lots of interesting cases - quite a few stroke patients, but also meningitis, guillen-barre, myasthenia gravis, duchenne’s, ALS, NPH, seizures. I got very good at doing a neurological exam very quickly as each patient required one every morning. We learned the basics of reading CT scans/MRIs

5th rotation: Pediatrics

Columbus has its own dedicated children’s hospital, so all of our pediatric experiences are based there. There are a wide variety of options available - ambulatory, general medicine, endocrine/renal/rheum, pulmonary, cardiology, heme/onc, infectious diseases, etc. Pediatric neuro/psych/surgery are assigned as part of the neuro/psych/surgery rotations. Most people got one ambulatory (outpatient clinic month) and one inpatient month. I got two inpatient months.

My first month was infectious diseases. Very, very busy service as it seemed like any patient who currently had a fever or who had had a fever any time in the past two weeks got admitted to our service, even if the real issue wasn’t an infectious disease. We saw a nice variety this month - we had several complicated pneumonias (requiring chest tubes), lots of newborns admitted for possible sepsis, mastoiditis, rashes, Henoch-Schonlein purpura, Stevens-Johnson syndrome, lots of RSV+ bronchiolitis, abscesses, cellulitis, etc. Some very, very sick kids. I had hoped to become comfortable with antibiotics this month. Although I didn’t quite achieve my goals, I was less clueless at the end of the month than at the beginning.

Second month was renal/rheumatology/endocr ine. These services generally don’t have a lot of patients each, so they are combined into one service for resident coverage. I didn’t think I would like this month, however, I learned a lot. Pediatric nephrology (and nephrology in general) is far cooler than I ever would have given it credit for being. And, much of what I learned about renal function here is applicable to adults as well. We dealt with both acute and chronic renal failure. From the endocrine side, it was mostly new onset type I diabetes (some admitted in diabetic ketoacidosis).

6th rotation - last but not least - internal medicine

Internal medicine is also divided up into one month blocks and there a wide variety of sub-specialties to chose from: nephrology, heme/onc, pulmonary, diabetes, cardiology, gastroenterology, etc. I did one month of general medicine and one month of cardiology.

General medicine had a great variety. You would think that it would be a lot of non-specific stuff, but it seemed like we ended up with a lot of stuff that should have been admitted to one of the specialty services. We had chest pain patients, stroke patients, neurology patients, surgical patients, etc. My residents and attending physicians this month were great.

Cardiology was a great month as well. I saw a huge variety of patients. We dealt with acute heart attack patients, patients with valvular disease, heart failure patients, and patients with all kinds of arrhythmias. I didn’t learn nearly as much about reading ECGs as I would have liked, but I continued to learn about managing patients in the inpatient setting.

Overall, I can’t believe how much I learned this year. I remember seeing how much responsibility the new interns had last July and thinking that there was no possible way that I was going to learn enough over the course of med 3 and med 4 to be able to not kill people. The amount of things you learn in med 3 is absolutely incredible - and so much better than Med 1 and Med 2. I’m looking forward to next year and applying for residency programs. I start the year on my emergency medicine rotation in July.

If anybody has questions or wants more detail about my various experiences, ask away.

Hi Emergency,

I just wanted to thank you for sharing your experiences with us. It just makes me more and more motivated towards this goal.

Thank you!

What a GREAT rundown of what 3rd year is like! Thanks for putting all your time into this Emergency! I would echo your thoughts on how much you learn in 3rd year, although I’m still not convinced I’ll be ready in a year to be taking over the care of patients. That being said, I’m doing my sub-I right now and am loving it and am actually feeling a little more positive about my ability to care for patients. Sub-I’s are great because they give you the opportunity to reinforce the fact that you DO have a knowledge base and you WILL be able to handle this.

Best of luck as you 4th year rolls out!