I recently had the pleasure to be a panelist for the Van Wormer Student Judiciary Committee at AUC. As current AUC students are aware, there are many, MANY questions involving clinical rotations, USMLE Step examinations, and residency applications, accompanied with some confusion about where to find the answers. Below are my questions and answers.
*As a side note, for all of you out there interested in matching into Surgery, Dr. Hernandez is an excellent resource. He can be contacted at firstname.lastname@example.org.
- Can you give an example of when you were in rotations and an alarming or ethical situation arose and how you decided to deal with it?
During my emergency medicine rotation, I had a very ambitious resident that did not quite respect my limitations as a student. There were multiple occasions where he pushed me into a situation or procedure for which I as not adequately trained. One good example were ABGs. I had only done them on mannequins previously while in medical school, and had practiced only a couple times on a live patient. I as not prepared to do them without supervision, because of the potential risk of harming the patient. The resident told me specifically to do an ABG on my own for a patient who had just been admitted. After doing so, I approached him and asked if there was a reason for this conflict and explained my perspective. He reflected for a moment and stated he was overworked and taking his stress out on medical students. We came to an agreement that while I was more than willing to learn and do procedures, until I felt comfortable on my own I would appreciate the supervision while doing so. He thankfully agreed and taught me how to do proper ABGs until I felt confident enough to do them on my own.
- What clinical sites did you choose to complete your rotations at? Do you recommend changing sites often or utilizing one main hospital?
I did my OBGYN and Surgery rotations at Epsom Hospital in the UK, about 30 minutes south of London. My fiancé, Tylor, came with me and we thoroughly enjoyed our time in England. In addition to learning an entirely different healthcare system, Tylor and I had the opportunity to travel around Europe at a relatively low cost. We never would have seen so many countries or experienced the unique cultures within them if I had chosen to complete all of my rotations in the US.
Afterwards, my remaining clinical rotations were completed in New York between 3 separate hospitals: Flushing Hospital, Nassau University Medical Center (NUMC), and Bronx-Lebanon Medical Center.
Here is what my schedule looked like:
Tylor and our dog Brutus (@brutesmcpoops if you’re interested in the best doggie instagram ever) were living with me during my clinical rotations. Because of this, I decided to stay in one location the entire time – Queens, NY. I attempted to place our apartment location in the middle of all 3 hospital sites, with a reasonable commute between all of them. It worked out alright, my only complaint was the commute to Bronx Lebanon. 2 Trains, 1 bus, and 1.5-2 hours later I could arrive to the hospital for a 6am shift. To NUMC was about 30-45 minutes (you’re going in the opposite direction of morning and evening traffic which is AMAZING), and about 15-20 minutes to Flushing.
- What do you think was the most attractive quality about a clinical site where you completed a rotation?
Whether or not the rotation made an effort to incorporate medical students, and how supportive nurses, residents, and attendings were of each other. The worst rotations were those who treated medical students as a nuisance. It was obvious we were there to hinder their work instead of learn from it. Lectures were always over our heads and there were large gaps of time where we couldn’t do anything,
A good support system is also what I’m looking for in a residency program right now. I don’t want to work in a toxic environment, where there is a constant internal struggle between nurses and doctors. Personally, I learned the most from the nursing staff and to see them mistreated fostered an environment of distrust.
- Did you feel that medical school wholly prepared you for clinicals? What do you think, if anything, would have improved your performance in clinical rotations?
To be honest, the main focus on the first two years of medical school are basic sciences. The majority of your time will be spent in preparation for the Step 1 exam. Once you begin clinical rotations as a 3rd year medical student, there is a distinct transition from the books to the hospital world. The best way to prepare for this is to keep in mind that everything you read about, whether the subject is microbiology, pathology, or physiology, MUST be applied to a patient in a clinical setting. Always visualize a patient presenting with these problems, and it will make the transition smoother. Also, do not learn these subjects “separately.” If you remember that everything is connected and the subjects you learned in basic sciences are intertwined together, you will build a strong differential diagnosis for any patient presentation.
- Did you feel like other medical students were respectful of you being an IMG? Did you ever feel being an IMG was a problem with a preceptor? Why or why not?
For me, the hospital sites I rotated in had strong representation from not only AUC students, but other Caribbean medical students as well. Because of this, we were united on that front. There were medical students from other schools (like NYCOM at NUMC for example), but for the most part, everyone was respectful of each other. Where you went to medical school came up occasionally in conversation, but confidence/competence as a medical student had a stronger impact.
- How do international core rotations look on a resume? Do you believe completing some of your core rotations in the UK was beneficial?
A lot of program directors weren’t aware that I completed my OBGYN and surgery rotations in the UK until I brought it up in an interview, but when it came up it became an interesting talking point. Because of that, I do believe completing some core rotations in the UK was beneficial. You have to remember that these programs are interviewing hundreds of applicants for a handful of positions. Now that you’ve made it past the Step cutoff scores and have been selected to interview, it’s up to you to pull out memorable details from your application that will help you stand out. It’s a good idea to have a list of 5 interesting talking points from your application that you always try to incorporate into the conversation. For me, my time in the UK was one of those talking points. A word of advice: schedule these rotations as early as possible. There are some factors involved with doing rotations in the UK, including taking time to move back to the US. Especially for the September class, you must stick to a strict schedule in order to match on time.
- How did you schedule your core rotations, or is that pre-selected at your clinical site?
The first rotation you schedule should not be something you’re interested in. That way, you can make a total fool of yourself during that rotation while you get used to the system and it won’t matter. I wasn’t interested in surgery or OBGYN at the time, so I scheduled those 2 first. From the UK, I scheduled the rest of my core rotations in New York. Keep in mind that you want a letter of recommendation from your specialty of choice before you submit your application for The Match on September 15th.
AUC’s Core Clerkship Guide: https://www.aucmed.edu/content/dam/dmi/www_aucmed_edu/PDFs/academics/OCSA-Core-Clerkship-Guide.pdf
Can be used to find programs of interest according to their geographical location. You submit a list of your top 4 program choices to your advisor at email@example.com and a couple days later, they will send you an email with your updated schedule. For elective rotations, there is an elective request form that can be found on AUC’s website.
*Scheduling rotations must take place AFTER passing Step 1.
- Did you take any breaks in between your core and elective rotations?
I had a 2 week break in between my core and elective rotations. I would recommend scheduling a 2-4 week break before taking the USMLE Step 2 CK examination.
- What was your timeline after leaving the island?
Comp Exam: March 23rd, 2016
Left Island: April 19th, 2016
Step 1: June 20th, 2016. Score received July 13th
Arrived in Epsom, UK: September 12th for my first clinical rotation!