In the third and fourth years of medical school at UB it is easier to think of the year in blocks. Each block is a uniquely challenging experience, and given your hard-earned knowledge base status-post BOARDS you will have plenty to show off and apply.
Behold the Tabs of Enlightenment!
Clerkship Coordinators: Dr. David Holmes ude.olaffub|semlohd#ude.olaffub|semlohd
Unlike other rotations, the majority of your clerkship will be spent
in private practice. Before the rotation begins, you have an
opportunity to request a specific physician you'd like to work with -
if you don't know any then you just put down a preference for either
an urban, suburban, or rural practice. If you choose an urban or
suburban setting, you'll do inpatient family med at ECMC, BGH, or MFSH
for 2 of the 6 weeks; the other 4 weeks are spent with your preceptor.
If you choose a rural preceptor your inpatient experience will just be
a normal part of each week. Lectures are on Monday mornings in the
Clinical Competency Center classroom on South Campus. There
is also a clinical skills exam, a la CPM, except you have 15 minutes
per patient. You will also have a patient safety project (or some
other sort of project), and 2 community service requirements.
Family med inpatient:
From what I hear from people who did inpatient Medicine, this is very
similar. The patients tend to be less sick, generally. You do
prerounds (talk to your patients, write progress notes) starting at
around 6:30 am, rounds are usually at around 8 or so, depending on the
attending. Rounding can last anywhere from 2-4 hours, depending on the
attending and the patient load. After rounds, if there are any
admissions, you'll go down to the ER and do an H&P; if not, you walk
around hunting down imaging results/lab results/whatever else the
residents send you off to do. You do 3 weekday calls and 1 weekend
call during the 2 weeks. When you have weekday calls you can leave
anywhere from 6-11 pm, depending on your residents. Weekend call is a
"24 hour" call, but all that means is that you might be there past 11
pm, and then have to come in the next morning to do rounds before
going back home. If you don't have call, you'll probably leave the
hospital around 5 pm each night.
Family med outpatient:
This is highly variable and depends a lot on your preceptor. For some
students, it's more or less a glorified, extended period of shadowing.
For other students, you'll be seeing patients on your own and
performing minor procedures with supervision. Some preceptors give out
H's like candy, others never give H's. Some have pharm lunches every
day, others once or twice a week. Ask third-years about their
experiences with their preceptors, make a note of a preceptor's name
if the level of responsibility that preceptor gives his/her students
sounds like what you want, because you're allowed to request
preceptors. Make sure to check your mailbox before the end of second
year for the preceptor request form.
Rural Family Medicine
Sites: Olean, Westfield. For the most part enjoyed by all students who participated. The negative part is the extra gas money you will have to shell out to pay for driving back and forth EVERY WEEKEND in order to attend Monday morning lecture. You are expected to return to Monday afternoon clinic as well. Housing is paid for by UB. Please see forum for some student accounts.
Clerkship Coordinator: Dr. Linda Pessar ude.olaffub|pfl#ude.olaffub|pfl
The psychiatry clerkship is not complete without a taste of Inpatient Psychiatry. This is where the acute patients from CPEP or other emergency rooms are brought voluntarily or involuntarily if they are a threat to themselves or others. Here you will see the successful, or unsuccessful, treatment of patients; the disappearance or new onset of voices and visions; and the reality testing of delusions. You get to experience police codes for out of control patients and medical codes for stuporous or intoxicated ones. Most of all, you will get a taste of what full blown psychosis, delusions, and mood disorders really are, and also get to see how much a person changes when the medications kick in, or don't. The best way to survive this part of your clerkship is to find out what your attendings expect from you and how to ask your residents for help. The residents are key, and they are your best source of information. Do not forgot to create a differential before presenting to your attendings, for what may seem to be an obvious diagnosis will almost always need exclusion of all other diagnoses. Never forget AXIS II !!! Also remember that some patients really feel Psychiatry is very taboo, so don't get offended if you patients will not speak with you because you are not a "medical doctor." If you have the opportunity, I highly suggest working at the VA hospital. The cases are different than that you will see at ECMC, but just as interesting. Dr. Xu is the senior attending, and she will make sure you know your stuff by the time you are through with her afternoon lectures. However, expect to work full days while you are there, all the way until 4pm.
CPEP is a wonderful environment to see acute psychiatric issues and emergency care. It is the place medical students dream of for viewing psychosis, mood disorders, and personalities galore. One cannot describe the amazing satisfaction of witnessing a first psychotic break; just wait until you get to CPEP. With all this said, the difficulty in adjusting to an emergency room setting is quickly obvious to the medical student. Clearly medical students are the lowest part of the CPEP ladder, and we are constantly skirting nursing staff, residents, and attendings, just to get a quick peek at the patient clipboard to see if there are any "first lined" patients awaiting a student to "second line" them. When not busy checking the clipboard, consulting medical staff for patient issues, or scribbling quick SOAP notes in the far corners of the "CPEP fishbowl," students are sequestered away in the conference room. Essentially a closet of retreat where students can read psychiatry material, discuss patient cases amongst themselves, or again write patient progress notes.
Attendings come and go like whirlwinds and it really feels this way in CPEP to the medical student. The confusing part is that every attending expects write-ups/presentations/follow-ups in a different manner, but there is rarely a good time to divulge attending expectations to the scattered medical students. In other psychiatry units the residents will often direct the students for a more streamlined team effort, but CPEP only has one resident for 4-5 students, and the resident is often swept up with patients as the attending is. Nursing staff, in turn, may feel obligated to take a part in shuttling students around, pointedly reminding students to remain in the conference room when not presenting patients or making collateral phone calls.
To succeed in CPEP, make sure you know what the day attending expects of your student team (ie. Dr. Improta likes you to chase him down and hound him to present your patient while Dr. Millward will come seek you out when he is free and prefers that you wait in the conference room.) Beware the nurses that prefer you stay out of their way, and befriend those you can turn to with questions. Learn all of their names and expect good returns. Also, since Emergency Room care is shift-duty, you must stay your full 8:30-4:30 shift and wait past 4:30pm if necessary should the evening attending arrive late. You will be expected to present your patient(s) to her/him before leaving for home.
Clerkship Coordinator: Dr. Susan Gallagher gro.htlaehadielak|rehgallags#gro.htlaehadielak|rehgallags
Because of the broadness of internal medicine the clerkship tries to simplify things as much as possible. But even still there is much confusion. You're given a schedule at orientation that will tell you the order of your module (inpatient, outpatient, elective). You're also given a nice 3-ring binder containing the course outline and expectations and case questions for your weekly lectures on Tuesday afternoons. These lectures you attend throughout the entire 12 weeks. You are assigned a hospital (BGH, ECMC, VA, Mercy) and the outpatient clinics associated with each.
Inpatient is more straightforward as you will be expected to stay at the same hospital for the 4 weeks. Since 3rd years, 4th years, residents AND attendings all switch teams at different times throughout the year you will likely be experiencing a few team switches during your rotation. Outpatient is a bit more chaotic as you will likely be rotating through several different clinics. You'll go to one in the morning and then perhaps a different one in the afternoon. For one week of the outpatient portion you will be doing geriatric homecare in which you'll be driving out to an elderly patient's home (with a medical staff member of course) and conducting interviews in the patient's home.
Throughout your inpatient and outpatient rotations you will be expected to turn in weekly patient write-ups. During your outpatient rotation you will need to turn in an ethical dilemma paper in order to complete the clerkship.
The shelf exam consists of 2 components: written exam (100Qs multiple choice) and the practical (think histology/anatomy exam but with vignettes, microscopes, EKGs, CTs, etc). These exams plus your clinical assessment determine your final grade.
Clerkship Coordinator: Dr. Wayne Waz ude.bohc.apu|zaWW#ude.bohc.apu|zaWW
BLOW YOUR NOSE OR THE BOOGIE MONSTER WILL GET YOU.(1)
Pediatrics gives you the opportunity to work in both outpatient and inpatient
settings. Before the rotation starts, you will be asked if you want to be at
Children's or South Buffalo Mercy. If you choose Children's, at orientation, you
will be assigned to 3 weeks at an outpatient clinic somewhere in buffalo and 3
weeks to an inpatient team. Mercy is a combination of outpatient and inpatient
every day for the whole 6 weeks.
During outpatient clinic, you will be able to practice your history and physical
exam skills as well as see a wide variety of findings in children. Clinic is
usually from 9 to 5. You work with your attendings one-on-one and also with
residents at some clinics. You have to opportunity to see your own patients and
present them and your plan to the attending like a resident would. It is very
straightforward and you can make of it what you want. Your attending evaluates
you at the end of the 3 weeks.
The other 3 weeks are at Children's on V7, V8, and V10. You will be assigned to
either the Blue, Red, or Green team. Each team is headed by 2 or 3 attendings, a
senior resident, and 3 or 4 interns. During inpatient, you will follow at least 2
patients (1 is allowed the first week). You will present them in the morning on
rounds to the attending and the rest of the team and follow-up on their
labs/procedures during the day. Rounds start at 9, so most students get there
around 7 to see their patients and write progress notes (they are long). There is
11:30 lecture MTW which are optional per Dr. Waz but the residents probably want
you there and they are the ones that grade you. Also, there is an 8 am lecture on
Thursday and Friday, so you must have your notes done by 8. Rounds are still at
9. Radiology rounds are at 2 pm everyday and you will go with your team to see
everyone's x-rays for the day. The day ends after sign-out at 4 pm except when
you are on call. You will be on call every 4th day from the end of sign-out to 9
p.m. The last team you work with is the team that evaluates you (sometimes their
rotations overlap with ours). There are two short-write ups during these 3 weeks
and random presentations as well. On the last day of inpatient, everyone on your
team will get together and do your evaluation so get to know your team well.
Clerkship Coordinator: Dr. Mandeep Brar ude.olaffub|rarb#ude.olaffub|rarb
Please don't forget to wear the shoe covers!
For OB/GYN here's how it works. 8 people go to Children's, 8 go to Suburban for the first 3 weeks and then you switch. However, if there are more than 16 people, the remainder go to Sisters. You'll pick out of a hat. Also once you pick, you can switch sites and partners. The best thing about OB/Gyn is that it is a nice mix of medicine and surgery. The first 3 weeks are likely at Children's where you will get most of your labor & delivery experience. The 2nd 3 weeks are at Suburban where you will see most of your gyn surgeries.
At Children's you will deliver lots of placentas and the occasional baby as well as assist on plenty of C-sections for interesting high-risk pregnancies that are only dealt with at Children's. You also go to the Women's clinic to provide antenatal care and diagnose the occassional STD. You will learn to master the sterile speculum exam. You must be at the hospital by 5:30AM most mornings, where you will round on post-partum's and give a brief one-liner presentation at morning rounds at 7AM. There are four 24-hour call days where you will learn what it is really like to be in OB. You get out what u put into this: Technically, u can nap whenever u want, BUT they will NOT wake-up you up for deliveries or C-sections. So, if u want to participate, you pretty much have to stay up most of the night.
At Suburban, you will see more hysterectomies than u could ever want to see. But there are also a bunch of other kinds of surgeries including laparascopic tubal ligation, ovarian cystectomy, pelvic support procedures, and even retroperitoneal lymph node dissection for various gyn cancer staging. This is a great opportunity to get accustomed to the operating room - scrubbing in, suctioning, suturing, knot tying - before u do the Surgery rotation, if that is what u are interested in. You also do some labor & delivery, but not nearly as much as Children's since most of the patient's at 'Burban are private. So if u are interested in L&D, then make sure u particpate while at Children's.
In terms of evaluations: There are a total of 32 residents that u can possibly work with during this rotation, so you will not have extensive contact with any one resident. Instead of trying to cater to the residents, just be proactive, put the patient first, and hopefully a few of the residents will rememeber you.
Clerkship Coordinator: Dr. Judy Smith gro.krapllewsor|htims.yduj#gro.krapllewsor|htims.yduj
"I prefer scalpels to knives when eating my steak now." -fictitious person
Surgery is a fascinating rotation, you’ll get to do and see things that you would not believe. Everyone is always worried about the time commitment, I sure was. It really is not that bad, I had time to study and do social events (i.e. your life is not over). At ECMC, your day starts at about 5:30 am where you write down labs for your team’s patients. Then you round with your team from about 6-7:30am. If it is your precall day, you watch and hopefully scrub in on surgeries the rest of the day. If it’s your post-call day, you go home at about 9am. If it is your call day you try to find a surgery to watch, but the team whose precall day it is gets first dibs on the surgeries. You participate in clinic for a few hours on your call day. You spend a lot of time waiting around so bring books! Then a trauma will come into the ER and you can do things like put in a foley, do stitches, put in an NG tube etc. just ask the resident you are with. They should send you home at 11pm (don’t be afraid to ask-nicely, it’s a rule).
Expect to get yelled at constantly in inpatient-it’s not you, they yell at you but have never told you what they wanted you to do in the first place and everyone wants something different. You have to try to find out what each member of your team expects-don’t worry, it will take about a month and then you leave. Be polite, friendly, helpful, ask to do things, only you can advocate for your learning. It’s hectic and everyone is stressed so try to develop a thick skin. Also try to get to know your residents as people, asking someone about themselves is a sure way to get them to like you. You can also be in charge of ordering dinner on call days, everyone is nicer after they have eaten.
Outpatient varies. I had a great preceptor that I basically followed around for a month. I was at Mercy Hospital where they have no residents, so you get to be the assistant on many surgeries. I only had to come in one Saturday. If you are placed at Roswell expect to be there constantly, it really is not fair. It’s great if you are really interested in surgery but the time commitment can be more than for inpatient and the surgeries are too specialized for the shelf. These complaints were voiced so hopefully some changes will be made.
It is a great rotation and for the many people who don’t want to be a surgeon this really is your only opportunity to be in the OR so make the most of it. The eight weeks goes by fast. Everyone I know made it through the rotation in one piece and many of them truly enjoyed it. Be prepared to work hard and it will be over before you know it.