The [Half] Year in Review

I've been reflecting on the last six months of rotations, and I have realized that my feelings / experiences with certain rotations / fields have turned out much differently than I had expected before M3 year or even during the rotations themselves.

Last year, when I chose my elective track, I basically had already ruled out surgery and obstetrics / gynecology, so I purposely put those at the beginning. I was kind of not very big on going into psychiatry, but I knew that I liked the subject and therefore made sure that it was after the first two so that I would be more experienced during it. Internal medicine and pediatrics were my top choices for residency, so I put those in the best spots available: the first two rotations of the second half of the year. Family medicine, though not being ruled out, was placed last as it was not as high on the list as med or peds, and I knew that it would be an easier rotation with the other rotations already out of the way. I was also seriously considering pathology, so I was considering doing a two week elective rotation in it during my M3 year.

Surgery

Looking back, surgery was kind of painful, but a lot of that pain was simply the hours, the commute (getting to my site at 5:00AM using public transit was pretty gruesome), and the fact that it was my first rotation. It didn't help that I not only had to quickly learn how to be an M3, but that I also had to learn how to behave in the OR. It also didn't help that I started the rotation basically being scared of the rotation and M3 year in general; in particular, the question "what the hell am I supposed to be doing" came to mind. The first week was a barrage of unfamiliar duties, terms, and concepts - I didn't know what a KUB was, I had no idea what 4x4 referred to, and I definitely didn't have an inkling as to what I should have on me at all times (despite reading Surgical Recall.)

However, that all passed. My major beef with the rotation / site was the constantly changing rules during the first three weeks or so; changes in time of reporting, ways to write notes, weekend duties, lecture times, lab sheets, OR responsibilities, and various other changes occurred on nearly a daily basis. The hours and travel also sucked, but I got used to it and it was better after I was no longer on inpatient duty. Despite the complaints about the rotation, by the end I had actually kind of grown to like it; I even considered surgery for a brief second or two. Yes, there was a lot of bitching and annoyances on my rotation, but overall I got very comfortable with my site (I pretty much knew where everything was in that hospital, including minor departments and various odds and ends), my residents, my attendings, and my responsibilities as a medical student. I even liked the OR and the clinic, and was proud to be on the surgery team. I was pretty amped about doing the pre-OP, OR, post-OP things, and then seeing patients in clinic afterward; I also really enjoyed entering the surgery area. Even looking back on those things now, I realize that I kind of miss being part of the most hardcore and efficient team in that hospital.

Another thing that helped during my rotation was my "sub-team." The "team" itself consisted of the residents and the six medical students; my "sub-team" was myself and the two medical students that had inpatient and outpatient with me. We somehow intuitively began to move as a unit, thus reducing the possibility of one of us screwing up or not having back up if things go weird. We also were really good at bitching and releasing tension, thus making the rotation a lot better. Despite liking the other three medical students, I think my sub-team was l33t and the best possible one. Also, it helped that I had somehow become immune to the bitchiest resident (unfortunately, the two other students on my sub-team were not immune), and that I had the nicest resident as my "call-buddy" resident, since the schedule and the number of medical students happened to make me have the same resident on every call night. Finally, I think a few situations had shown my dedication and positive qualities to the residents, thus making them even nicer to me and making the environment that much better.

Obstetrics / Gynecology

Ob/Gyn started off on a different foot - despite being considered dead last among the core rotations during my M2 year, Ob/Gyn became an actual consideration after I read about it during the weekend before the rotation. Part of it was me riding the good feelings from the end of my surgery rotation, combined with the more interesting subject matter of ob/gyn and my interest in the care of pregnant patients and delivering of their infants. Thus, along with the other two medical students who were also interested in Ob/Gyn, I was pretty big on the rotation and making sure that the residents knew that I was considering the field. It also helped that had the rotation at the same site during the previous slot and thus told me that the people were nice and the rotation was awesome, which created a very different feel than the "holy shit I'm blindly entering surgery" feeling. was completely right: the people at my site were nice and loved to teach. However, they were also gossipy, which was entertaining (especially since they would involve the medical students if the students showed they were interested) but also a little bit alienating. Also, a lot of the rotation was either sitting in the Ob "board room" with the residents / attendings / nurses or sitting in the clinic conference room with the attending / residents / nurses, which meant that I was sitting in a room with the same people for long periods of time. Also, learning the language and skills of Ob was a little weird and definitely on a learning curve, bringing back some memories of the first weeks of surgery. On the plus site, the public transit route was good (one bus, from the start of the route to the end was all I needed.)

My first two weeks were on the Ob floor, which was cool because my site let you deliver the babies yourself once you were trained and showed competence (I delivered a baby on my first night on call, which was my first full day of the rotation). Despite being what I found the most interesting part of the rotation, looking back I realize that I kind of didn't want people to be delivering when I was on duty, which probably shows a subconscious lack of interest. The next two weeks were in the clinics, which was usually considered the worst part by medical students but which was awesome for me because I was trusted with basically doing the entire visit myself which only having the resident go in at the very end to see the patient. Also, I saw a lot of gynecology, which was a weakness at my site (my site had a lot more Ob than almost any other site but nearly non-existent gynecology on occasion.) I also had cancer clinic, which I believe I was the only medical student to go to of the six students that had been at my site. In fact, despite being tedious, clinic was probably my favorite thing. The last two years were gynecology, involving being in the OR again. The gyne surgeons were all pretty awesome and I even saw the now-rare MMK procedure (for incontinence) and had a gyne / general surgeon who was very good at allowing me to do things. Despite enjoying being in the OR, by that point I had decided against Ob/Gyn due to finding the practice to not be very interesting; oddly enough, the other two medical students had decided the same thing, so three students went from "this may be my future career!" to "screw this" in six weeks.

Surgical Pathology

My two week surgical pathology rotation was a strange experience. First of all, I ended up with a member of the sub-team, which was cool but weird since she wasn't interested in pathology and got randomly thrown into the rotation. Second of all, many of the residents were away at a conference during the first week, thus reducing the number of things to do. Next, due to the short nature of the rotation, we really never got into doing certain things or got comfortable with what was going on. Finally, most of the rotation was sitting around waiting for things to happen, which was boring.

Despite what the M4 [future dermatologist] student would have you believe, your experience on a rotation is NOT equal to your experience working in that field; despite the fact that I was sitting around being bored, the residents were actually doing something but that something was reviewing slides and considering preliminary diagnoses, which wasn't exactly a group activity. So, despite being bored on the rotation, I was still interested in the field. I loved the amount of knowledge required, not only the awesome ability to recognize thousands of things on a slide but also the ability to correlate it with clinical knowledge and the implications of the diagnosis, including treatment, prognosis, pathophysiology, cause, and other things. I also liked how up-to-date on their knowledge that they were, including even giving some advice to clinicians on treatment decisions; pathologists are incredibly smart people. However, certain things irked me - I was not very big on the idea of looking into a microscope all day and I was a little bit perturbed by not actively seeing patients (though I was a little relieved to not see patients after 14 weeks of surgery and ob/gyn.) However, I found myself loving looking at slides and even enjoying doing presentations on findings and histology, so I left the rotation feeling like pathology was a competitor.

Psychiatry

Feeling tired from 16 weeks of rotations, I worried how motivated I would be during my psych rotation. I was also concerned about my rotation for two opposite reasons: (1) how could I write such long notes after having short notes beaten into me for the first two rotations / how could I ask so many questions (2) how would I survive being so hands off and feeling like I was shadowing (this fear came from reports from previous medical students, who said that they basically just shadowed the whole time.) Both of these concerns melted away rapidly after the first two days, which showed that this rotation was going to rock hard, especially after I discovered that I was on the same inpatient team as Psych Master timefornewtoys. The first day on the unit, we found out how awesome our team (residents, attending, social worker, occupational therapist) was and I was assigned my first patient immediately, so by day three I was already in charge of something and already feeling comfortable with my duties and with the psych unit in general. The patients were interesting, the subject was interesting, even writing the notes was interesting. I had responsibilities and actually had important duties with the team, often providing information and opinions that would actually affect the way that the patient was cared for; I also could make the patient more comfortable and actually address their concerns. Most of all, both myself and timefornewtoys were so eager to learn yet comfortable with what we did know that could actually control our learning experiences. The computer system also made our lives easier, as it made writing notes easier (I wouldn't want to handwrite notes like I did at my surgery and ob sites). Clinic was slow and somewhat shadowing-esque, but that was good at first because I definitely didn't feel comfortable doing the outpatient interview / assessment at that time.

Our crowning achievement for the rotation was when one of our residents was on vacation and the other was at conferences / something for two days, and thus we basically ran our team service ourselves. timefornewtoys and I divided up patients and saw every single one before rounds, presenting them to the attending ourselves and doing necessary collateral information gathering and work. Though it is true that we were gung-ho psych nerds, I have to give credit to basically all nine medical students at our site - we were a freaking l33t squad of students, with all of us able to throw down with DSM criteria, treatment options / med pro/cons, and rules / legal issues. In the end, I found myself loving that rotation and that field. It was pretty great, and unless medicine or peds or the combo blows psych out of the water, I'll be more than happy to enter that field.

Urology

The final two week rotation was a required specialty in urology. I had basically ruled out urology, since I had ruled out surgical fields in general and even if I decided on surgery I would be unlikely to consider urology over general surgery or other surgical specialties. I was lucky to have a site that was laid back in terms of hours - literally a 9-5 clinic every day and that's it. Both fortunately and unfortunately, my site had little going on in terms of OR experience, so I never saw a live urological procedure.

I spent the first week of my rotation without computer access, which made my life difficult and limited the number of patients that I could see. Once I got my computer codes, however, clinic turned out to be pretty fun, and I really got into the urological interview and the assessment and treatment of urological conditions. The people on my rotation were awesome as well and everyone from the students to the attendings had pretty good senses of humor. Of course, I still don't consider urology as psychiatry is still on top, but it was a nice two weeks, though a painful two weeks as it was the two weeks before my long awaited vacation.

Conclusion / Next

Next I have the more "normal" rotations; that is, the rotations that fit the general description of what various M1 and M2 lecturers have presented as "your future career" and that I have had experience with via hospital visits and shadowing in my first two years. On one hand, this makes me excited for medicine, pediatrics, and family medicine, but on the other hand it makes me concerned about maintaining interest levels and energy. I'm glad to be out of the OR, but somewhat sad to be away from the psychiatric unit.

As of right now, psych is the best fit, but I'll have to see what the next rotations / fields are like. I am excited for internal medicine, mostly because it means I can return to some of the subjects and diagnoses of M2 year that have been missed thus far.