3rd Year Rotations Updates & Family Medicine Thoughts
Hey guys, it's been awhile! I don’t even know how to fully put into words my first semester of 3rd year but all I have to say is WHEEEWWW CHILLEEE.
JK! Let me just start with this-- clinical rotations are where I am meant to be. Where I flourish. So much so, I have honored 3/4 rotations so far!
I am so happy to be done with the first two years of med school. I had fun, but looking back I thank god that I never have to deal with sitting in a classroom for the rest of my days. Although clinical rotations are 100x better than didactic learning, clinical have been extremely exhausting, fulfilling, and heart wrenching all at the same time. Filled with ebbs and flows, learning hospital rules and politics, knowing your place without compromising your morals. I am going to try my best to organize and narrate my last few months of clinical rotations. Here we go:
Disclaimer: I won't be revealing where I did my rotations. This is to keep privacy not only for the institutions, but my safety. Any stories I tell are generic/tweaked in a way that won't identify any specific person/ situation. Just want you all to get the common themes. Thanks for understanding!
Details:
Our school let us choose our rotation schedule and the clinical sites we wanted to do our rotations at. I love my school for this reason. Giving people the option for different clinical experiences based on patient population. We had many sites to choose from all throughout NY and NJ. I decided to stay local for my first semester of rotations, and then spread out during the second half. My reasoning: As a 3rd year, I wanted to get my foundation and basics in a hospital I felt comfortable in. Once I established my grounds, I would spread out and see different hospitals. Other classmates I know used different reasoning (being closer to family/ partners, wanting to live in the city, not having a car and using the subway, etc.) Whatever the reason, all are valid! I am glad I got my first 4 rotations in the same hospital, I feel prepared for my next rotations elsewhere.
How I organized my rotation schedule:
My first 4 rotations in order: Family medicine, Psychiatry, OB/GYN, and finished in Pediatrics. Why this particular order?
They are the specialties I am most interested in. I wanted to get them in first so I can really decide if I was going into any of these fields. The earlier I decide, the better I can be with securing letters of rec, taking more initiative throughout the year in extra curricular opportunities, and being a more competitive application for these fields.
I was coming right out of Step 1, we only had a week vacation before starting 3rd year, and there was no way I was going to throw myself into a crazy rotation like surgery or internal medicine. I needed a real break chileee.
It was summer time, so I wanted to start with "easier" schedules while the sun was out, and finish the hard rotations in the winter. Yup, I wanted to live my best hot girl summer life, and it was so worth it.
Family medicine was first because I thought it would be a good intro to "medicine" in general, and I love outpatient settings, so I was excited to have this be my intro to 3rd year.
I intentionally put OBGYN 3rd because it's specialty I am most interested in. I would have 2 rotations that would have given me the practical skills, knowledge, and clinical acumen to be confident enough to push myself past my comfort zone in OBGYN. The goal was to still be "early" enough in my rotations as a 3rd year to still get the benefit of the doubt, but comfortable enough to make a good impression.
How did I prepare for my rotations?
Before every rotation started they gave us an "orientation" with the clinical directors of the program. They went over expectations of us, schedules, grading policy, mandatory clinical practice days/ tests, and some specific clinical skills to help out with each rotation. For example: for obgyn we worked with our "Simulation-Man" and delivered plastic babies, went through the cardinal stages of labor, and went through some scenarios of when things go wrong in labor. I loved orientation because I never had exposure to most of these fields besides family medicine, so I felt slightly prepared after. But no matter how long orientation lasts, nothing prepares you for the real deal. LOLZ
Expectations vs Reality
I know I might be super extra, but before every year, I have ideas and expectations for myself and what I expect to get out of that year.
As a postbac, I had a very specific idea and goal in mind, FOCUS. I talk about this a lot in my postbac post. My entire undergrad career I was spread all over the place, joining clubs and doing everything else but focusing on my major. During my post bac it was time to redeem to myself that I can focus, and I can master any class I get involved in. I did just that, finishing with a 4.0 GPA, completing my personal goal.
My goal for step 1 was to get above a 230. To finally be "above average" instead of average like I’ve always been. I did just that, I hit my personal goal. So, I set goals for my clinical year as well.
My goal for 3rd year is "Learn everything I could possibly learn in the 6 weeks while I have access to this specialty and the patients" I have to credit this expectation not to myself, but another resident doc.
After reading this post, I knew exactly what my goal was going to be for my clinical rotations. I am sharing it below because it inspired and changed my outlook completely on my next two years of school.
@mike.natter
https://www.instagram.com/p/BivZnlyDMBR/
The thing is, when you talk to any other med student or doctor, the conversation around rotations is very self centered.
"What type of specialty are you interested in? Do you know what type of lifestyle you want? Make sure you talk to this dean to get this special letter if you want to do _______ specialty. Don’t worry about surgery if you're not interested, just go to this hospital and hide in the back they don't care about med students really. "
It's almost as if you are taste testing all the different flavors of ice cream and picking your favorite flavor. And it's even more intense, because you can only eat that ice cream for the rest of your life, yikes. Do I like Oreo or rainbow sherbet more? Well, rainbow sherbet has more procedures, but Oreo you don't have to be on call all the time. It's literally ONLY about us as the med student.
Although these questions are extremely important and need to be asked, I think it does a huge disservice to the point of rotations to begin with. We are in a program to become MDs/ Dos. We do rotations to make sure we have common knowledge in these fields, so when we graduate, we can confidently say— I may not be a "pediatrician", but if there's a pediatric patient right in front of me, I should know the basics of this field, and how to help get them to the specialist they need. I honestly never realized this was the point of rotation's until I read Dr. Mike Natter’s post. Another reason why I am so grateful for all the med influencer’s out there… this post changed my outlook on my last two years of med school.
So my goal? To bust my ass and learn everything I possibly could about that field. 6 week rotation to try to understand everything I need to know about psychiatry? LEHGO. 6 weeks of pediatrics? LETTTSSS GOOOOO. Even if at times I didn't like it! (Trust me there's a lot of stuff that I was like I would never do this as a career, or omggg I'm hella bored how do you do this everyday.) I pushed myself to find something to like, or learn something from somebody. The patient, the patient family, the social worker, the scrub techs, scribes, nurses, PA's, interns, residents, and of course, the attendings. You can always learn from someone, or even from yourself.
Good example, I loved almost everything about my peds rotation, but one thing that I didn’t enjoy was the outpatient experience. The doctor and his office were wonderful, that wasn't the problem. Having a line of 50+ snotty nosed kids with their parents was the problem. And I only did it for 3 days!! I was getting sick, I was getting annoyed, I was over it. AND I had my exam that week, the last thing I wanted to do was keep this positive attitude of "you only have 6 weeks". So, I took this opportunity to try and be better with kids.
Ima be honest with y’all. I'm one of those people who's not really a jumping for joy when kids are around. I know I know (get over it lol). Idk, they scare me, they are kinda weird, mad aggressive sometimes, strange, and they cry and you can never figure out why.
They're dramatic, and I get sad when they are really sick. Any kid under 7yrs old I just look at them like the little foreign unfiltered minds they are. So, I pushed passed my awkwardness of kids and my goal for the 3 days of outpatient Peds was to get to know the little beings. Next thing you know I was holding babies so mom could get a break, learning how to clean poopy diapers, playing with kids, getting to know them, etc. One kid even gave me a hug at the end thanking me for helping him (I literally didn't do shit for you kiddo, you should be thanking the doctor! Lol) Clearly not apart of the course curriculum, but I learned so much those last three days. I also learned the proper way to say no to giving antibiotics for viral illnesses. That's a tough clinical skill. I mean really, you can always find something to learn.
I highly encourage any person entering the clinical experience to think of your time in this way. It drastically changes your outlook on the fields your entering, and changes it from "what flavor of ice cream do I personally like the most?" to “How the hell do you even make the best rainbow sherbet ice cream”? Whatever. you get the analogy. How can I use these skills from the past 6 weeks for the rest of my life. Also, it's less boring and a little overwhelming when you feel like you have 6 weeks to find out everything you need to know.
Now, lets move onto………
Details of my family medicine rotation:
Overall Rating: 8/10
Pros:
THE HOURS! OMG THE HOURS. I had 5-6 hour days, lunch breaks, and Friday's basically off. Hot girl summer INDEED
Rapport with patients. Besides the hours, patient rapport is the most attractive thing about family medicine. People that have been with the doctor for 20+ years. The doctor knows the daughter, uncles, grandma, etc. It's nice knowing you have a mutual beneficial relationship, it seems like the patients care for the doctor just as much as the doctor cares for the patient. Can’t get that inpatient or in ER (not really, besides the “regulars”)
Run your own. You really have ownership of your practice. You can do things your own way without anyone micromanaging you (well, besides the insurance companies). The doctor I worked for started his own "weight loss" regimen and it was a healthy combination of diet, exercise, sleep, and prescription for those who qualified. He had so many patients on this system people who had been obese/overweight for years were coming back excited for their "monthly check up and weigh in". It was so inspiring to see even I started using his method and I've officially lost 20 lbs since the start of 3rd year. I haven't been this weight since before I started med school. How awesome is that?
Free food, free parking. These perks are things I took for granted. Something about pharmaceutical companies catering the best sushi and dessert everyday had me hooked.. Buying lunch everyday and paying for parking is for the birds… take me back to family medicine days
"Center of team medicine" One of the most impressive encounters I've ever seen is the role of the family doc in action. Great example: There was an older male who had coronary artery disease. He was basically failing lifestyle and medical management.. and continued to be symptomatic, so patient was now considering the surgery route. The doctor sent the patient to one cardiology specialist but you could tell the patient was still struggling with the decision. The patient didn't know the best decision and wished all the doctors could talk to each other at the same time to make a decision together.
Doc instructed the med assistant to make a new cardio referral AND make the appointment for the patient
Doc gave the patient his office number and personal cell number just incase he wasn't in that day.
Instructions: Once pt was in the cardiologist room, we made the appointment for the patient and the new cardiologist, they were to set up a conference call. That way the family doc could be apart of the conversation and address and questions/concerns they might have in the room LIVE with the cardiologist.
The patient let out a big sigh of relief, thanked him so much for being accommodating, and told the doctor he really felt supported through this tough decision. I was taken back… WOW. That's how you do it. That's how you use your power as a family physician to center the team, all the consults and referrals, and make sure every decision is made so the patient feels centered, comfortable, and supported. I will take this lesson with me no matter what field I go in. Such an important take away!
Cons:
Can be repetitive/ boring. Overall, family medicine is all about the basics. Physicals, school/ work clearances, managing chronic diseases, etc. Although I like certain parts of family medicine, there are parts I could really care less about (writing scripts for ear infections, common colds, managing asthma medications). Yup, the meat of primary care i’m not too fancy of. It can be repetitive and more boring than inpatient life.
Dealing with insurance/ business. The one thing the doctor constantly complained about, having an outpatient practice is literally owing your own business. If you aren't business savvy yourself, you need to hire someone you trust (that's not going to steal form you because that is a thing). Dealing with insurance is a whole other beast.
Shelf Exam:
When I told some of the upper class men in my med school I had family med first, they laughed and prayed for me. Why you ask? CUS ITS HARD AF. If you were one of the lucky ones to choose family medicine first, I highly suggest you start studying within the first week of starting rotations. There's no UWORLD questions for family medicine BTW. I, along with many of my peers, signed up for the 2000 question bank from AAFP which is free for students. It takes like 1-2 days to get access to it, make sure you sign up early. I somehow did all of them. I also recommend online med ed, it helped with learning because family med is really all over and everything, it's hard to organize what exactly you need to know. I also did all of the NBME's. I was able to get a "high pass" grade, and that was the only rotation I didn’t honor because I didn’t turn in some evaluation forms on time.. smh. Lesson learned.
What I did well & what I would do differently:
I'm not tryna flex… but I'm just going to give y'all a quote from my evaluation.
"She is the best NYMed Student I’ve ever had".
Now, maybe the doctor I worked for just says that for every student…but I will take it! Stop popping my bubble.
I think I did a lot well. I'm really good with patients, and making people feel comfortable. I didn't back down when faced with challenges and opportunities. Literally on my second day of my rotation..
Doc: "Have you ever drawn blood before?"
Me: To be honest.. not really.. On a mannequin during orientation, not on a real human.
Doc: Perfect, get over here and draw my blood, I need some lipid levels sent on me anyways. Oh, and you're drawing blood for the rest of the week on all my patients.
Me: "*internally freaking out no way the doctor I am working for is going to be my first stick*
Doc:….
Me:…………………
Doc:
Me: Okay. But if I kill you, you still have to give me a good grade"
We laughed. He had good veins so it was an easy draw. And I was a damn good phlebotomist that week. Now I feel confident in lab draws
I asked a BUNCH of questions. Stupid questions, good questions to everyone— medical assistants, nursing students, and other med students in the clinic. I wrote everything down. All the little mnemonics and specific things he wanted us to know I made sure I knew by the next day. What are the 5 P's for chest pain? Pericarditis, pleuritis, pneumonia, PE, pneumothorax. Tried to stay off my phone as much as possible. And above all, I tried to be as helpful as possible. The reality is, we don’t know much, and we are probably a little more burdensome than helpful, so I tried my best to be more helpful than anything. If I can help with the little things, helping the MA in the room with getting shots ready, or starting to chart, it made everybody's job easier.
What I would do differently? Be more organized (still don’t have this down). Study more. Be more confident. I frequently let this other med student show me up at times when in reality we were on the same level. I was just too scared to speak up, yay imposter syndrome! Practice my Spanish even more. And known my vaccine schedule.
I give this rotation an overall 8/10. It was an amazing intro to medicine. I loved the hours, the free food and parking. But above all I freaking loved the practice I worked at, the doctor and his staff were awesome and I was genuinely sad to leave. I built a good relationship with all of them and I thank them so much for the best transition to 3rd year. I wish I could reveal the docs name for anyone looking for a family doctor because he was that good! Solid experience, family medicine is definitely still on my list for a career choice :).
Next post will be all about my psychiatry rotation and my ranks of specialties before and after my first semester, stay tuned!!
