Island Med Student

Check out my post on Medscape to find out the answer. This post was inspired by you, Cindy! And is for all you pre-meds and aspiring docs out there!

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“What to expect when you’re expecting…to begin clinical rotations.”

Finally, the post I have been meaning to write for a very long time. I get questions about clinical rotations (also called clerkships) very frequently, so below is Kendra’s guide to medical school clinical rotations, in FAQ format:

1) What is a clinical rotation?

It’s a period of time that you spend at a given hospital (or clinic, doctor’s office, etc.), gaining hands-on clinical experience from seeing patients and learning from patients, nurses, residents, attendings, and anyone else who chooses to teach you.

2) How many clinical rotations do I have to complete?

Well, this varies slightly from school to school, but most students must complete required “core” rotations, and “elective” rotations. Core rotations include:

Pediatrics: 6 weeks
Obstetrics/Gynecology: 6 weeks
Internal Medicine: 12 weeks
Surgery: 12 weeks
Family Medicine (considered an elective by some schools): 6 weeks

“Elective” rotations are just that. They are voluntary. You can usually choose which elective rotations to do, but most schools require a certain number of “medicine” or “surgery” sub-specialty electives. Ross University requires a total of 30 weeks of electives.

3) How do I schedule rotations?

The answer to this question really depends on your school. For Ross University students, you apply for core rotations through the clinical department. You can request roations at any of the affiliated hospitals, and they will try to schedule you for them. Keep in mind, however, that they can only schedule you for availalbe slots. So, what you get will depend upon your schedule, and availability. For elective rotations, you can can request them through Ross’s clinical departemnt, or you can contact the hospital directly.

4) How do I know which rotations are best?

My best advice? Ask around. Word of mouth seems to be the best way to find the best rotations. I don’t think ValueMD has much merit. And see question numbers 13 and 14, for more information related to this.

5) What do med students actually DO during clinical rotations?

EVERYTHING!

Okay, let me be more specific. Here are some common things you will do:

- Perform, write-up, and present H&Ps (histories and physicals)
- Write SOAP notes on patients (progress notes)
- Follow up on things related to your patients. This includes (but is not limited to!) following up on lab results, radiological reports, consults, etc. The more you know about your patient, the better you can help them, and the more your residents and attendings will love you.
- Perform “procedures.” Examples include drawing blood, placing lines, placing NG tubes, suturing, putting in foley catheters, and anything else you can imagine. As far as what you are allowed/expected to do, this really varies from hospital to hospital. But at minimum you should be prepared to draw blood, place lines, and hold retractors (for long periods of time!). As far as training for the procedures is concerned, this also varies from hospital to hospital. But remember the golden rule: NEVER perform a procedure if you have no idea how to do it!
- Round on patients.
- Attend all lectures, presentations, etc.
- Present information on various clinical topics.

6) What are “rounds?”

Some attendings prefer sitting rounds, some prefer walking rounds, and some do a combination of both. Rounding on patients simply means going through the list of patients and presenting information on each one of them. If they are a new patient, you are expected to present the entire case. If they are not, you may just need to provide an update. You then generally go from room to room as the attendings and residents talk to and examine the patients. Expect to be asked many questions during rounds. And this is a great opportunity for you to ask questions as well!

7) What is the “hierarchy” in the hospital?

Med students are the lowest on the totem pole, then residents, then fellows, then attendings. Sometimes you will work only with the residents, and sometimes with the attendings, and sometimes all of the above.

8 ) Will I receive traditional (didactic) lectures during my clinical years?

Again, this really varies highly from hospital to hospital and rotation to rotation. I’ve received lectures in almost every one of my rotations (all the cores), but the amount of time I spent in lectures versus other activities varied widely. You will “learn” clinical medicine via many routes. This includes didactic lectures, “teaching” rounds, and of course, at the patient’s bedside.

9) What is “pimping” and should I be scared?

“Pimping” simply refers to a higher-up (usually an attending, but can also be a resident) asking questions (sometimes in a machine-gun style) about anything and everything. No, you should not be scared. But yes, you probably will be anyway. It’s scary to be put on the spot. And you will never know the answer to all of the questions. But you should remember that you’re not expected to know all of the answers. Keep that in mind, and you will be less stressed out by the situation.

10) What is the schedule like for clinical rotations?

Again, this varies WIDELY based on the hospital and the rotation. Expect to spend longer hours during your core rotations versus electives. Almost all core rotations also involve “on call” hours, which involves staying late or during the night. An average day at the hospital during a core might go something like this:

7:00 – Report to hospital for morning sitting rounds
8:00 – See your patients, write SOAP notes
10:00 – Walking rounds
12:00 – Lunch
1:00 – Follow up on patients
3:00 – Lectures
5:00 – Walking or sitting rounds again
6:00 – Go home

Again, this is just a template. Night calls vary from a few hours, to 12-hour or 24-hour shifts. Most rotations give you “post-call” days. This means that if you have a call shift, you are allowed to go home afterwards and have the rest of the day off before you come in again the next day.

11) Are there written exams?

Again, this varies, but most of the core rotations will have quizzes and exams. Of course, you will also need to take your board exams (USMLE, etc.) and Shelf exams, if your school requires them.

12) How are you evaluated?

This varies. But for most rotations, your grade is ultimately based on your exam scores and your “clinical performance,” which is based on your clinical skills, clinical knowledge, professionalism, and other areas of performance.

13) How do I perform well during clinical rotations?

Actually, I wrote a post that has some really important tips, to answer this question. You can view it here.

14) What’s the most important piece of advice you can give about clinical rotations?

That you get out what you put in!

Yes, the hospital matters. Yes, the attendings and residents matter. Everything matters. But the most important piece of the puzzle, and the one that YOU have ultimate control over? Yourself. If you show up early, volunteer to stay late, ask questions, and are a very motivated leaner, you will succeed and learn how to be an amazing doctor. It’s as easy as that.

That’s all I can think of for now! I hope this helps some of you out there. Please do email me or comment if you have more questions, and I will add them to the list!

Okay, so the title of this post is very misleading. I am attending Ross University School of Medicine, and I would like the world to know that I have had a very positive experience with Ross thus far. I have never regretted my decision to attend a Caribbean medical school. But I’ll admit that I am also a “chronic optimist.” I tend to always see the glass as half full, and I very rarely complain about things. However, I receive emails all the time from people who want to know the “dirt” on Caribbean schools. And I received an email a few days ago from a student who asked me to list the “top 10″ things that I don’t like about Ross (in order of importance). This will be a very hard list to create. But here goes:

1) The stigma. As I’ve said many times, there is obviously a stigma associated with attending a Caribbean medical school. However, I must say that I have found this to rarely be a problem (again, my darn optimism!).

2) The large class size. Yes, Ross accepts many students every semester. And for some people, this makes it challenging to “be heard.” But again, I will say that this has never been a negative for me. I’ve almost always found that I’ve gotten the attention I needed…but that leads me to number three.

3) Scheduling clinical rotations can be challenging. Because of our class size, and because of the fact that there are limited clinical spots for us students, it can sometimes be difficult to get individualized attention, and the “best” spots available. But all in all, I must say that I have been “mostly” satisfied with my scheduling, and most of my rotations.

4) The cost. This might be the worst thing that I can complain about. Ross’s tuition and fees is on par with the more expensive U.S. medical schools. And when you add on the additional costs related to traveling, the price really adds up. If I have one regret, it is the astounding amount of student loan debt that I’m facing.

5) Living in Dominica. This one is really difficult for me to count as a negative. For me, this was one of the TOP reasons for choosing Ross. I was truly excited about living in Dominica. But for those people who can’t appreciate the beauty of this wonderful country, I guess they count it as a drawback.

6) There isn’t really a “home base.” Since you spend a portion of your time in Dominica, and then the rest at various sites in the U.S., it can sometimes feel a little discombobulating. For me, this was actually a great advantage. But for others, it can be unpleasant.

7) It’s difficult to place into competitive residencies. Yes, it’s harder for Ross grads (or other non-AMG grads) to place into more competitive residencies. But the reality is that you CAN place, and it does happen. But you may need to work harder and have a better CV than your AMG counterparts.

8 ) Not enough administrative guidance. Since we really don’t have a solid “home base” and because there are so many of us, it can be difficult at times to get good guidance from the school. Although, I’d say in my experience, I have been mostly satisfied with the response I’ve received.

9) Having to repeat semesters. Many people complain about the fact that if you fail one class by even one point, you must repeat the entire semester. While I can understand and appreciate this complaint, I also understand Ross’s policy. If you are struggling with even one class, it means that you really need to get a better hold on your studying routine, and try again.

10) It ain’t Harvard. Nuff said.

Sorry if you were expecting better complaints, but I am just not a good complainer!

Note: I actually had to google “Ross Sucks” and go onto ValueMD to come up with this list!

Check out my post on Medscape to read about my algorithm for choosing a residency program (it’s actually more complicated than this, but this is a good start!)

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Check out my post on Medscape to read my top 10 residency interview tips (it’s very similar to the post on my blog, but there is a poll to take as well!).

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I plan on writing a more official list for Differential post, but I thought I’d share some tips here as well (I’m not allowed to cross-blog).

I received a pretty good response from my residency applications so far. I have already had some interviews, but still have many more to go. Obviously, you don’t have to believe anything I say. I haven’t yet matched, so I could be completely off. However, there are some things that I have picked up on during my interviews so far, and from other sources on the web. I thought I’d make a nice list of tips to share. Read at your own risk!

1) Stay Organized! A very awesome doctor (Katrina!) told me last year to make sure and stay organized during residency interview season. How right she was! I am completely organized to the max, and it has been super helpful. Here are some things I’ve done and recommend doing:
a) Create email folders and sub-folders, if necessary. You will send and receive many emails. Keep them organized.
b) Create a binder for program info. I have a sweet color coded, chronological system set up.
c) Keep all your interview dates on a calendar! I have mine both on paper and electronically, which has worked super for me.
d) Keep all the papers and info they give you. I have mine in a nice expandable file folder system.

2) Research the programs. The more you know about the program, the better decisions you can make, and the better you look on interview day. Almost every program has asked me, “why are you interested in this program, in particular?” If you can’t answer this question, you will look silly!

3) Dress professionally. Wear a suit. Use common sense here. No chest hair showing, no huge gold dollar sign necklaces, no hooker make-up. Note: I love hooker make-up just like the next girl, but it just doesn’t work in this setting.

4) Be on time. Seriously, I can’t emphasize this enough. Leave WAY early to get there in time. Expect traffic delays and build in time for them.

5) Be prepared for questions. There are many great resources on the web with lists of common residency interview questions. You should try and go though most of them and come up with an idea of an answer. You don’t need to memorize every single question, but you should be prepared to answer the commonly asked ones.

6) Ask questions! It’s not a bad idea to make a list of questions about the program in advance. Trust me, you will hear “do you have any questions?” one hundred million times on interview day. If you don’t have any questions at all, you look like you’re not really interested in the program.

7) Write thank you notes to your interviewers. Either electronic or paper, or both.

8 ) Know your strengths and weaknesses. Be able to give examples of both. Know how to sell yourself. Be confident about yourself as a candidate!

9) Have water accessible during the interview. Maybe this is just me, but I tend to get super dry mouth when I’m interviewing. I always make sure to have a cup or bottle of water nearby. I learned this lesson the hard way.

10) If you are really interested in a program, go back for a second look. This helps you remember the program, and shows that you are truly interested!

I hope this list helps some folks out there! I will likely be adding some more items to this list as time goes on. Good luck to everyone who is interviewing right now!

Check out my post on Medscape to read my list of top 10 mistakes to avoid making in clinical rotations.

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In addition to the information I posted about studying for the USMLE Step 2 CK, I thought I’d share with everyone my opinion (and the opinion of other students I’ve met) about which books are best for each core rotation/clerkship.

Internal Medicine: Step-Up to Medicine (Step-Up Series)

Surgery: Surgical Recall, North American Edition (Recall Series)

Obstetrics/Gynecology: Blueprints Obstetrics and Gynecology (Blueprints Series)

Psychiatry: Blueprints Psychiatry (Blueprints Series)

Pediatrics: I haven’t had peds yet, so I don’t want to put this info up yet. I will update this once I take peds, or get good opinions from other students who have completed it!

This is a post I have been meaning to write forever. It would probably be better if I had written this a long time ago, when I was still in Dominica (as everything would be fresh in my mind, and the resources there would be the same), but nevertheless, I feel like it might be helpful for me to list some things.

Here is my disclaimer: things might have changed in Dominica since I was there (from 2006-2008). Also, let me say upfront that what you decide to bring really depends on the type of person you are. If you don’t really care so much about brand name items, and you are willing to pay a little more or less, you really don’t need to bring that much. If you are the opposite, you should bring more. I only brought two suitcases, within the weight limit, and was pretty much okay. You will have to decide for yourself what you really need.

Here are my suggestions (in somewhat order of importance):

1) ALL computer/tekmology related items that you need. This includes laptop, cables, camera, iPod, headphones, jumpdrive, etc. Technology items are expensive and very hard to come by in Dominica. Bring everything you might need.

2) Clothes. This is rather obvious. There are clothes available, but not necessarily the ones you would like. Bring plenty of t-shirts/tank tops, shorts, flip flops, underwear, etc. Dominica is HOT. You will need to dress accordingly. But you should also bring a pair of jeans, and a sweat shirt, etc., as the classrooms and library tend to be very cold. Bring some shoes that you can hike in (I highly recommend hiking), and a few work-out outfits for running, going to the gym, etc. Also bring some swimwear and at least one nice outfit, with shoes, for your white coat ceremony. You will need dress clothes for ICM and stuff like that, but not until your 3rd semester on.

3) Toiletries. If you can’t live without a special type of deodorant, make-up, or face lotion, bring it with you. If you don’t mind using whatever is available, you will be able to find other substitutes in Dominica.

4) Medicine. Although there are pharmacies and such, it’s not a bad idea to bring a supply of any medications with you if you can. It just makes things easier.

5) Food. If there are items that you CAN’T live without, bring them with you. Dominica has plenty of food, but maybe not the selection that you’re used to in the States or Canada.

6) Books. This is a complicated issue. It depends on if you decide to buy your books in advance, or buy them once you get on the island. In retrospect, I think I would have bought them in advance on Amazon and had them shipped, but this really just depends on what your needs are.

7) School supplies. You will be able to find almost any type of binder, highlighter, notebooks, etc., at the RossU bookstore. However, they will be much more expensive there. If you want to pay less, you should buy these in advance.

8 ) Heavy duty flashlight and umbrella. It’s not that you can’t find these in Dominica, but it’s probably easier if you just bring them with you, as you will need them every day!

9) Battery operated clock. If you have an iPod, I highly recommend the iHome. You can buy clocks in Dominica, but it’s not a bad idea to have one from the outset.

10) A good pair of scissors and a can opener/swiss army knife. For some reason, these are hard to come by in Dominica.

11) Bug spray. You can find it there, but if you like, you can bring it with.

Okay, now here is where my advice is different from other lists I’ve seen online. I really don’t think you need much more than the above items. Obviously, if there are other items that you CAN’T live without (favorite stuffed animal, photo of your loved one, a pet rock) you should bring those as well. However, I don’t necessarily agree with other lists I’ve read. You don’t “have” to bring everything under the sun with you. You can find plenty of things in Dominica. You don’t need to bring pots and pans with you, unless you are very specific about the kind you need. Again, as I said above, you can find many things in Dominica, just perhaps not to the standard you’re used to. But for me, that was part of the fun! Why go to a new country and live there for two years without experiencing what they have to offer?

Anyway, that’s my list. Much shorter than most, I know. Please feel free to add, subtract, or comment!

Med school isn’t the only place to learn about the art of medicine. There are many colleges, universities, and other institutions that offer free online medical courses and education resources to self-learners around the world. Here are 10 free resources to explore in your spare time:

MIT OCW – The Massachusetts Institute of Technology offers more than 50 free health science and technology courses through the school’s OpenCourseWare (OCW) program. Courses typically include lectures, reading lists, assignments, exams, and other self-study materials.

JHSPH OCW – The John Hopkins Bloomberg School of Public Health also offers free courses to self-learners through their OCW program. Courses cover a wide range of public health and medical topics, including child health, adolescent health, public health, mental health, aging, chronic diseases, infectious disease, nutrition, and health policy.

Open Michigan – The University of Michigan provides several free medical courses that are open to everyone with an Internet connection. The school also offers courses in nursing and dentistry.

LearnersTV – LearnersTV provides hundreds of free medical lectures from colleges and universities around the world. Lecture categories include immunology, bacteriology, virology, parasitology, mycology, infectious disease, anatomy, physical examinations, and neuroanatomy.

Health Sciences Online – This virtual learning center provides high quality courses and references for medicine, public health, pharmacy, dentistry, nursing, basic sciences, and other health sciences disciplines. The center currently offers more than 50,000 hand-selected resources.

GFMER – The Geneva Foundation for Medical Education and Research offers hundreds of free education resources on their website. Resources include free medical journals, databases, books, and professional publications.

Medscape – Medscape is a free online resource for specialists, primary care physicians, and other health professionals. Offerings include articles, journal commentary, book reviews, medical news, free textbooks and medical journals, conference coverage, and medical practice information.

eMedicine – More than 10,000 physicians contribute to this clinical reference from Web MD. The online reference includes nearly 7,000 medical articles.

Medical Animation Library – This online library from the University of Pennsylvania hosts medical animations that can be viewed with free video players. Animations cover a wide range of medical topics. Each animation includes a short explanation of the topic to help viewers understand what they are seeing on the video.

SlideWorld – Designed specifically for medical professionals, this online library contains more than 7 million PowerPoint slide presentations. Slides are sorted into 20 medical topics and are easy to find using the site’s search features.

Guest post from education writer Karen Schweitzer. Karen is the About.com Guide to Business School. She also writes about top online colleges for OnlineCollege.org.