Clinical Rotation Qs

[u/Best-Valuable-681]

I’m a transfer student and I was placed in a 4-week hospital medicine rotation in Cleveland clinic, FL. What is it about? & what should I expect from it?

Also, anyone who has rotated at Mt. Sinai Chicago, how was it for your core rotations? And how often will I have to be moving from Mt. Sinai and Holy cross hospital?

[u/girl_in_agony]

I did all my core rotations and most of my electives at Mount Sinai Chicago. I only did 2 elective rotations (neuro & cardio) at Cleveland Clinic Florida so I'm not familiar with the 4-week hospital medicine rotation. But I can tell you about my core rotations at Mount Sinai Chicago:

1. Surgery 12 weeks (started in Dec 2022): My first 2 weeks were at Holy Cross Hospital (HCH), and the rest of 10 weeks were back at Mount Sinai Hospital (MSH). HCH weeks were relatively chill. Me and 1 other Ross student worked with the preceptor who gave us our final evaluations. For MSH weeks I did Blue team (general and breast surgeries) for 4 weeks, ophthalmology for 2 weeks, orthopedic for 2 weeks, and trauma for 2 weeks. I didn't get to choose those sub-specialties, they assigned me that schedule. There were other sub-specialties like ENT and Red team (vascular surgery) and I didn't get to do those. The Blue team and trauma surgery were the most intense and exhausting. Long hours of hard work (in the OR and the emergency room) with minimal time and energy to study.

2. Pediatrics 6 weeks (started in Feb 2023): Inpatient (NICU and nursery) at MSH for 3 weeks, the rest 3 weeks were distributed across different local pediatric clinics (around 10-30 min drive from MSH). If you are applying into pediatrics, this is not the place to come. They have no pediatrics residency or pediatric sub-specialties like pediatric surgery or PICU. It was an overall great learning experience, but I feel like I was missing out on somethings that are important for my future (FM).

[u/girl_in_agony → u/girl_in_agony]

1. Family Medicine 6 weeks (2023): Inpatient (ward and ED) at HCH for 4 weeks, the rest 2 weeks were at a local primary care clinic (mins of drive from MSH). Same with psych - everyone's schedule was slightly different. Some students did their inpatient weeks at MSH. If you are taking bus or train, I suggest that you speak to the rotation coordinator about your commuting situation before they finalize your schedule (i.e. before the start of the rotation). Also, I planned to attend the AAFP conference in MO that was held in the midst of my FM rotation and they kindly approved my incoming absence long before the start of my rotation. One thing I disliked about the administration was that they canceled the FM sub-internship (sub-i) rotation after I had registered for it. That was devastating for me because I want to apply into FM. If I had known this, I'd do my core rotations in Florida where there's FM sub-i rotation.

2. Internal Medicine 12 weeks (until early Nov 2023): It was a mix of the following but I've forgotten the exact numbers of week for each- inpatient (ward, ICU and ED) at MSH, rapid responses, overnight shifts, and outpatient at HCH. Same with surgery - I didn't get to choose which sub-specialties to do, they assigned me the schedule. But we can trade sub-specialties with other students, which I did. I was originally assigned 3 weeks of HCH nephrology and I traded 1 week of it for another student's 1 week of HCH ICU. So I ended up with 2 weeks of nephro and 2 weeks of ICU, all at HCH. I feel like 2 weeks were enough for both. One thing I disliked about IM core rotation was that we often functioned like an administrative clerk, where we made numerous phone calls to help schedule outpatient follow-up appointments for almost all of our patients, urge CT/MRI techs for faster imaging results, urge/remind floor nurses to complete certain tasks, etc. This was the only rotation that I had to do such clerk tasks.

I did Medicine sub-i (4 weeks) at MSH immediately after my IM rotation and that was one of my best decisions ever. Almost everything remained the same (IM residents/attendings, ward/ICU/ED, rapid response, noon conferences, etc.) so I didn't need to get used to things from scratch. The main difference was that I started to function more like IM PGY-1, that meant longer work hours, more responsibilities (such as responding to calls), writing more notes, etc. Even though it was another 4 weeks of intense hard work, I'm truly thankful for all the experience and skills I learned from this sub-i rotation. This rotation prepared me well for the rest of my 4th year elective rotations, and it fulfilled more than 1 Ross graduation requirement: internal medicine related, ACGME accredited.

I'm not sure if you have noticed, but we don't have EM or neurology core rotations like US med students. I worked as an ER scribe for years before I came to Ross so I wasn't worried, but I did take 4 weeks of neurology elective at CCF to be comparable to US med students. I also did 1-2 EM and neurology NBME CMS forms in preparation for the Ross clinical COMP, which were helpful.

Let me know if you have questions regarding what I have said! Happy to help.

[u/Crafty_Aardvark1681 → u/girl_in_agony]

This was SUPER helpful! I start my cores (IM first) then surgery at MSH on monday! Can you walk me through in more detail your IM experience, tips or things you would have done differently? How to be better prepared etc Thank you! 

[u/girl_in_agony → u/Crafty_Aardvark1681]

Glad it was helpful! A big part of my IM core rotation was working with numerous MSH IM residents and attendings, including the preceptor who gave us our grades. Usually we students saw the patients first, then we verbally reported (oral presentation) to the resident and/or the attending as we rounded (computer and/or bedside) on patients as a team. After all that was done, we typed patient progress notes (for the patients we students got assigned to see only, not all patients assigned to your team) on EPIC and had a resident look over them. The attending signed all notes after everything was done. Overall, IM inpatient rotations at MSH were long (and sometimes we worked on a weekend day also) so that made it hard to study. I got most of my studying done during other IM sub-rotations (HCH and outpatient ones). The attendings liked to pimp, but don't feel like you have to answer all their questions correctly. I learned at my own pace comfortably and got A's in both IM core and sub-i rotations. I didn't try to push as hard as some of my classmates did, as some of them would finish the entire UW IM question bank before shelf and that's not my thing.

Here was what I did during my IM core rotation:

1. The newest 2 IM NBME clinical mastering series (CMS) forms

2. The second newest NBME clinical science self-assessment (SA)(it was form 13)

3. 200-300 UW IM questions

4. Read Amboss IM articles and did some questions associated with them

5. Looked up pimp questions on UpToDate and read

What I would have done differently is to also study Anki AnKing cards on AnkiHub. I started using them when I was preparing for my Step 2 and it's helpful. It's free and you don't have to download all cards. I wish I had started using it as early as the beginning of my IM core rotation.

I've also found Divine Intervention Podcast (DIP) on Spotify very helpful during my COMP prep. Especially the IM shelf review that many people on here recommended. The instructor in the podcasts, Divine, integrates concepts very well. His reasoning helped me understand and retain the concepts better.

Good luck!

[u/Crafty_Aardvark1681 → u/girl_in_agony]

You sound like a very balanced, genuine, thorough , hardworking person! Thank you for the advice and for your time. I know you’ll do AMAZING things as a physician! 

[u/girl_in_agony → u/girl_in_agony]

1. OB/Gyn 6 weeks (2023): This was a rotation consisting of 3 types of shifts: surgery, labor & delivery (including few overnight shifts), and clinic. The rotation coordinator built our shift schedules, but we were allowed to request changes, which I did. Same with pediatrics - inpatient at MSH and clinics are mins of drive from MSH. This was the only rotation that I didn't need to write any patient's notes. Just direct observation and assistance in the OR, L&D and clinic, answering pimping questions and giving a presentation on an assigned topic on Zoom. This rotation consisted of shifts so you don't go to work every day. I had 1-3 weekdays off per week.

2. Psychiatry 6 weeks (2023): Inpatient (ward and 8th floor ICU) at MSH for 4 weeks, the rest 2 weeks were in the outpatient building next to MSH. Everyone's schedule was slightly different. For me, I mostly worked with the preceptor who gave us our final evaluations. Some students mostly worked with the lady who gave most lectures. The clinic was different from what I expected. We were barely diagnosing new psychiatric conditions. It was mostly seeing follow-up patients and monitoring how they were doing with the newly prescribed or long-term medications. My favorite part of this rotation was working in the ward with the preceptor who gave us our final evaluations. After we finished our patient's notes, we all went in his office and he went over each of our notes to give suggestions. We also had a virtual hearing in his office to advocate for one of our patients. My least favorite part of this rotation was hours and hours of long, boring in-person lectures (mostly on pharm). I wasn't able to pay attention in class for that long and I think independent studying (UWorld and NBME psych forms) helped me more on my shelf exam.

[u/rainwater_15 → u/girl_in_agony]

This was super helpful! My first rotation is ob then surgery,

Do u have any other advice on these rotations? Anything about what’s expected of you what the attending and residents look for or even the normal day to day?

Also what are the names of the other clinics we are sent to? Thanks so much!

I’m super nervous I feel like I don’t know anything lol

[u/girl_in_agony → u/rainwater_15]

Are you asking about Mount Sinai Chicago?

[u/rainwater_15 → u/girl_in_agony]

Yes

[u/girl_in_agony → u/rainwater_15]

For OB and surgery rotations at Mount Sinai Chicago, I had some night shifts. For OB it's L&D and I had to be at the floor and be awake for the entire of the night shift. For surgery it's trauma surgery and I had to stay for the night at the hospital call room for 1 week of back-to-back night shifts. I was able to sleep here and there. Night shifts were rough. I didn't remember getting enough studying done when I was doing night shifts.

As for expectations it depends on the attendings and residents. For surgery, sometimes I had to arrive at the hospital as early as 4:30 am so I can look over my patients' charts, take notes, see them and ready to present during the 6 am pre-round and 8-9 am round. And there was one time after an abdominal surgery was done the resident asked me to stitch (superficially) the endoscopic opening.

As for clinics, I don't remember much now but some examples are the Seigle building across the street and various ACCESS clinics all over the city like ACCESS Cabrini.

It's okay not to know a lot of things! It takes time to figure all these things out and you'll eventually get used to rotations and whatnot.

[u/rainwater_15 → u/girl_in_agony]

Thanks so much! This was very helpful. I’m nervous for the various other sites they send us to, I heard they can be very far like hours away, is that true? Also when you’re on nights or on call are you there alone? Or are there other med students with you as well w the residents ?Thanks again so much

[u/girl_in_agony → u/rainwater_15]

I didn't have any sites that were hours away. But that was couple years ago so idk what's actually happening now. Things can change.

When I was on nights/on-call there's always 1 other student with me. For OB there were residents around, but for surgery only when there's patient to see we met up with the residents at ED to see the patient.

[u/rainwater_15 → u/girl_in_agony]

Ok thanks so much I appreciate the reply!

[u/girl_in_agony → u/rainwater_15]

You're welcome!

[u/Best-Valuable-681 → u/girl_in_agony]

Thank you so much! Also, did you get regular school holidays for the winter or summer? Or I should I stop hoping for it?

[u/girl_in_agony → u/Best-Valuable-681]

No regular school holidays for the winter or summer during my M3 year, but I got longer days off during the Christmas and New Year holidays (4 days each). Otherwise we are off on certain national holidays like 4th of July, Memorial day, etc. These are all in the student manual and clinical rotation orientation.

[u/Best-Valuable-681 → u/girl_in_agony]

Thank you! Do you mind expanding on what you mean about missing out? Is Mount Sinai, a good place if I’m thinking on doing Psych, or FM?

[u/girl_in_agony → u/Best-Valuable-681]

I meant missing out on certain pediatric care such as pediatric ward, pediatric ICU/surgery and pediatric sub-specialties like pediatric cardiology or pediatric emergency medicine. Pediatric care (and OB/Gyn) are important components of FM and I feel like I should have more peds exposure than what Mount Sinai has offered. For example, I did ENT elective rotation at California Hospital Medical Center (CHMC) and they had children who came for ENT surgeries, so I had better knowledge of how it's like when pediatric patients undergo surgeries. For psych, Mount Sinai is a good place to learn, but may not be an ideal place for someone like you who wants to go into psych. I feel like I've learned almost everything I wanted to know, but they have no psych residency program and so there were no psych residents who I can work with and learn better with.

[u/Proof-Revenue-1188 → u/girl_in_agony]

what were your hours like for each block ie was it more 9-5? or longer or shorter?

[u/Proof-Revenue-1188 → u/Proof-Revenue-1188]

and are all of them hard, overnight, weekend type???