Scheduling Your 3rd Year Clerkship

Question

In what order should I schedule my rotations? What are the best strategies?

Response from Megan L. Fix, MD Assistant Professor, Tufts University School of Medicine; Director, Medical Student Education, Maine Medical Center, Portland, Maine

Your third year of medical school can be exciting and also daunting. Many students ask what the "best" schedule is for their third-year clerkships. Although there is no right answer, there are a few guidelines that can be helpful.

First, try to determine your chosen field of interest. Take some time during your first and second years to shadow physicians, talk to residents and faculty, and make an educated decision about your future plan. This is especially important if you want to go into a field that is either competitive or not a core rotation (such as dermatology, ophthalmology, or emergency medicine). If this is the case, you might want to plan a block in the second half of your third year to do an elective in this field. That gives you a chance to confirm your chosen field, gather letters of recommendation, and schedule an away rotation or subinternship in this same field before submitting your residency applications. It might even be necessary to postpone a core rotation until your fourth year to make sure you can complete your specialty electives(s).

Once you have determined your intended career path, scheduling your third year becomes easier. There are many opinions on this. Some recommend that you get hard rotations out of the way. Others suggest that you do internal medicine first as an overall introduction. It might also be wise to do your chosen field two thirds of the way into your third year so that you can perform well. Overall, the method is up to you. In 1 online survey , 25% of respondents suggested doing internal medicine first, 20% said they would rotate in their chosen field during the second half of their third year, 18% advised doing something easy first, and 14% suggested doing something difficult first. As you can see, there are many options and opinions.

My advice is to combine many of these suggestions into the following guidelines:

1. Talk to upperclassmen about your schools process. Some schools have multiple rotation sites that offer very different rotation experiences. For example, there may be a hospital that is "the place" to do your surgery rotation if you want to go into surgery. Some schools have a lottery system and it is important to know about this.
2. Avoid doing your chosen field first. This allows you to "get your feet wet" in the clinical environment before you make an impression on the residents and attendings who will be your advocates for a residency position.
3. Schedule your chosen field rotation in the second half of third year but do not wait until mid-fourth year.This not only allows you to be a stronger student during this rotation, but it also allows you time to schedule a subinternship or away rotation in that field early in your fourth year and/or take another rotation if you end up not liking your chosen field as much as you thought.
4. Do internal medicine early. Although many say to do internal medicine first, this is not always possible. It will give you a broad introduction to medicine that is applicable to all fields. If you are choosing medicine as a career, I recommend doing it third or fourth year so that you can shine and then springboard to a subinternship.
5. If you don't plan to pursue surgery or pediatrics, consider doing one of these first. Surgery is good to "get out of the way" and it also serves as an introduction to the wards. Pediatrics is generally a kinder month and also serves as an introduction to the wards.
6. Avoid scheduling hard rotations back to back. This is most applicable to call months such as surgery and OB/Gyn. Give yourself a lighter month between these or a vacation so that you are fresh and ready for the next rotation.
7. If you are going into a specialty that is not one of the core rotations, plan carefully to allow for this in the second half of the year and talk to upperclassmen about the best approach. For instance, if you wish to go into emergency medicine, many schools require that you complete your core clerkships prior to an emergency medicine rotation. Furthermore, it can be helpful to complete at least 1 home rotation and 1 away rotation in your chosen specialty before applying to residency. Depending on the process at your school this might require extra planning.
8. Even though electives are generally not allowed until late in your third year or early in your fourth year, think about scheduling an away rotation in your chosen specialty EARLY because slots fill up quickly.

Overall, your third year will expose you to core clinical rotations and prepare you for your fourth year and, eventually, your internship. Plan ahead, especially if you are going into a competitive specialty, so that you can be prepared for success.

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