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Developing Your Third-Year Schedule

Clinical training begins in the third year at many medical schools. This is an incredibly exciting time, as you are taking the next big step toward becoming a physician. However, it is usually also very anxiety-provoking because it differs markedly from your preclinical training and requires that you develop and use a whole new set of skills in learning to care for patients. But once that initial anxiety dissipates (which it will!), your third-year clerkships are a wonderful time on your path to becoming a doctor as you begin to figure out the kind of medicine that you want to practice and begin to develop your own professional identity.

Depending on your school, now may be the time to consider the structure of your third-year schedule. Each institution is different in terms of scheduling, and you may have more or less ability to influence exactly what your year will look like—what you will take when and in what sequence. Regardless, there are a number of things to think about when making your schedule requests, particularly if you are considering internal medicine:

  1. The first rotation is often the most challenging. Although comfort levels differ markedly between students, simply making the transition from the classroom to the clinical clerkships is significant. In addition to learning the content in a particular discipline, the first rotation also requires that you master the flow of being on a “real” clinical service and understand what is involved in caring for patients on a very practical level. Things such as rounding, presenting, using the electronic health record, documenting, and figuring out how the ancillary services in your hospital work can be intimidating and consume a lot of mental and emotional energy. Even though most schools provide opportunities to interact with patients during the preclinical years, entering the clerkships full-time is a completely different experience. Although everyone makes this transition relatively quickly, the process may interfere with your desire to immediately experience those areas in which you have an interest. Therefore, some students prefer to schedule a rotation in an area where they have less of a career interest to allow them to develop a certain comfort level before rotating through those clerkships in which they are considering as a possible career. If you are considering internal medicine, there is no specific need to take it as the first rotation of your clinical training unless this is what you would prefer to do—it will not make a difference in your ability to successfully apply in internal medicine if you choose to do so.

  2. The internal medicine core clerkship tends to be one of the longest rotations of the third year. It is also considered by many to be a "foundational" clerkship, meaning that what is learned during this time helps serve as a fundamental groundwork that helps prepare for many of your subsequent clinical rotations. For example, patients seen in the medicine clerkship almost always have significant organ-specific diseases and frequently have more than one at the same time. This requires an understanding of the normal and abnormal function of these systems, and, importantly, the interaction between different systems. Although this obviously occurs in other rotations, the nature of medical patients and the settings in which they are cared for during the medicine clerkship helps develop knowledge and understanding that is extremely valuable as you rotate through your subsequent rotations. Because of this, many students prefer to take the internal medicine clerkship relatively early in their third year so that they have this experience before their other core rotations instead of later once they have already completed many of the basic clerkships.

  3. Some students may have an interest in experiencing one or more of the subspecialty areas of internal medicine (such as cardiology or gastroenterology). You will undoubtedly gain some exposure to those areas of internal medicine during your basic medicine clerkship, although this will most likely be through interactions with subspecialist consultants who may be helping to care for your patients. If you believe that you have a real interest in one of these areas, there are several options for exploration. Most medical schools allow students to take one or more electives during their third year, and scheduling a rotation in your area of subspecialty interest may be possible. However, it is usually preferable to rotate through a subspecialty area as an elective in your fourth year once you have decided to pursue internal medicine. The advantage is that your skill set will be much more advanced and you will be able to more fully participate in the rotation and obtain a better sense of whether this is an area that truly interests you. Many students choose instead to use third-year elective time to explore areas in which they might have interest but may not be a part of a required third-year clerkship.

  4. One instance where it may be worthwhile considering scheduling an internal medicine elective rotation during your third year is if you are truly considering internal medicine as a career option but are not able to schedule your core medicine clerkship until very late in the year. Although a medicine elective would differ from the core clerkship, it would still provide an exposure to internists and internal medicine through one of its subspecialties.

It is worth considering these points as you put together your schedule request. Obviously, your schedule needs to be tailored to your own circumstances, and the advice of the students who have already been through the third year and residents who can look back at their own experience may be helpful in deciding how to structure your rotations.

Also, if scheduling limitations prevent you from structuring your third-year schedule the way that you would like, don’t panic. There are almost always other options available to help make your schedule work in a way that will help you with both your learning and deciding on a career path. Your advisors and mentors, both within the department of medicine and dean’s office, can provide invaluable input and guidance in making your third-year schedule meet your goals.

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