Medical Education US

What are the last two years of medical school like, and what do rotations entail? I would just like to learn a little bit more about your experiences. Do you move during this time? What kind of sub specialties of medicine are you exposed to? What is the work load like?

Also what is residency like? Is this where you get to specialize in psychiatry or does that happen before?

When choosing medical schools should I consider their psychiatry program? Do you have to move away for residency? Or can you stay at the medical school you were trained?

In general terms what are the last 6 years like, sorry this is a string of questions.

Hi there...

I have not reached years 3 and 4 yet, but I know about how it works at my medical school. Most schools are pretty similar, from what I have seen.

Years 3 & 4 are when you really get your feet wet with experience in the hospital and clinic. You work with attending physicians, residents, and the like, for several weeks in each specialty. You rotate through the required general subjects (Peds, Psych, IM, FP, surgery, etc.) -- and you have a few electives, as well, in case you want to look at sub-specialties or other stuff. At my school, you have fewer electives in year 3 than you do in year 4.

At my school, at the end of year 2 you select which clinical training center you will enjoy for the last two years, and we have about 15 clinical training sites throughout the Northeast. Some other schools with really large training hospitals may keep their students closer to home.

As mentioned above, you get some exposure to psychiatry through rotations. However, you are getting exposure to all aspects of medicine, which is a very good thing! Your actual psychiatric residency training doesn't begin until you graduate from medical school.

The "match" determines where you will do your residency. Graduating physicians apply and interview with residency directors all over the place, and rank their preferences. The residencies rank their preferences, and then you find out where you will be doing your training.

Agan, I am not a resident yet, so I will defer to the docs to describe what that's like.

As you may know, the traditional set-up for a medical school is to have the first two years being classwork, studying the biological sciences - things like anatomy, physiology, histology, etc.

The last two years are the clinical years. Depending on the school the required rotations may be just in the third year with the fourth year being electives, or the requirements may be third year and part of the fourth year.

For most medical schools, the definite required rotations will include: internal medicine, surgery, pediatrics, ob-gyn, and psychiatry. Some may also require things like neuro, derm, oto, radiology, but my school didn't.

The clinical rotations as a med student are where you really start to do what doctors do. I started third year with my general surgery rotation, at a small private hospital on the north side of Chicago. The med students would start around 6am, and we'd see the patients we were following, check their lab results, etc. (called pre-rounding), before we'd round with the interns and residents. We'd then see all the patients on the team with the interns and residents, check relevant things on physical exam, change their dressings, etc - the students goal was to have the scissors ready to cut tape, have tape ready to replace dressings, etc. We'd also tell the interns and residents anything relevant on the patients we were following.

After those rounds, we'd then divide things up as to whether we would stay on the floors to care for anything that might come up with the patients, or whether we'd go scrub in for surgeries. If we were going to scrub in for a surgery, usually we'd review one of our text books the night before and right before the surgery so we'd know the relevant anatomy, procedures, etc.

Usually, after any surgeries, we'd round with the interns, residents, and attending physician to see the patients. Surgery was definitely the longest days. For the rotation I did, I was on overnight call every 4th night, which was busy, but was definitely the best experience. We'd stay in the hospital overnight and we saw any surgical cases that came into the ER, and deal with any surgical emergencies within the hospital. We had residents with us to guide us along the way.

After general surgery, I did my specialty surgery rotations, which were similar, but in fields of neurosurgery and urology.

I then did Ob-Gyn - which was similar, but the hours were not as long, and the time was split between gyn (which is very much like surgery) and OB (which was more focused on delivery of babies and monitoring high risk pregnancies).

Next I did my psychiatry rotation. It was basically general psychiatry, some child psychiatry, and some substance abuse treatment.

I then did my internal medicine rotations - I did an oncology rotation, a general medicine rotation, and a nephrology rotation. It was almost all inpatient work that I can remember, with a little outpatient.

I then did pediatrics - general peds, peds infectious disease, and the newborn nursery.

Fourth year was all electives for me. I did some rotations in internal medicine, pediatrics, psychiatry / child psychiatry, medicine subspecialties, and research electives.

For most med schools, you don't have to move for 3rd and 4th year electives. However, I did do some rotations at hospitals that were far enough away that the school provided us with a place to stay during those rotations.

What is residency like? It really depends on what your residency specialty is. This is where you get to specialize in a field, like psychiatry. For psychiatry residency programs, you typically will start of with 4 months on internal medicine + 2 months of neurology. You then will do 1 year of inpatienet psychiatry, and the remainder is outpatient psychiatry, consultation psychiatry, child psychiatry, addiction psychiatry, geriatric psychiatry, ECT, and some other stuff.

When choosing a medical school, I would not consider their psychiatry program. Psychiatry rotations in medical school are a very brief part of the med school curriculum. You want to make sure you get a well rounded experience in medical school - you'll want to select your residency to be excellent in whichever field you choose - as you'll really learn the specialty stuff there.

You don't have to move away for residency. You will have to match into the program that you want - just because you go somewhere for med school does not mean the residency program will accept you. For psychiatry, however, most US med school grads can go to most psychiatry residency programs - only the top programs are competitive.

Hope that at least gives you a little more perspective on those things you asked about.