clerkship.txt

Frequently Asked Questions (FAQ) about Clerkship
================================================

Revision Date: September 8, 1998

Original DocumentDate: February 27, 1998
Version: 0.9a
By: Kevin Leung
E.mail: [email protected]

Foreward: Here is a summary of some of the questions posed during
clerkship info night. Please keep in mind that the information provided in
this FAQ are necessarily biased (towards my opinions) and definitely do not
represent the perspective of all clerks. THESE ARE MORE OPINIONS rather
than definitive answers. But I'll try to answer as honestly as possible
and invite all those reading this to comment or contribute. I apologize in
advance for any inaccuracies and if I offend anyone. You read this at your
own risk. <gasp>

Background: To help you understand where I'm coming from.

I did ASCM/First 2 years at Wightman - General division.
I did 3rd year clerkship mostly at the Wellesley hospital.
I did 4th year clerkship at St. Michael's.
I applied to Internal Medicine/Family Medicine for residency.

***New ***
I ended up matching to Family Medicine at McMaster University. This was
not my first choice but more than acceptable to me. I was enrolled in a couple's
match and my S.O. got matched to Radiology at McMaster.

My rotation schedule for 3rd year is now moot (as it is no longer offered)
but my 4th year rotation was #1 (starts with ACE).

So enough bullshit, here are some questions and answers. Only read answers
to questions that you care about as I'm a bit long winded in this little
ditty.

1. Which academy should I choose?
==================================

Perhaps the most frequently asked questions and the one causing the most
angst among pre-clerks. The truth of the matter is that it probably
doesn't matter and the general consensus is that you will receive a strong
medical/clerkship experience at any academy. Having said this, you
probably won't believe me... So let me summarize some general consensus
statements.

Medicine is medicine. However, Wightman has a reputation for the some of
the best teachers and the best (marginally) learning. This is offset by an
equally infamous rotation of having the highest expectations and "intense"
internists/morning reports around. It is true that they have a fair number
of "power" internists sitting on the admissions committee, but you can find
committee members from any of the hospitals.

Sunnybrook seems to have generally happy clerks. Don't know much about
them or Peter's academy.

St. Mike's is "more laid back?" with both clerks and staff being a little
more relaxed. Is this true? Definitely :) Actually though, there were
some complaints that medicine was not as enjoyable as it could have been.
But as always this varies with your resident.

2. Which rotation should I choose?
==================================

Again another one of those "it doesn't matter" answers. Having said that,
you won't believe me on this one either. Generally, the MOST important
concept is where your electives sit and with the new clerkship rotations,
you are guaranteed 12 weeks (2 rotations) of electives that you can get
reference letters from and send to CARMS so it doesn't matter. Some feel
that it may be best not to have Med/Surg last in 3rd year right before
summer. Also, I think that having Med/Surg last in 4th year is tough too
as you have LMCC exams to study for at the same time. You get 2 weeks
after your last rotation before your examination!

3. What about electives? When should I set them up? Who should I do them
with?
===========================================================================

Hmm. That's a mouthful but here's my take on it. Let's suppose that (in
Kevin's World) there are 3 type of electives and the answer differs for the
various types.

a) Learning
b) Power
c) Slack

They are not mutually exclusive but there are subtle differences in
strategy. Let me elaborate.

a) The learning elective

There is a belief that electives in the community give you an opportunity
to do more and possibly learn more. These electives can be set up pretty
much at any time but try and make sure that you have some idea that your
supervisor is good. Also, there are many physicians in the core hospitals
that are equally good teachers. But you have to make sure that elective
allows you adequate time and opportunity to learn and that you aren't too
far down the chain to get a chance to "do stuff"

Despite all the high-flying concepts of learning and a well-rounded
experience (which I do believe in) there is the very pragmatic fact that it
is competitive getting into any residency program and you have to try and
maximize your chances. Which brings us into the next class...

b) The power elective

This is often with a program director, head or program or someone that is a
big name in a specialty/field. These electives are best set up a little
earlier as there tends to be a greater demand for spots. Even if you don't
shine, the concept is that you will be able to impress staff with your
affability and general "chumminess" level that they will let you into their
program. Don't laugh - it may be true. Some say that these electives are
best set up after you've gained a little experience in a field so that you
don't look like a total fool. There's some validity in this. However,
this matters less than getting to know the right people/person.

c) The slack elective (my favorite)

It's no secret that radiology is extremely popular electives during the end
of 4th year. What with regular hours (typically 8-4) and no call you can
study/have a life/get drunk - and still learn a bit. Don't worry about
these electives. You can generally set one up at any time. Just don't say
that you're applying because they're slack and you're in. A caveat. This
may not be the best choice for an early elective if you're going to apply
to a really competitive specialty.

*IMPORTANT NOTE*

The most important choice in electives comes from either 1) power or 2)
knowing of a good elective/staff from word of mouth or personal contact.
Be very wary of the electives catalog as the quality of those listing can
vary widely.

If you're planning to get a reference letter from an elective, try to avoid
electives that have you rotating between clinics/staff every week as you
will simply not have enough contact with anyone to get a good reference.
Personally, I think it is good to tag along with 1-2 staff so they get to
know you, trust you (the fools!) and even teach you to do stuff.

4. What is clerkship like?
===========================

It depends. There is a lotta luck involved as it depends on your staff and
your resident for much of your learning experience. In general, expect a
minimum of an 8-9 hour day on top of any studying you plan to do at home.
It's especially difficult to study on the rotations you have to do call on
(read - Med/Surg) as you're often tired by the time you get home.

Don't worry though, there is time to fit in loved ones, clubbing, computer
games and socialization... But you have to be careful about your time.

A lot of your education (60-90%) depends on which resident you have and how
active/interested they are in teaching. Also, do expect scut - just hope
that you're rewarded with good teaching (good luck!).

Remember though, if you slack off (eg. skip call). Besides the possible
loss in marks, it means your team/colleagues will have to take up your slack.

5. How will they mark me?
=========================

This is the toughest part to accept. Your ward mark (50-60% or your
evaluation) is very subjective. It depends on whether you can achieve a
good bond with your staff or resident and whether you're given the
opportunity to shine. Lotta luck.

Hey, if you've never heard of Heriditary Hemmorhagic Telangiectasia, you
just can answer "Tell me what those spots on her lip suggests?" right?

The best things you can do to cover yourself.

Try to be affable. Don't try to cut up your staff/resident too much and
show some interest in your rotation and a willingness to learn. It doesn't
mean you have to take too much shit but try to give your staff some slack
and perhaps even some reason to like you.

Try to show up on time (my Achilles heel) and to make sure that your
staff/resident knows when you're around and up to stuff. Makes no sense
for you to do scut and your resident not to know of it. The easiest (and
most sensible way) to achieve this is just to keep your superiors
up-to-date on your activities and their patients when requested to do so.

Finally, there are objective exams and tests and even 3 more OSCE's. The
faculty don't want to hear this but you should. One of the best ways to
study is to ask around about what was on the previous exams. This is
especially true for OSCE's as they always try to cover the broad, most
important topics in these.

6. What about my marks? Will they suffer?
===========================================

They might and even the gold medallist can't boast of a straight "A"
average. So, try to get good marks (if you so desire) but don't kill
yourself over a "B" in your rotations. EVEN IF YOU DON'T GET AN 'A' ON THE
SPECIALTY YOU HOPE TO GET INTO - IT PROBABLY DOESN'T MATTER.

However, 2 points (which you are probably well aware of).

- we are the last school (in Ontario anyways) that gives letter grades
still so a "B/C" is equal to what students get in most other schools which
is a pass. Also, honours is often 85%+ in the other schools which is hard
to achieve by any definition.

- you're 3rd year marks count the most. Keep in mind they're probably
3rd-4th on the list of things that residency programs consider (after
reference letters, extra-curricular/research/awards and essays). In fact,
your 4th year marks don't even make it into Carms before the match!

7. What should I concentrate on then?
======================================

Don't ever forget you're paying the buggers $5000+ to teach you! <ERIC CHU
suggests that you try to minimize scut. Also to show up in front of staff
as much as possible - their clinics, OR's, etc...>. Also, I REALLY would
start collecting reference letters early if you know you even have a slight
interest in the field or if you think you can get a good one.

Most residency programs require 3+ letters of reference. It is best if you
can get at least 1,2 or even 3 from the same field. Except for really
competitive fields, it matters less who you get it from than how positive
the letter is. Trust me on this one. (Ignore what I've said if you're
going for Ophthalmology or Dematology - there, you should really kiss butt.)

Here's a cautionary tale:

After completing a rotation I did extremely well in and where I had lots of
staff contact and was told I was the "star" on the rotation, I naturally
asked whether he would write me a reference. "Yes, of course"

I went 3 months later (before my CARMS deadline) and asked for one. What I
received was a lukewarm letter. Didn't hurt my application. Just wasn't
nearly as strong as it probably would have been if I had asked that my
letter be written AT THE TIME. I know it's embarassing to ask. I know you
don't even know if you're going apply. But JUST DO IT!

8. Can I commute to school?
===========================

The consensus is yes and it is being done. Traffic just isn't bad at 8 am
and the only problem you might encounter is when you're doing call. But
yes, I've known several people who have managed to do it well. Just don't
expect parking downtown to be cheap.

9. Out of town electies?
========================

You should set these up early. Especially if you want to go out of
province. I went to Kenora, Ont. via the NOMP program (it's in the
catalog) which was a fully funded and housed elective in rural Ontario. If
that's what you're interested in...

I'm afraid that I've already gone overboard, if you have any questions,
please feel free to ask them of me:

[email protected]

and I'll try and include general questions into any updates of this FAQ
that I make. Good luck in your choices and your clerkship.

**** PLEASE REMEMBER THAT THIS FAQ REPRESENTS MY OPINIONS/BIASES AND YOU SHOULD TRY AND GET MORE INFO/TALK TO CLERKS FROM THE ACADEMY YOU'RE GOING TO CHOOSE ****
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Kevin Leung, B.Sc., Meds 9T8
e-mail: [email protected]