Selecting the best MS3 clerkship track order6 min read

Today’s inane image of the day:

The problem that arises with writing blog entries is that sometimes you have to stretch the truth in the title to grab your prospective reader’s attention. Am I going to go over a couple of factors to consider when selecting your 3rd year clerkship track order? Absolutely. But is there some magic formula to picking the “best” or “perfect” one? No. Plus, at the end of the day, it doesn’t matter all that much. Yup, I went ahead and shared the dirty little secret… clerkship track order really won’t make a substantial difference on your success as an MS4 – no, that’s up to your individual effort. So, even if you do not get your 1st, 2nd, or even 3rd choice, please, do not panic and make the best of it.

So back about 2 years ago, I submitted my own clerkship track preferences. I ended up getting my first choice and was very happy about how my 3rd year panned out. However, the tracks and a couple of the clerkships themselves have since changed [most of these changes, I agree with – but that’s perhaps a discussion for another time] so my track option is no longer a viable one.

The current 6 options for tracks feature either a front-heavy or a back heavy schedule. The heavy-hitting clerkships are classically Surgery, Internal Medicine, Pediatrics and OB/Gyn. Generally, any specialty that requires a lot of inpatient work will demand much more time. This past year, they tested out 2 months of inpatient Internal Medicine with one day a week of clinic [correct me if I’m wrong, current MS3s!], but I think they’ll be reverting back to the 1-month outpatient and 1-month inpatient schedule again [which, I think is a much better balance because most internists/sub-specialists practice in an outpatient setting and it gives you a glimpse into the sub-specialties that you may not otherwise be exposed to]. Pediatrics was also lengthened out to 8 weeks, allowing for more time in a private practice, outpatient setting. Again, I agree – any changes to the schedule that reflect real-world practice, I tend to applaud. After all, this is the year most medical students fall in love with [or decide to rule-out] certain specialties – it’s best to have a glimpse into your future practice. Surgery and OB/Gyn did not see any major revisions [from what I know].

Now… for some tips to select the best clerkship order for your goals:

1. Ask yourself if you want a front-heavy track or wish to ease yourself into the year by selecting a back-heavy track.

I really think this is the easiest way to narrow down which 3 to focus your attention on. Are you the type of person that likes to “get the hard stuff out of the way”? I am. Which is why I personally would have selected tracks 1-3 if I had to do it all over again. In the spring semester, many of you will be trying to arrange your away rotations, plan/study for Step 2 CS/CK and get things in order for ERAS [e.g. letters of recommendation, researching residency programs you’d like to apply to, etc]. Having a steady 8am-6pm Monday thru Friday type schedule will make this planning much easier.

2. Try to put the specialty you are most interested in toward the middle – but be wary of the last clerkship of 1st semester because you will be burnt out.

The age-old advice about trying to place the specialty you’re most interested in toward the middle of the academic year is on-par. This is the optimal placement because after a couple of months, you would have gotten the hang of how to get around the hospital, how to navigate the electronic medical record [Epic], how to use UpToDate like a pro, how to attempt to write notes and how to study for shelf exams. You may not be on top of your game for all of the aforementioned items, but at least you won’t be a fish out of water. But you don’t want to wait too long because knowing what specialty you’ll be applying for at the end of the year and planning for 4th year is much easier when you’ve answered that looming question of “what am I going to do when I grow up?”

My recommendation is that you should put the specialty you’re most interested in at the beginning of second semester. I heard from some of the current 3rd years that even with “easier” first semester, they were still tired and ready for a break by the time December rolled around. That low level of general enthusiasm for being at the hospital or clinic really does not bode well for impressing your residents and attendings [who you may be asking for a letter of recommendation from!]. Would I prioritize this advice over my first tip about selecting a front-heavy schedule? Maybe. Depends on how confident you are in the specialty you’d like to pursue. I was not sure what specialty I wished to pursue in February of 2013 when I submitted my track preferences, however, I thought I might be interested in OB/Gyn because of my work with AMWA and because it appeared you could “have it all” – surgery, long-term relationships, preventative health counseling and outpatient work – so, I tried to get OB/Gyn in the middle of the year [turns out I didn’t like it much, so it didn’t matter in the long run and I was very glad that I had an “easier” second semester].

3. OB/Gyn before General Surgery if interested in a surgical specialty.

Some of my colleagues that knew the operating room was their calling tried to put OB/Gyn ahead of General Surgery so that they could learn/practice suturing, knot-tying, and other surgical skills prior to starting on their General Surgery clerkship. I think this is great advice.

4. Go into 3rd year with an open mind and enthusiasm to learn – even if you don’t think you’re interested in the specialty you are on.

This may be the most important tip of them all. As I noted earlier, it doesn’t really matter what order you do your clerkships in. You will only be successful if you are pleasant to work with and interested in learning. Show up early. Do your reading. Ask questions. You never know what specialties will surprise you.

Finally, for those of you nervous about starting on the wards, I’ve already doled out advice for 3rd year. And if that’s not enough for you, try Success on the Wards: 250 Rules for Clerkship Success – I read this book almost cover-to-cover on my DTW -> LAX and LAX -> DTW flights. Some of the information was obvious to me, but there were some good pearls in there. Plus, it’s < $10 used through Amazon marketplace, so why not?

Current MS3s and Ms4s, did I miss anything?