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3rd Year Clerkship Overview: Student to Student Advice

Modified for SUNY Downstate from NYU Med Document, August 2008
* Item is meant to be used in conjunction with third year survival guide received at transition to clerkship orientation.

Disclaimer The statements in this document are based on aggregate responses of a number of students from the past couple of years and should only be viewed as student to student advice. None of the information is official, and a number of clerkship changes occur continuously; changes may not be reflected in this information. Course websites and information from Clerkship Directors should be your primary source of information about what is going to happen during each particular clerkship. Advice should also be sought from the Office of Academic Development as per school recommendation. There exists a website that was designed some years ago by gracious students, www.francoverde.com, however the information contained on there is very outdated and should be interpreted as such. Consider this information organized rumor-mill. General Tips for the Wards The one thing that you as a third year medical student has absolute control over is timing, that is you MUST MAKE EVERY EFFORT TO BE ON TIME. Morning rounds are the best time to impress your attending, so make sure that you know patients well and keep very organized following a systematic format. Browning points can be earned aside from showing knowledge by discussing the differential diagnosis when presenting a patient for the first time and attempting to formulate assessment and management plans. Load up your white coat pocket with materials commonly needed (pen light, tongue depressors, cue tips, reflex hammer, blood work materials, etc.) It looks really great when you come prepared with these things and in the very least it couldnt hurt especially when the workload is high. Consider bringing in review articles pertinent to your patients and/or volunteering to do a presentation on a topic especially one that you may have been pimped on and did not know about. E.g., if asked a question about something and you didnt know, say I dont know at the moment, but Ill present on this tomorrow. This may seem like a waste of time, and arguably it is. However, voluntary presentations on your behalf show great enthusiasm and will actually help you learn. Regarding shelf exams In general, if you can get your hands on USMLE world subscription, probably the single best source of questions overall. 2nd best source of questions would be Kaplan Qbook unless otherwise specified. Questions will help you learn and retain information better than reading texts especially as far as shelf exams are concerned so do lots of questions! Focus a lot on patient management of patients because many questions will be phrased along diagnostic tests and how to manage patients medically. Make sure to study early for shelf exams as they make up a significant portion of clerkship grades and ultimately make the difference for most students between P, HP, and H. When actually taking exam, MAKE SURE TO FINISH. If you are unsure, pick an answer and move on and return to unsure answers at the end if you have time. Answering 10 questions with uncertain answers is better than leaving five blank! Do not wait to the last week or two thinking you can cram. Start doing questions early.

***Questions will be more beneficial than reading all day.***

Regarding hospital site selectionsIf you want to work hard on your rotation do them at kings county/downstate because they will work you but also make you feel like a part of the team. The outside sites like Maimo, LICH, Brookdale, etc. from my experiences do not work you as hard and sometimes they dont really miss you when you are not there. The drawback being that you may not get enough exposure at those sites. THE MORE RIGOROUS THE ROTATION, THE MORE EFFICIENT STUDYING HAS TO BE. Each Core Clerkship carries with it the requirement to seek a midclerkship formative evaluation in the middle, i.e. must be handed in during the 3rd week of a 6 week clerkship. This is one source of feedback. However, we recommend that you SEEK FEEDBACK ABOUT WARD PERFORMANCE several times (at the end of a week, or bi-weekly), this will show that you are interested in your own performance and may add points to your final evaluation!!! Remember, direct quotes from your clerkship evaluations will appear in your Deans Letter for residency.

It is said that shelf exams get harder throughout the year, and concomitantly more is also expected out of you on the wards as time progresses. More or less both statements are true. INTERNAL MEDICINE Your team will consist of: 1 resident in charge of team (2nd or 3rd year) 1-2 interns 1-2 Sub-Is 1-2 MS3s You will also have a ward attending who will meet with your team to discuss the patients on your teams service. In addition, you will have a teaching attending dedicated to medical students (separate from the ward attending) with whom you will meet ~3 times a week. You will discuss various topics with your teaching attending and will present some of your patients during these meetings. You will have 2 teaching attendings during the rotation, 1 at each of the 2 sites where you will work. **To begin with, most sites you work 6 days a week, so no weekends for like 10 weeks! You will also meet with your firm chief (another attending) once/week to discuss other topics. What to expect: Your resident will assign you to follow a couple of patients (an intern/sub-I will also be following your patient). Your responsibilities will include pre-rounding on the pts in the morning, following up their lab results/imaging studies/diagnostic tests/consultant reports, and writing a note in their chart each day. You may also be asked to draw blood, call consults for your patients, and present your patient on daily rounds. In addition to ward responsibilities, you have 10 patient write-ups to complete. Each write-up is approx. 5-10 pages and includes the case presentation (HPI, Physical exam, etc.) as well as a thorough discussion of the differential diagnosis. A discussion, with a literature review, is also required. The write-ups generally take a considerable amount of time, so prepare and plan ahead. It is difficult to do the write-ups and study for the shelf at the same time. Rumorville states that you may be able to get away with less, (around 8 or so) however Id recommend counting on doing a full ten in most circumstances. Twice during the rotation we have a meeting with the clerkship director, first time for orientation to the clerkship and the 2nd time for a mid clerkship reunion. What you studied for step 1 might show up on the wards or the floor. Schedule: The day generally begins with pre-rounding from 7:00-7:30am. This is when you quickly check up on your patients, check their vital signs from that morning and overnight, and find out if there were any significant events that occurred overnight. Speak to nurses as well for if needed they may have some information that may not be clearly stated in the chart. Afterwards, the entire team of residents will round on the patients as a group. This is where the daily plans for each patient are usually discussed. You may present your patients to your team during rounds. Following this, on some days, you will then have ward attending rounds where new patients or complicated patients are discussed with the resident team and the ward attending.

During the rest of the day, you will work on your notes/draw blood/call consults for your patients. There are often lunchtime conferences during the day that you will attend. There is also intern morning report and grand rounds that students may be expected to attend. On non-call days, you will hopefully end the day around 5 or 6 PM (sometimes earlier, sometimes later). On long-call days, you may be there until 10 PM. Teams have variable on-call schedules, and the day after call is termed post-call day. Overall: Medicine is a very busy clerkship, but you will learn a lot about patient management. Generally, you will be in the hospital 6 days out of the week (no golden weekends, officiallythough some variability may exist). This is the clerkship that probably requires the most after hours work as well. Evaluation: Based on input from your teaching attendings, firm chief, and preceptor/teaching attending for the most part. Shelf exam at the end of the clerkship factors into grading as well, contributing 35%. Your team leader/ resident also will play a part in your evaluation and comment on your ward performance. An average of all ward evaluations will constitute 65% of your final overall numerical grade. Sometime during the final two weeks of the clerkship you will be expected to perform a complete H&P on a hospitalized patient in the presence of a faculty member who will evaluate your performance. How to succeed: Your medicine grade is largely determined by the evaluations from your teaching attendings and firm chief. Therefore, you will want to impress them when giving presentations or doing patient write-ups. The resident teams also play a role in your evaluation. Enthusiasm, a good work ethic, teamwork, patient rapport, and a good knowledge base play into your evaluation. Grading policy is strict to the point where one has to meet certain cutoffs to make grades of HP or honors. If one criterion isnt met, then it is likely that one will not get the grade even if all other criteria are fulfilled. Shelf exam: special key for this one is doing questions. Some material tested is similar to step1 material. Physical Diagnosis Exam: For physical exam at the end of the rotation: It all depends on the attending who grades you. a) Start with introducing yourself to the pt and announcing that you are going to go wash your hands! b) Do the exam on the right side of the pt if possible. c) Anything that you would do, but will not (because you are pressed for time) should be verbalized: "At this point I would ..." and then ask the attending: "Would you like me to do ..." at which point most attendings go: "that's ok, keep going". d) The grading sheet has the following gems: Full history: CC(7 dimensions of the symptom), HPI, Social (including occupation, sexual, smoking drugs and ETOH), Medications, Allergies, full ROS. e) Physical starts with washing hands (wash them at the beginning because you will most likely forget otherwise). Then vitals: pulse, respirations and pressure. Then a complete physical exam, just like we practiced at the end of second year including: HEENT with ophthalmoscope and full eye exam, neck, chest exam: both anterior and posterior --inspection, excursion, diaphragmatic descent, fremitus, percussion and auscultation in any order you want. Heart with inspection, palpation, PMI and auscultation. Liver, spleen, abdomen, pulses (radial, popliteal, post tib and dorsalis pedis). Edema. No neurological exam beyond sticking out the toungue and looking for symmetrical pallate rise (unless they had a neuro problem). Be courteous, nice and helpful to the pt. (part of the grade).

Grade Policy as of August 2008:

Grade Honors Pass NBME subject test score Ward 75 (raw score) and 61 (raw score) and Average Practical 75% and 92% and Pass 75% and 87% and Pass or fail 75% and 76% and Pass or fail < 75% and 76% and Pass or fail Cons Long book

High Pass 71 (raw score) and Conditional 5660 (raw score) or

Fail < 56 (raw score) and/or < 76% Pass or fail Book Name Pros Kaplan IM Lecture Notes High yield info, WRITTEN BY DOWNSTATE FACULTY!!!!! Pocket Medicine First Aid for the Medicine Clerkship Step Up to Medicine Pretest for IM MKSAP3 Question Book Kaplan Qbook Medicine section ABSOLUTE MUST HAVE to carry on the wards


IM case files

Bulleted format, less Great if you're a fan of the first aid series; covers everything briefly story like all the information needed to know is there but the book rather lengthy to get Most people use it though through Good to have in pocket for questions on downtime, good for unfamiliar topics and weak topics Very good source of questions for most students BEST source of questions; 8 tests of 50 questions each Present classic clinic scenarios so after answering many question you already have the appropriate ddx in mind after reading the clinical case Questions may not be presented in the question fully representative Used in combo with a question book, enough to get you decently by for the shelfitself wont get By

Y concise explanation of different medical conditions

you honors

Bbabab blueprints medicine Pr

SURGERY Your clerkship will be divided into 2, 4-week rotations, one home (UHB, Kings county, a few others), and one away. The home rotation is usually more demanding, and more meaningful in terms of teaching and evaluations, so this is not the time to slack off. Depending on your away site, you may get more variety of cases depending on what that hospital is known for. Your general surgery team will vary, but generally consists of: 1 5th year chief 1-2 third/fourth year residents 1-2 second year residents 1-2 interns (generally teams will have about 4 interns/residents in total) 4-5 students There are also several attendings on each team. There may be 4-5 attendings whose patients are covered by the surgery team. What to expect:

During the course of the day, patients may be admitted to the hospital for surgery, either through the ER or as previously planned procedures (same day admits). When new surgery admissions come in, you will be asked by your resident to do an admission history and physical exam of the patient. You will follow this patient and participate in their surgery. You will follow these patients in their post-operative course. You will round on these patients daily, writing progress notes as per instructions from your resident team. You will be able to scrub into a number of cases on this rotation. Your responsibilities in the OR will vary greatly depending on the attending/resident with whom you are working. You may expect to help your resident open or close the case (assisting with suturing/ possibly suturing the skin yourself/ holding the layers together for your resident). You will also do plenty of retracting, suctioning, and cutting suture strings. Much of the time in the OR will be observation of the case. Daily schedule (varies greatly depending on which hospital and specialty service): 6 AM is the usual start of the day, when the team rounds on their patients (most of whom are post-operative). The students should arrive slightly before 6 AM (if 6 is the starting time) to make sure that when the rounds begin, you arent late because surgery resident rounds move quickly. Students generally dont present their patients on rounds as they do in other rotations but do assist the residents with dressing changes and looking up relevant information pertinent to the patients you are following. Around 7am, once the resident team has made their rounds, they generally meet with the attending to discuss new patients or complicated current patients. After these meetings and any morning lectures, surgeries begin. Teams generally expect a student to be present in every operation, so the students usually divide the cases amongst themselves. It is best to get a schedule of the following days operations at least one day in advance so you know which students are covering which cases prior to the morning of the surgeries, and so you can read before your case, as you will almost definietlybe pimped in the OR. There are surgical lectures and workshops, usually held 2-3 times a week. Do not feel bad about leaving an operation to go to these student lectures, as it is mandatory that you attend. Absences from the OR due to medical student lectures/ meetings with teaching attendings, are expected. Teams usually round again in the evening to check up on the teams patients. On a non-call day, students leave following afternoon rounds, generally between 5 and 6 PM. Once or twice a week you will get to observe in surgical outpatient clinic held at the VA or at Bellevue. Also, many recommend talking to your Tisch attendings and finding out if they would allow you to see patients with them in their private clinic. Some Tisch attendings are great teachers and taught a lot in their private clinic. Call schedule: Site dependent. Usually made up among students Overall Surgery Advice: The surgery rotation forces the student into fairly long hours in the hospital where you will have to stand for long periods of time. However, there is not very much outside work required in this rotation. You have very

few at home assignments except studying for the shelf. Usually, on general surgery you will go in on weekends only when your call days fall on a weekend. There are 2 kinds of studying material required to do well: OR studying and shelf studying. The knowledge required to do well in the OR involves anatomy and surgical procedures - surgical recall. How to succeed: Your grade for surgery is based mainly on your performance on the general surgery portion of the rotation. Enthusiasm is important on the wards. While there are fewer presentations to make to your teaching attending, it is important to take advantage of those opportunities to make a good impression, as your teaching attending has a big role in your evaluation. ** Dont neglect surgical subspecialties when studying. High Yield shelf topics: Dont neglect surgical subspecialties (urology, ENT, optho, etc) and Trauma/GI are very high yield!!! Books: Read something small: Kaplan lecture notes of blueprints should do. Depends on preference, but questions are much more important, so dont spend too much time on this. It should be meant as an overview Shelf knowledge is more along the lines of medical management of surgical patients. Surgery Kaplan Qbook
Book Name Kaplan Surgery Lecture Notes Pros Very quick read, amazing accuracy for shelf Tons of high yield material only pertaining to what necessary for the shelf Used in combo with a question book, enough to get you by for the shelf Cons Size of book may make you feel under prepared Specialty section overdone Not good enough to get you honors

First Aid Surgery Case Files Surgery Surgery NMS Case Book Surgery A&L Questions Kaplan Qbook
Kaplan Qbank for Surgery Surgical Recall Pretest for Surgery

Waste of time Excellent prep for the shelf, reserve these for closer to the actual exam 2 full tests with 50 questions each Excellent prep for the shelf Very good quick reference for the floor. Fits in pocket, good for reading before case. Great for pimping Cover a broad range of topics, esp key topics for shelf. Good for topics that are lower yield.

Shouldnt be sole source of info ?s helpful but not the best, poor explanations

What others have said: if you definitely don't want to do surgery, then do it at maimo PEDIATRICS Your in-patient team may vary but generally consists of: 1 Resident 2-3 Interns 2-4 3rd year students *teams may have SubInterns as well as this is once of the required options for SubI (either medicine or peds).

There will also be an attending for your team. In addition, you will meet with a teaching attending/ Preceptor approximately once a week. For students at UHB/KCHC, the rotation is divided into 4 weeks inpatient peds, and 2 weeks outpatient where youll spend afternoons working at the outpatient clinic. In the mornings of your outpatient week, youll spend 1 week in nursery followed by 1 week at various subspecialty clinics. What to expect (inpatient): During your inpatient rotation, your resident will assign you to cover a couple of patients. You will round on these patients every morning, write notes on them, and sometimes call up consults and draw blood/IVs/ABGs on these patients. As new admissions arrive, you may be asked to write H&Ps on them. Depending on location/team/service your experience may consist of a less active role given that the interns are very early in their stage of training and are usually eager to work. However, depending on your ambition/aspirations, opportunity exists to be given more responsibility. Daily schedule (inpatient): At about 7 AM, you will get the sign-out from the night-float team and after that you will begin rounding on your patients. During the course of the day you will write your notes on your patients, and take care of any work for your patients such as getting them to their necessary studies and drawing labs. You begin signing out to the night float team around 3 or 4 p.m. Call Schedule: On your inpatient rotation, you will have a total of 6 calls. These calls will consist of 2 ER calls, 1 NICU, and 1 weekend+ 2 night calls on the wards. During the week, if you are on call, you stay until around 9-10 PM. Weekend call is a 24 hour shift, but generally students are let out earlier than that. Additional UHB/KCHC Experiences: If you are assigned to UHB/County, you will have one week in the Newborn Nursery. In the nursery, you learn how to do a newborn physical exam. You get to follow your newborn patients for the first few days of life and talk with the mothers. You may be asked to participate by orally presenting updates on your patients on morning rounds. What to expect (outpatient): During the outpatient portion, you will spend time in general pediatrics clinic during the afternoons, as well as rotate through pediatric specialty clinics one week and spend time the other week at the nursery. Usually you will get assigned to see a patient in clinic and will have the first opportunity to interview the patient (and parent), and then examine the child. You will then present the case to the resident/attending in charge of the clinic. You generally have an opportunity to see several patients in a given clinic session. Expect more responsibility in terms of seeing patients on your own at UHB and more shadowing at KCHC. However, if you do request for more autonomy, most likely it will be granted. Daily schedule (outpatient): Mornings are spent either at nursery or peds subspecialty clinics will generally run from 9-12 or 12:30. Afternoon clinic generally is from 1:30-5. From 1-1:30 at either UHB or KCHC there will be some sort of presentation or discussion so make sure to be there at 1, bringing lunch with you if necessary. During your

outpatient rotation, you will also be assigned to a couple of shifts in the pediatric ER. Except for days when your ER shift is on a weekend, students have no weekend responsibilities on the outpatient assignment. Evaluation: Your preceptor, inpatient attendings, and aggregate experiences from outpatient clinics play a role in grade determination. Shelf exam plays a 30% role therefore not something to be taken lightly. Grades are along the lines of for Honors: outstanding evaluations and >80% shelf, High Pass: very good + 7080% for shelf, and otherwise adequate and 50-70 for the shelf to just Pass. Less than 50, retake exam. Overall: The outpatient schedule is much more time-consuming than the inpatient schedule. You usually will have 3 full write-ups over the course of the clerkship. You may also make some presentations for your teaching attending/ preceptor and review some written cases with your teaching attending/ preceptor. How to succeed: Your preceptor/ teaching attending will determine a portion of your grade. You should prepare well for any presentations that you give your teaching attending, and make sure that your write-ups are thorough. Your inpatient evaluations probably carry more weight than the outpatient evaluations, but overall, your teaching attending is going to have the most input. Be enthusiastic on the wards and avoid significant conflicts with your team (of which there shouldnt be many!) High yield shelf topics: GI, Cardio (know congenital heart diseases, know the description of different murmurs), Resp, Exanthems (measles, mumps, rubella), infectious disease, Peds Emergencies how to manage,
Book Name Kaplan Peds Lecture Notes Pros Very thorough and concise; easy to read Cons Few mistakes with regard to vaccines

Pediatrics Blueprints First Exposure for Pediatrics Kaplan Qbook

Pretest Pediatrics First Aid for Pediatrics Pediatrics Blueprints Case Files Pediatrics

excellent to learn about patients, not as useful for shelf exam

3 full tests of 50 questions each; level of difficulty right on point BEST Source of Questions for Most Students, One of the best in the pretest series, excellent for shelf Again, if youre a fan of the first aid series, this is for you. Is helpful to learn basics of pediatrics, Charts are useful if you like that format Must Have; Used in combo with a question book, enough to get you decently by for the shelf Too few questions

Tough to read and retain, poorly written

OB/GYN At UHB/KCHC, your rotation will be divided into the following: Labor and delivery (daytime hours) 2 weeks GYN ambulatory surgery (daytime hours)2 weeks OB/Gyn outpatient clinic2 weeks (1 week of ob, 1 week of gyn) What to expect:

Labor and delivery: Your main duty will be to admit patients who present to the hospital for delivery. You will participate in the delivery process, assisting the patient in pushing, and culminating with the delivery of the baby. You will also participate in c-section deliveries as well. Your responsibilities include writing an admission H and P and assisting the resident in other floor work related to the labor process. You will be involved with C-sections as well. Sources say that if you work directly with the clerkship director, he will give you some extra responsibility. In the morning, you are responsible for helping the intern write daily progress notes on the post-partum ward. You generally need to arrive early in the morning to help finish the notes by approx. 7am. Gyn surgery (both benign and oncology): Students are responsible for participating in operations. Students will also round on patients in the morning, and write progress notes on those patients. Students also may assist residents with consults/floor work. Clinic: Students have the opportunity to see patients in the clinic. You are assigned a variety of clinics including colposcopy clinic, reproductive endocrinology clinic, family planning clinic, maternal fetal medicine, etc. Students will get assigned a patient, and will interview/examine the patient before presenting the patient to the resident/attending in charge. At UHB/KCHC, you will be able to do the female breast and pelvic exams with assistance by a resident. Daily Schedule: Labor and Delivery (some variability b/w hospitals): At 6:00 AM you will begin rounding on post-partum patients and writing their notes. Afterwards, you will proceed to the labor and delivery floor where you will start following patients who are currently in labor. The students on the service will divide up the laboring patients so that all deliveries have a student involved. Additional patients who come in during the day will also get picked up by a student. Students get to leave at 4 p.m. majority of days barring extraneous circumstances (i.e. scrubbed in for surgery). There is a morning report everyday of the clerkship from 7 a.m.8 a.m. that students are expected to attend. Gyn Surgery: Students will round on patients starting around 6:30 AM. Afterwards, students will participate in OR cases or will do other floor work/write notes on patients. Students generally are finished around 5-6 PM. Clinic: Morning clinic session runs from 9-12:30. Afternoon clinic runs from 1:30-5. Call schedule (KCHC/UHB): The night float that you have is the same thing as on-call. There are a total of 6 on-call sessions, these are divided into three ob and three gyn sessions. On Ob, you just do night shifts on the labor and delivery floor. On Gyn, you work directly with the resident doing Gyn consults mostly for the emergency department. The sessions last starting 6 p.m. until the end of morning report the next day. Evaluation: Based on input from teaching attendings and residents - 40%. Shelf exam - 40%. And oral examination (20%) is 20 minutes long three questions one of each: Obstetrics / Gynecology / Office Practice either primary care/prevention related OR

Overall: The time on labor delivery is very time consuming, with the very early starting time. Night float requires some adjustment of your time schedule, but is not too bad. The 24-hour calls can be physically draining, but you only have to do one of them. This clerkship does not require very much work outside of the hospital, other than preparing for a couple of very brief presentations to the resident teams/ teaching attendings. The shelf exam seems to be important in this clerkship. It is important to study for it throughout the rotation. How to succeed: Be very enthusiastic when on the wards. Participate in the deliveries when asked to and even try to volunteer when you are not asked. OB-GYN knowledge, especially the OB knowledge, is not covered very thoroughly during 1st and 2nd year. You should brush up on some of this material so you arent embarrassed when you feel that you dont know anything about the labor process. Of all the rotations, monday lectures are very helpful for oral and shelf exam. High yield oral topics: cancers (gestational trophoblastic neoplasia), infertility workup, contraceptives, vaginitis, types of incontinence, new york heart association classification, step by step processof delivering a patient with heart problems Differences between hospitals: Most students at UHB/KCHC get to catch babies during their rotations. KCHC generally has more patient volume, so youll see more deliveries and more surgical cases there. UHB tends to be quieter, both on the labor floor and on the gyn in-patient services. You may be more likely to play a role in the delivery process at UHB, however, esp if Gabbur is around.
Book Name Kaplan Ob/Gyn Lecture Notes Slim, accurate and concise Pros Cons Although not long as many other books requires time to read & absorb

Ob/Gyn Blueprints First Exposure for Pediatrics Kaplan Qbook ob/gyn section
Pretest Ob/gyn Ob/GYN Blueprints First Aid for ob/gyn Case Files Ob/Gyn

almost as good as recommended text but shorter in length; gives basic info that is needed for rotation excellent to learn about patients, not as useful for shelf exam
Questions are very similar to the shelf Difficulty of the questions are similar to shelf exam Easy to read and retain Good to study oral exam materials! Used in combo with a question book, enough to get you decently by for the shelf Too few questions Can be too specific May not be enough detail

Bbabab apgo questions online T

these are old shelf exam questions. They give you an idea of th the type of questions that may be asked plus the topics that may be tested.

PSYCHIATRY You will spend the entire 6 week clerkship on one of the psychiatry wards, which you choose before the rotation begins. Students are sent to various locations and experiences will vary widely accordingly. On the

wards, you will work closely with a fellow, resident, or attending (depending on the ward). The treatment team on the inpatient service may include: Attending/fellow/resident Social worker Activity therapist Psychologist Nursing You will also have an outpatient portion of the clerkship that you will participate in once a week. In addition, you will also have 4 8 hour shifts at CPEP (Comprehensive Psychiatric Emergency Program, otherwise known as the Psychiatric ER). What to expect (inpatient): Experiences on each of the psych units varies due to the vast differences in patient populations between the sites. However, overall, the psychiatry rotation gives students a lot of autonomy in dealing with the patients. Generally, you will cover between 4 and 6 patients on the service. Responsibilities include interviewing and doing initial assessments on patients who were admitted to your unit and following the daily progress of these patients. You may be required to call other departments to order consults for your patients. In addition, you will often lead discussions regarding your patients with the treatment team. Social work issues will become more important during this rotation than others, and you will end up working closely with the social workers for these patients (unlike most other rotations). Each patient that the student meets with gets discussed with the resident/fellow and a treatment plan will be formulated. There are also a number of group conferences and lectures that are organized by the clerkship director. Attendance at these events is expected, and absences from ward responsibilities during this time should always be excused. Students on-site are also expected to attend grand rounds. Daily schedule (inpatient): The day generally begins around 9:15, with the morning community meeting where patients can discuss issues that pertain to the entire community in front of the rest of the patients and staff. Afterwards, the treatment team will meet and discuss any overnight events with the patients. Any new patients who were admitted will be discussed at this time. Following this, the student will then meet any new patients theyve been assigned, or can go and talk with their current patients. During the rest of the day, you will continue to check up on your patients and write progress notes on each of your patients. Each day there is usually an hour or two of conference that students are supposed to attend. Students generally leave around 4-5 PM. Outpatient rotation: Once a week, students will go to their outpatient assignment. Usually this is a few hours long, once a week. Considerable variation exists between outpatient site assignments. On Call Schedule: Students are assigned 4 shifts in CPEP. Usually 1 shift is on a weekend, and the other 3 are weekdays. Shifts are 8 hours long (usually 4 PM until midnight). During these shifts, students are assigned to interview a couple of patients, as needed (usually 1-3 patients per student per shift). Sometimes students will interview patients along with another resident. The case is then discussed with the attending on call, and then the student fills out the appropriate paperwork for the patient.

Overall: The psychiatry rotation is one of the less time-intensive clerkships as far as required time on the wards. Students do not come into the hospital on weekends except when on-call in CPEP. There is no call schedule for the rest of the inpatient rotation. The rotation does have several write-ups that are required, along with a psychopharmacology quiz. Some of the conferences require that you prepare beforehand, though those usually do not require very much time. There is a decent amount of outside work required for this rotation. Most of this outside work involves patient write-ups and psych summaries/ discharge summaries. Evaluation: Based on a combination of clinical evaluations ( %), written exam ( %), and shelf exam ( %). . How to succeed: Since much of your evaluation is based on your evaluation from the resident/fellow/attending, your performance on the ward is very important. Therefore, enthusiasm while on the wards will be important. Also, the write-ups for your fellow/attending are taken into consideration by them when they evaluate your performance, so it is important to be thorough on those assignments. The quiz during the clerkship is on psychiatric pharmacology. Students can succeed by studying the materials provided, as well as the cases discussed during conferences. High yield shelf topics: child/adolescent psychiatry and psychopharmacology are high yield. Study drugs very well as well as diseases which more common in outpatient setting such as depression, anxiety, personality disorders. Differences between sites: Based on the location of your inpatient assignment, the patient population with which you work will vary. Here are some generalizations about some of the different sites: Consult liason Kingsboro
Book Name Kaplan Psychiatry Lecture Notes Pros Cons

Appleton & Lange Psychiatry

very high yield, short and sweet. BEST Source of Questions for shelf exam; covers key concepts
Questions not very representative of exam content; too many low yield questions to justify buying it use Qbook & A&L instead There are not many

Pretest Psychiatry Kaplan Qbook Psychiatry

First Aid for the Psychiatry Clerkship Psychiatry Case Files

Good explanations; Closest Questions to the Actual Exam; great questions Great if you like the first aid series, otherwise use blueprints; perfect for review two weeks before the exam Used in combo with a question book, enough to get you by decently for the shelf

NEUROLOGY Your team will consist of: 1-2 residents 1-2 interns 2-3 medical students Team attending At KCHC/UHB, there were teaching attending meetings daily from 8-9/9:30 before attending rounds started. What to expect: While on your rotation, you will mainly be working on the inpatient neurology service (though sometimes you may be on the neurology consult servicesee below). On the inpatient service, the student will be assigned to a couple of patients. Students will be involved in assessing patients upon their admission to the neurology service and will follow patients that are assigned to them during their hospitalization. You may also accompany your resident as they are called down to the ER as part of neuro. Consult. Daily schedule: The day generally begins around 7:30. At this time, you will round on your patients to take a quick look at them and find out if there were any overnight events that took place. Afterwards, you will round with your team. During rounds, you will usually present your patients progress to the rest of the team, and the plan for the patient will be discussed at this time. After rounds, you will begin writing progress notes and doing any other work that your patient requires. You may have some lectures or meetings with your teaching attending during the day as well. Students generally are finished by 4 or 5 PM. Also, usually one afternoon each week you go to the neurology outpatient clinic to participate in evaluating clinic patients. You will either see patients alone and then present the patient to the resident or you might shadow the resident while they see patients. Clinic is assigned to each student a total of four times. Consult service: Depending on the teams inpatient load (and hospital site), some students may be assigned to the consult service. If there is a consult service, students usually spend 1 week of the clerkship on this consult service. When doing consults, you will evaluate patients who are inpatients on other services. The resident will usually inform you of which patients to see. The students will evaluate the patient and then present the patient to the consult resident, who will then evaluate the patient as well. Most students state that this portion of the clerkship Call schedule: Students usually have 2 calls during the clerkship. One of the call days is a weekend. The remaining call days are weekdays. Weekday calls are usually from 6-10 PM. Weekend calls are 9 AM 10 PM (though students tend to get out by 5 PM). Students on call generally will go to consult on patients and help out the resident who is on call. Most consults while on call are in the ER. Overall:

You will usually have 2 full write-ups and occasional presentation to give to your teaching attending, but otherwise, the outside work is not too bad. Make sure to work hard as this is a big chunk of your grade, (20%; each write-up is worth 10%). In addition, there is a case workbook that students receive and usually these will be discussed with the teaching attending. Evaluation: A large portion of the evaluation is based on input from your teaching attending. The residents/attending on your team also have some input into your evaluation. Together the two evals combine for 40% of the grade. There is a shelf exam at the end of the clerkship counts for 10% of the grade, while the oral exam is 30% of the grade. And as previously stated, the two write-ups together are 20%. How to succeed: As the teaching attending has a very large input, it is important to impress them by doing a good job on your write-up and on any presentations that you deliver. If your teaching attending discusses the workbook cases, it is important to be prepared to discuss them. Enthusiasm on the wards, as with every rotation, is important to get good evaluations from your resident team. Study by chief complaint and try to figure out the diagnosis...think things out like Dr. Soma does :-) Draw out pathways and correlate symptoms with possible lesions...thats a great way to think things out for your papers. Oral Exam: The Oral Exam requires a little more studying effort. It is not a bad exam; the setup is pretty relaxing; the examiners are not malicious. The exam is based upon 4 patients that you choose and last about 15-20 minutes (supposedly 5min/pt., but not all patients are always discussed). They use the diagnosis and illness of each patient as a SPRINGBOARD to pose questions and find out what you know about Neuro, not about your patient in particular. Many people make the mistake of learning what tests and symptoms that their patient had and the results, but a more common type of exam question is "what kind of signs/symptoms would you expect in a patient that presented to the ER with a lesion here, like your patient [usually talking about a stroke patient]". I'm not saying that you should only know your patient name and diagnosis, but not much more than presenting symptoms and CT or MRI findings. Also, know the Status Epilepticus protocol, drug dosages are not necessary but may impress the examiner. Studying for this could be accomplished with Blueprints in Neurology and UP To Date readings based upon your patients. The outside "required" reading that is in the clerkship syllabus is extra and unnecessary.
Book Name Neurology Case Files Lange Clinical Neurology Pros Used in combo with a question book, enough to get you by for the shelf Great Review for Major Topics of stroke/seizure/headache Useful for material related to oral exam Great review for non-major high yield topics, movement disorders, Good reference for patient write ups Surprisingly good prep for shelf exam Its always useful to review neuroanatomy, including vascular supply, especially if you will review MRI and CT scans with your team Cons Inadequate for oral exam obviously

Blue Prints Neurology Neurology secrets

Neurology pretest Netters anatomy atlas

Primary Care I: Do the honors project...it can only help you!! There are many examples on prime to assist with giving guidance on how to approach it. What to expect: In this rotation, you will be working in the clinic setting. Generally, you will rotate and work in different clinics depending on the day of the week. In the clinics, you will generally be assigned to a patient. You will take the patients history and examine them. Afterwards, you will go and discuss the case with the attending and develop a treatment plan. Primary Care: no shelf so all studying is for lecture prep and quiz. Reading given on Prime. Just use journals or online sources to look up things that come up in clinic. Daily schedule: Clinic sessions usually run from 9 AM until 5 PM, with a break for lunch. Wednesday afternoons are usually lecture days, so students do not go into during that time. Overall: This is not a very time-intensive rotation. The in-clinic hours are not too demanding. There are several assignments to complete (write-ups and some other reports), so those do take up some time. Overall, however, it is not a difficult clerkship. This clerkship gives students the opportunity to see well-patients to know what normal looks like as well as work up patient complaints and think independently about the cases. If you have this clerkship early, it serves as a great introduction to medicine. If you have this clerkship later on in the year, you may feel very comfortable dealing with treatment issues for the patients, and therefore, it can be a very rewarding experience. It will be a good review of your medicine clerkship as well. Evaluation: Based largely on feedback from your site preceptor and they take feedback from the various attendings that you have worked with. Also you must simply past the ECM component and complete all assignments on time. If you are seeking honors, you must have done the honors project. This doesnt count as part of the grade, but records must be kept of patient encounters. How to succeed: Since your evaluation is based largely upon your teaching attendings evaluation, it is important to present yourself well to them. This includes completing your write-ups in a timely manner and improving your case presentation skills as the clerkship progresses. As always, enthusiasm never hurts. In addition to performing at honors level throughout the entire six weeks of this rotation, if you expect to attain a grade of HONORS, a student's project must be completed. This is in addition to the student conference discussed in section "E" above. Your project should be directly related to primary or community medicine and should focus on something, which fits with the site at which you're working Emergency Medicine Your Clerkship will consist of a two week long rotation in which you will spend a series of 8 hour shifts (9 total), 6 hours of lecture (divided into 2 three hour sessions), and a in-house exam. You will spend time rotating through the various departments of the ED [at both KCHC and UHB] including general adult

medicine, general pediatrics, fast track, and critical care trauma. If you like it...wonderful...proceed to the 4 week elective to confirm. If you don't like it, thats ok...its only 2 weeks long. Your sleep cycle will be terribly disturbed...thankfully you think in algorithms. EM people are very strict on time, they do shift work and round very quickly so this may be redundant but MAKE EVERY EFFORT TO BE ON TIME!!!! The rotation is too short to buy a book unless its the field you want to go into. We recommend borrowing the book from either a classmate or the Office of Academic Development. We recommend that you at least read high yield chapters in First Aid Emergency Medicine: ACLS, Trauma!!!, Cardio, Respiratory, and one more piece of advice, it seemed as though there was at least one question from every chapter of the book so definitely make every attempt to at least skim through the topics that you cant read thoroughly. Be enthusiastic, do IV's (its the best time to learn), phlebotomies, ABGs, LPs if the opportunity arises, and get involved with codes if they are available. You will receive an outline from the course director as part of the syllabus and that should guide you in terms of studying. ELECTIVE FEEDBACK GI @ Brooklyn VA 8am-6pm Monday thru Friday, no weekends Saw a few consults, watched a ton of colonoscopy and few endoscopy procedures, 1 day a week of GI clinic, they expect you to give a presentation to GI attendings and fellows. Have not received evaluation as of yet Overall: There is a lot of scoping, may get a bit dull after a few cases, as they will not let you touch the scope, you could theoretically sneak off to library for a few hours if there are no consults, but they expect you to say until after attending rounds which begins at the very end of the day and they expect you to stay until its all over, which is about 6pm. There are 2 attendings in charge and the GI fellows are the Downstate GI Fellows. Usually no residents and no other students. Cardiology consult at Lenox Hill: Excellent elective. You'll read a ton of EKGs every day, so you'll feel pretty good about your EKG skills at the end. You hang out with the cardiology fellows, who are really relaxed and nice and willing to teach. You see patients in the ER and on the floors with them, but the patient load usually wasn't overwhelming, so there's a lot of time to read on your own or to see things like ECHO or the Cath Lab if you're interested. No exam or presentation was required. Hours are 8am to 5pm, though they will often let you out around 4pm if you want to leave early. Contact with attendings is somewhat limited, but when you do see them, they are great, i.e., really experienced clinicians, good teachers, and nice people. Dermatology Downstate/KCH Hours/day and days/week: 9-4pm 3 days a week, 9-12pm 2 days a week Clinical responsibilities: followed around residnets, did some biopsy's How were you evaluated?: There's an exam for which they provide you a study sheet with 2/3 of the answers Great Elective!!! Dermatology at KCHC:

Great elective. Hours are 9am to 4pm, with an hour break for lunch. No weekends. No clinic (or other requirements) on Wednesday or Friday afternoons, so you get out at about noon those days. Residents are very nice, teach a lot. Atmosphere is very relaxed, material is very interesting and useful, almost no matter what specialty you go into. The test at the end is somewhat difficult, but I'm sure they don't fail anyone. No presentations were required. Dermatology Hours/day and days/week:9am-3pm M-F Clinical responsibilities: Shadowed Residents (saw a few on my own) How were you evaluated?: interactions with residents Other comments: Can't see patients by yourself. The residents were cool. The attendings were uninterested. Pulmonary (Lenox Hill) Hours/day and days/week: 8-5PM 5 days/wk x4 weeks Clinical responsibilities: You follow pulm fellows around, who run the consult service. You can ask to see your own patients, see bronchs, or just observe. You have one teaching attending for the month, who rounds with the team for 1 hr, usually 3 times/week. How were you evaluated?: The teaching attending puts his name on the evaluation, but the fellows have a big say (since you work almost exclusively with them). Other comments: Very busy service, but you get out on time. It's a small team, so people will notice if you disappear. Bring a good attitude and you'll be fine. Pulmonology-Lenox Hill Primarily a consultation service but you will get to observe and assist during bronchoscopies and thoracenteses. Im pretty sure hours were 8~3:30 while I was there, but attendings switch each month and one attending likes to round at 7amcall ahead or ask around if 7 is too early for you. Overall atmosphere was very laid back. Technically we worked with the attending covering service patients that month, but we saw all pulm consults, including private ones. This meant that we worked with all the different pulm attendings and often meant sitting down and discussing cases multiple times throughout the day. Fellows and residents on elective time with us were very happy to have us, easygoing, and seemed genuinely interested in teaching. The attending on service while I was there left something to be desired in that she was brusque at times, with students fellows, patients, you-name-it. The other attendings were great and I got plenty of time with them. This elective carries the additional bonus of getting well-acquainted with drug reps. We had multiple lunches both in and out of the hospital while I was there. Heme / Onc - Downstate Elective was ok. Hours: 9am-4 or 5pm. M-F. Follows the general elective schedule...consults seen in the AM (maybe 2-3 a day but broken up between 2 residents and the students), clinics in the afternoon at downstate and kchc (depending on the day). They let you see the consults on your own and write up the consult which is a plus, and they expect you to f/u on your patients until they are discharged. I stayed at Downstate mostly and stayed with them for the entire month, though, I think in retrospect it may have been a better learning experience if I swapped to KCHC in the middle. They also have a lunchtime conference every Tuesday where food and a lecture topic are given. The fellows do all the procedures (bone marrow bx, smears, etc.), but they invited us to view the slides in the lab. I worked with Dr. Sanmugarajah who is fantastic. She is so sweet to her patients, and she enjoys teaching students when she is around. Youre evaluated by your attending. From 1-10, I'd rate this elective a 6. For the most part, the fellows could be running the show without the student, but we make their lives a bit easier. What frustrated me most about this rotation was not knowing the current

treatment guidelines for many of the cancers we saw. There are so many new chemotherapeutic drugs being made, and trials being performed that it was very difficult to know which regimen was correct. MICU - KCHC 5-6 days a week. (days vary due to call). Elective was intense, but I definitely enjoyed it. It's great experience learning how to manage a critical care patient. Terrific exposure to ventilation mechanics and broncoscopies. Patients are really sick, and they come in all different varieties. At one point, we had a patient with cerebral malaria, another with AML M3, another with scleroderma on a vent for pulmonary fibrosis, and another with terrible endocarditis requiring heart transplant. These are just a few examples. There are no bullshit admissions to the MICU (ex no more ruling out ACS). People are sick, and even though the patients may be on a vent, you still have to communicate to the patients family regarding your management which makes you still feel like you are involved in providing a human touch to taking care of a pt. Procedures range from the simple blood draw, ABGs, A-lines, central lines, if you prove yourself to the team youre working with, they will let you do anything. (They let us do A-lines and central lines as students) There is always something to be done, so it is never a dull moment. The schedule is Q4 call at kchc, you stay until youre done, so you never know when you leave. You can choose to do overnight calls when your team is on call. I did overnight calls because it was when we admitted, and when all the procedures got to be done. It was also the best chance to learn about the other patients. You get postcall off, and also if youre on call Thurs, Friday, Saturday, or Sunday, you get the day before your call off also. Get there around 6:30am to preround, rounding just like in medicine, notes all computerized. From 1-10, Id rate this a 10. You really feel like an integral member of the team, you present your patients and manage them like theyre your own just like in medicine. The variety of cases you can have is great, and you dont worry about bullshit admissions. When a patient is stable, they go directly to the floors. You learn about vents (which can be scary initially), and there is never a dull moment. Youre evaluated by your attending, and Im guessing by your resident too. I guess this rotation caters to my action junky side which may be why I enjoyed it so much. Rheumatology Downstate Hours: 9am-4pm. M-F. Elective was ok. There was a lot of downtime when I was on this elective. Consults in the morning (maybe 2-3 a day), then on Mondays, Thursdays, and Fridays there are clinics either at Downstate or KCHC. On Tuesdays and Wednesdays if you have no consults, you go home early. I did enjoy this elective because the fellows and attendings taught often. You get to see pts on your own, you write the consult up, and then you present to your resident and the attending on service. It was a great way to review rheum, which to me made the elective worthwhile, and also there are some bizarre cases of rheum that we see. Evaluated by the fellow and the attending. Rheum people are pretty chill, which also makes the rotation enjoyable. From 1-10, this elective is 8. I know the material will come back when residency starts, and Ill be prepared to take care of these patients. Invaluable. Infectious Disease (KCH) Hours/day and days/week: 9am-5 or 7pm; 5 days/week. Hours varied depending on when the attending rounded. Fischer tended to round late. Clinical responsibilities: saw consults on my own and presented to fellow before rounds and then presented to attending during rounds. wrote consult note. How were you evaluated?: I'm not sure yet; I haven't gotten my eval yet. Other comments: Long/unpredictable hours; 2 or 4 week elective option.

AIDS and other STDs Hours/day and days/week:8hr/d and 5d/wk. Depending on the day and clinic can be out between 3 and 5, not later. Clinical responsibilities: Depends on the clinic - STAR clinic is much more observatory, kind of boring, STD clinic in E Building is awesome, you're there the longest (get out b/w 4 and 5), but you see and examine patients on your own, write your own notes and report to the attending - you will get VERY familiar with the pelvic and male genital exam here - I can do them in less than 5 minutes now - not my favorite, but you need to know these things and I liked being independent in this clinic. HIV/AIDS clinic in E building was also very observatory, but really great teaching here. This was usually in the morning so it didn't affect what time you got out. We also had 1 half day a week. How were you evaluated?: Participation and Observation - show up and show interest and HP is your minimum. Other comments: I really enjoyed this rotation. There was a lot to be learned and getting more comfortable with sexual histories and genital exams was helpful and the attendings were great. EKG elective at KC/Downstate Hours/day and days/week: 3hrs/day, 3days/week. Approximately 2hrs of homework between sessions. Clinical responsibilities: No clinical responsibilities. Students meet with Dr. Nacht in his office and read EKG. How were you evaluated?: Not sure. He doesn't expect too much. As long as you attend and attempt to read the assigned EKG's. Other comments: Very minimal time commitment. Learn very useful info very quickly. EKG with Nacht Hours/day and days/week: 2 hours 3 days a week for total of 2 weeks Clinical responsibilities: No clinical responsibility. Only had to read the EKGs before class (and depending on how motivated you were anywhere from 2-4 hrs the night before) How were you evaluated?: He passes pretty much everyone Other comments: Great elective to do and learn from if taken seriously. He assumes a lot about knowledge base and doesn't do much in the way of teaching, but the best way to learn EKGs is looking at many of them. Also 1 day for interviews allowed as per course coordinator. Best way to get in contact is to go to A-bldg 6th floor. EKG Reading (KCHC) Hours/day and days/week: 2 hours/day for 3 days/week (with homework) for 2 weeks Clinical responsibilities: We do not see patients at all. We receive a book of EKGs from Dr. Nacht (cardiologist and EKG nut) to interpret, with homework assignments to interpret about 20 EKGs on our own and then review them at the following session. How were you evaluated?: I'm not really sure. I think Dr. Nacht just gives whatever grade... Other comments: Awesome elective. I learned how to look intelligently at EKGs when I thought I would never be able to understand them. It was also great for interview season because of the few required hours. EKG (Downstate with Dr. Nacht): I love this elective 3 days a week, 2 hours each day. Sit around and discuss EKG readings. Dr. Nacht is funny if you don't take his comments personally. You will actually learn how to read an EKG. He won't go over the basics, he'll assume you know them. You're thrown right into reading the strips but you'll pick it up quick. The down side......it's only offered as a 2 week elective, I wish there was an 8 week elective! Hope this helps.

EKG/CXR at St. Vincents Hours/day and days/week: 5 hours (variable, sometimes less)/day, 5 days/wk Clinical responsibilities: No clinical responsibilities. You follow a cardiology fellow around to interrogate implanted cardiac devices, watch cardiac caths, observe TEEs and cardioversions. How were you evaluated?: Not too sure. I think the Dept Chair, whom you see about 3 x a week is the evaluator. Other comments: Very relaxed elective. Ambulatory Care in Orthopedics- Downstate Hours/day and days/week: 8am-6pm 2 days a week, 10-6pm one day, 8:30-2pm 2 days a week Clinical responsibilities: followed resident or attending around. You can see your own patients if you are willing to dictate notes. This is a great elective when few students are signed up. How were you evaluated?: Don't know. Anesthesia (Downstate) Hours/day and days/week: 6:30 to 3/4PM, 5 days/wk x4 weeks Clinical responsibilities: Assist residents in the OR, very similar to the 2 week clerkship How were you evaluated?: You pick 2 attendings & 2 residents to write your evaluation, which will eventually be used to write your Chairman's letter Other comments: Hours are not that cush, but if you're serious about going into anesthesia, you should be ready to work for the month. You might be working with high level administrators (Chairman, Program director, clinical directors), so you shouldn't try to slack off here. Pain Management at Kings County: Clinic four days a week (Mon- Thurs) from 9am to about 12pm. Then lunch and then wait for pain consult calls. Usually after 12 and coming back from lunch there is nothing to do, just a lot of sitting around and waiting to be dismissed. I got out about 3pm everyday. On Fridays there are cases in the OR that you should go to but they want you in the clinic as extra man power but as a student you are entitled to go and should ask to go whenever there are cases in the OR. Anesthesia (LICH): Such a nice place to do an elective especially if you don't want to go into anesthesia. You are supposed to go in every morning at 6:45am for morning report and sign in. I never made to morning report but I still Honored it (I stayed long b/c I was interested in the cases). You just have to work with the same attending and resident for a couple of times so that they can write your evaluation (you chose your evaluators). You can pretty much leave after a case or two, they can't keep track of you. Just say you are interested in a case in another room. You'll be able to try intubating and etc..if you show that you are interested. Surgical Nutrition (Downstate) Hours/day and days/week: 10AM-2PM 5 days/wk x2 weeks Clinical responsibilities: Your round with Dr. Schulze and the TPN team at 10AM and write the TPN orders for the next day. Then you follow a nutritionist around and learn nutritional issues. Afternoons are reserved for surgical procedures like PEGs and Trachs. But I didn't run into any during my 2 weeks. How were you evaluated?: Dr. Schulze evaluates you based on 1 patient writeup and your roundsmanship. Other comments: Dr. Schulze is a great teacher. The TPN team is made up of nice NP's and nutritionists.

Good course to finally learn all the nutritional issues that we gloss over during 3rd year. Not too time intensive as well. Surgical ICU (KCHC) Hours/day and days/week: 8-10 hours/day for 5 days/week (calls were optional, but that may depend on the covering attending) Clinical responsibilities: We followed patients closely but were not expected to be entirely responsible for their care. We also got to do and perform some more advanced procedures (ABGs, central lines, NG tubes, etc.). How were you evaluated?: I think the attending on service writes our evals, but I'm not sure (I just finished it and I never really asked about grading). Other comments: Another awesome elective. It made me less frightened of going into the ICU as an intern next year (though I think the KCHC SICU functions really well and might make it seem too easy). EM research for 4 weeks Hours/day and days/week: Whatever you want to put in. I think in non-interviewing months they are more flexible. Technically it is supposed to be 12, 12 hour shifts. But I would go in whenever and enroll as many patients I could into studies. Clinical responsibilities: According to Dr. Sinert, you are not to do anything clinically. But if you hang out in KCH/CCT it is inevitable that you are going to ask to help out. This elective sort of ended up being a CCT/research elective for me. As for enrolling patients, you use the template documents and fill them out as thoroughly as possible. I think you are supposed to get lectures but the month I did it they were changing the course so I ended up only enrolling patients. How were you evaluated? As long as Dr. Sinert sees you a couple of times thru the month you're cool. Maybe going in when he's working is the best way to do it? Other comments: Great thing about this elective is that you don't have to fill-up any bogus research proposal paperwork before hand and I have found it to be very flexible with regards to time. EM research at KCHC/Downstate Hours/day and days/week:40 hrs/ wk , 5 days/wk, very flexible schedule Clinical responsibilities: No clinical responsibilities. You learn about the research protocols and try to enroll patients into studies. Meetings once a week on Wednesday afternoons. How were you evaluated? Directly by the research director. Other comments :Good opportunity for publications depending on level of participation. EM at KCHC/Downstate Hours/day and days/week: 8 hour shifts, 18-19 shifts over 4 weeks and 1 EMS ride Clinical responsibilities: You pick up patients on your own, present to either senior resident or attending. You work the full 8 hours. How were you evaluated?: By attendings or senior resident on each shift, they fill out a short form. Your grade is determined by the cumulative impression of your performance from all the forms submitted. One brief case presentation to resident. Other comments: Great if you think you are interested in EM. Also, check out the Attending schedule early to see if you can schedule shifts with attendings that you want letters of recommendations from. Emergency Medicine Hours/day and days/week: 8 hours/shift with 18 shifts in 4 weeks Clinical responsibilities: We see patients on our own when possible and present to attendings or senior

residents, as well as do basic procedures. If we are in the critical care/trauma pod at KCHC, we get to do more advanced procedures when available. We also go for an ambulance ride-along. How were you evaluated?: We ask attendings or residents to fill out a short evaluation form (like the one during the required clerkship) at the end of each shift. Other comments: REALLY AWESOME elective. I felt like a resident and it was great to have the responsibility, but I still knew that the most of the attendings were right there to back me up. Toxicology Lectures are Tuesday and Thursday, 10am-12pm. Work one day a week at the poison control center which handles calls from all city hospitals, and you call back to follow up on how the patients are doing and what treatments they are receiving. Fellows at the PCC teach well. You write a 10 page paper and present it, and take an exam at the end. Great elective to learn some cool stuff with little time commitment. Radiology Sounds like a cushy elective but is not. There is no call, no weekends, and the hours are basically 8-3/4 M-F. Course is highly structured and attendance is mandatory. Basic knowledge of pathophysiology and some very minimal exposure to prior plain film reading (as would be expected during IM, surgery, or EM) is almost necessary. Taking this as your first course during MS3 year is probably not a good idea. I took it as an MS4 and found it quite manageable, but I also kept up with all the reading because I planned to go into radiology. It isnt as soft as radiology at many other med schools, but the hours arent bad and youll be confident reading plain films after a month. Nuclear Medicine at KCH As an advanced radiology elective, this works more like other med school radiology courses in that you are relatively unsupervised for a good part of the day. A big part of this is simply the nature of the beast. Nuclear medicine scans take a long time, and the service isnt going to start at 5am so there are studies ready when you arrive at 9. So from 9am when you show up from lecture, till almost noon, expect to be reading. Furthermore, as program director, Dr.Strashun (nuclear attending) is often away from the workstation in meetings or covering nuclear at Downstate during the day. Hours should be 8-5, M-F. There are two hourlong lectures on most days, running from 8-9 and 4-5. Good exposure to a variety of nuclear med imaging modalities and a chance to work with the program director. Surgical Pathology (Kings County) Hours/day and days/week: I went the first Monday, two Weds, and the last Fri Clinical responsibilities: N/A How were you evaluated?: Good question!! Other comments: If you looking for nothing to do without taking a month off this is for you ( a bit of a waste of time. Even when you do show up nobody cares) Surgical Path KCHC Elective was boring, but it is an interview friendly elective. M-F. Or if you want some time off, you can take this too. I was gone more often than I was there due to interviews. Meet with Dr. Axiotis initially, he will tell you that as long as you show your face every once in a while, you will get a HP. In the mornings (9:00am) the residents present their path cases, and you look at slides for about 2-3 hrs and try to stay awake. I cant tell you how many placenta slides I looked at, it was nauseating. Some attendings teach, but more often than not, they did not just because it is so monotonous, and they also just want to get through the cases. There are

conferences during lunch, but the material is presented at a 2nd and 3rd year resident level. I had no idea what they were talking about most of the time, it was all about using X stain for Y receptor found in Z pathology... it was too much. I left around lunchtime. There were times when we went to autopsies, which were pretty cool, but when interview season came in full swing, I didnt go to many after the first week. From 1-10, this is definitely a 1, it was painful going and viewing slides for 2-3 hrs. It made me look forward to interviews as an excuse to escape, but on a brighter note, Dr. Axiotis did live up to his promise. Surgical pathology (Downstate) Hours/day and days/week: 9am-3 or 4pm; 5 days/week. Clinical responsibilities: sat in on "sign out rounds" in morning and afternoon when attendings look at slides with residents/students; 1-3 hour sessions beginning at 9am and 1 pm. In between, you are free. How were you evaluated?: I'm not sure yet; I haven't gotten my eval yet. Other comments: 2 or 4 week elective option. It's not very strenuous but you're expected to attend morning and afternoon sessions. Opthamology Hours/day and days/week: 9am-1pm M-F Clinical responsibilities: (did you see patients on your own, follow the attending around, hang out in the library all day...?) Shadowed Residents How were you evaluated?: based on interactions with residents Other comments: You can learns as much or as little as you like. Good experience Clinical Ophthalmology Hours/day and days/week:3hrs/day, 5d/wk Clinical responsibilities: Basically observatory, did do some direct ophtholmascope exams and one resident had a teaching scope on her indirect so I can view some dilated exams - also depends on how interested you are. I wasn't, so I mostly observed. Can also observe surgical procedures and minor exam room procedures (like removal of chalazia). How were you evaluated?: Participation and Observation Other comments: This is a really laid back elective. Obviously - if you're interested in ophtho you should probably put in a little more effort and maybe some fuller days than just the morning, but if you have no interest really (like me), come in for the morning and they'll tell you not to come back for the afternoon (the latest I've gotten out was 12:30pm) and if you have an interview or other appointment one day, they'll tell you to not even come in if you don't feel like it - and if you didn't tell them no one would notice so no worries there either. Also - they'll tell you in the beginning to come in by 8am for sign out, but I wouldn't bother - they just talk about other stuff and don't notice if you're there or not. I got there by 8:45am and did fine. Clinical Ophthalmology: This elective is usually done at KCHC, but I did it at LICH because there was no room at KCHC. Excellent elective if you are interested in ophtho. Hours are longer at LICH than at KCHC, I think, because LICH has a smaller clinic, but you get to see a lot of surgeries and get a lot of teaching/attention from the residents and attendings since the LICH clinic is smaller. Hours were about 8am to 5pm Monday through Friday, no weekends. No presentation was required, and there was no exam. ENT at KCHC and LICH (the elective is 2 weeks at each place): If you're just interested in learning some ENT but not in matching in it, I think the pediatric ENT elective, which is solely at LICH, may be better than this one, which includes both LICH and KCHC. ENT is super busy at KCHC. Hours were about 6:45am to 7pm at KCHC and the rounds are very long there since you

round on patients on both sides of the street. ENT at LICH has significantly shorter hours (roughly 7am to 4pm). No exam was given. Only requirement was 10 minute presentation at the last grand rounds of the month. Medical Bioethics Hours/day and days/week: Depends on how devoted you are to your paper. Clinical responsibilities: none How were you evaluated?: Quality of your paper Other comments: This is a reading elective so you are only required to come in the first day for about 30min to suggest your topic and hear the guidelines and you never have to come in again. This is the only time you really see Dr. Powderly. Weekly communication regarding your paper is required (sources, outline, bibliography need approving before you start your paper and those were each of my weekly emails). She gives good feedback and tells you exactly which are the best resources to use. It's a 10page paper for 2wks and 20 for 4weeks. I had no problems getting to this length because there is loads of info out there and you can cater to your own interests. (I'm going into Peds and I did my paper on ethical dilemmas in extreme prematurity). Also, even though the elective technically ends in 2 or 4 weeks, everyone gets an automatic 4 week extension (so even though I started at the beginning of january, I didn't have to hand in my paper until the end of february). Peds Cardio: The attending are Dr. Dhuper and Dr. Rheddy. They are both extremely nice, and very willing to teach. Dr. Dhuper gives you cases to work through with her and the residents, and Dr. Rheddy likes to go over EKG's and congenital heart defects. They day basically starts around 930, and you can get out anywhere from 1130 to 5, but it is much more likely to be much earlier than 5. Most days I was out around 1 or 2. There may or may not be a resident on Cardio, so you can actually do all the consults if you want to, and when you work with Dhuper, you will probably have to. Usually, me and the resident would go see the consult while the tech was doing the echo. Then we would present everything to the attending. It is a slow service, and there are very rarely patients on the floor (NS42). You do a ton of consults in the NICU for PDAs and PFOs. Much of the time is spent watching the tech or the attendings doing echo's, and you do pick it up very quickly. I felt comfortable by the end looking at an echo and knowing what was normal, and what wasn't. I definitely recommend it as an easier, minimal work kind of elective. There is very little to no studying or assignments. the only thing is that Dhuper makes you do one presentation on the topic of your choice at the end of the elective. On a scale of hard to cush, I would rate this as a "mostly cush". Chemical Dependency Half your time is spent in G23 inpatient detox, the other half is in Project Access, an outpatient treatment program for people with dual diagnosis- substance abuse and mental illness. When on detox, our attending had us come in around 9:30, we saw the new admissions, and were done at 1pm latest. During the outpatient part, we came in around 9:15 and either saw new patients or sat in on group sessions. Out by 2:30. No presentations, just clinical evaluation. Excellent elective to see a part of medicine rarely taught.