Phase III orientation "retreat"

The administration recently held a retreat for the class of 2013 to demystify Phase III. "Retreat" is a bit of a misnomer since the conference was held in a lecture hall on campus. Regardless, a lot of thought and energy went into organizing this event, which was primarily for our own benefit and turned out to live up to its purpose.

So many questions...

What are clerkships?
Clerkships are the same thing as "clinical rotations." Their purpose is to expose the third-year medical student to a particular field or specialty. The student experiences that field from the clinical perspective and becomes as clinically proficient in it as he or she can get in the number of weeks allotted to that rotation.

What clerkships are required?
Ten clerkships must be completed during Phase III:

* Hospitalized Adult Care (a.k.a. Internal Medicine) - 8 weeks
* Infant/Adolescent Health (a.k.a. Pediatrics) - 6 weeks
* Musculoskeletal Care (a.k.a. Orthopedics) - 2 weeks
* Women's Care (a.k.a. OB/GYN) - 6 weeks
* Urgent and Emergency Care - 2 weeks
* Psychiatric Care -4 weeks
* Neurologic Care - 4 weeks
* Operative/Perioperative Care (a.k.a. Surgery) - 8 weeks
* Adult Ambulatory Care - 4 weeks
* Rural and Community Care - 4 weeks

These clerkships are then scheduled within six 8-week blocks starting April 25, 2011 and ending April 20, 2012. Mixed in there are three clinical interludes (about which I know very little) and a few federal holidays sprinkled here and there.

So, you get some holidays off?
Maybe. Holidays during Phase III "may not apply at all clinical sites." It's at the discretion of my attending physician. That said, the holidays listed on my schedule are:

* Memorial Day, May 30
* Independence Day, July 4
* Labor Day, September 5
* Thanksgiving, November 24-25
* Martin Luther King Jr. Day, January 16
* Presidents' Day, February 20

I also get a Fall break from August 15-19 and a Winter break from December 17 - January 2. Those breaks are certain, but they may fall in the middle of a clinical rotation, in which case I imagine the break wouldn't be completely worry-free.

In what order will you do your clerkships?
I don't know, yet. I will post my Phase III schedule here when I get it in early February.

Do you get to choose your schedule?
Not really. But, the administration has set up a system in which every student identifies two priority clerkships. Last year, every student but one got their first priority clerkship. On top of that, there is a student-led swapping program that permits two students to switch clerkships if both students agree and if the switch does not cause any other scheduling conflicts. As you might imagine, a lot of anxiety surrounds this whole process.

What were your first and second clerkship priorities?
I chose to have the Adult Ambulatory Care and Rural Community Care rotations (they are scheduled together) first (priority #1) and my Internal Medicine rotation second (priority #2). My reasoning for this was several-fold.

Numerous people - including my preceptor - suggested doing Internal Medicine earlier rather than later because it serves to prepare students to perform better in subsequent clinical rotations. In fact there is an article in the Journal of the American Medical Association (JAMA) that provides evidence supporting this notion:

The positive association between initial internal medicine clerkship experience and subject examination performance throughout the clerkship sequence may reflect general understanding of internal medicine concepts, providing a fundamental basis for medical knowledge in all clinical disciplines.
JAMA. 2010;304(11):1220-1226.

I have other personal reasons for requesting these priorities. I prefer to approach the longer clerkships earlier so I'm less tired and burned out for them. I prefer to do the rural rotation during the Spring/Summer months when the whether is more forgiving. Also, several interns and residents I've talked to said that Adult Ambulatory Care and Rural Care are relatively easy ways to transition into the clinics.

Regardless, the administration was careful to emphasize that there are no guarantees that we'll get even our first priority. So, let's just put this out of our minds and wait until February when I'll have a concrete schedule.

What's this about a rural rotation?
Yes, a rural rotation. Except for Denver, Colorado Springs, and a few other smaller cities, Colorado is a very rural state. As such, the School of Medicine places a strong emphasis on rural medicine. That includes requiring a clinical rotation in rural Colorado. Housing is provided by a program called the Colorado Area Health Education Center (AHEC), either in condos or town homes owned by AHEC, or with a host family. I don't know all of the rural sites, but we select our top preferences from a list in a process similar to prioritizing our clerkships.

It's also worth noting that many of the clerkships have rural sites. Emergency Medicine, for example, has a rotation at St. Mary's community hospital out in Grand Junction. The Women's Care rotation has sites in Colorado Springs, Frico, and Brighton. If I wanted to, I could probably arrange to spend more than half of Phase III outside of Denver.

Will you have a life during Phase III?
No. In fact, this point was specifically emphasized in case there was any ambiguity on the matter. We were told to ask our friends not to get married during this coming year. In fact, it would also be best if none of my family or friends have birthdays or decide to die over this coming year. I'm not to get sick, either.

In all seriousness, though, the administration explained how there are involuntary absences (e.g. sick) and voluntary absences (e.g. wedding, birthday). They then told us that any absences - voluntary or not - may delay our graduation date if we are unable to make up all of the clinical requirements that we miss as a result of our absence. So far, it's certain that I will miss my Nana's 80th birthday celebration. Still up in the air is a close friend's wedding. Luckily, I will most likely be able to attend my sister's graduation, but only because it happens to be local.

This is depressing. But as I told my little sister when we were discussing her graduation and my Phase III schedule, I knew that this was coming when I signed up for medical school.

The rest of the conference

The rest of the conference consisted of presentations by the various clerkship directors. We were also given an opportunity to talk in small groups with the clerkship directors and ask them any questions we had about that particular rotation. I found this extremely helpful.

The co-presidents of the Class of 2011 (current fourth-year students) spoke to us, imparting their hindsight-is-20/20 wisdom. One of them made a list of concrete pieces of advice for incoming third-year medical students, which I will provide in a separate post.

Finally, the 8-hour conference was capped off by a dinner hosted by Student Affairs. A chief-resident sat at each table and chatted with us in that informal setting. The keynote address was given by Dr. Steve Lowenstein, an Emergency Medicine doctor with a degree in public health. His entire speech was excellent, but one quote stood out to me. On how to avoid and deal with burnout, his advice was to fall back on kindness: "Kindness is easy to administer and exceptionally well tolerated." Moreover, kindness speaks to the reasons why I decided to go into medicine in the first place.

There's no doubt about it: Phase III will be physically and emotionally exhausting. But I am looking forward to jumping into that next phase of my medical education.


P.S. Please e-mail me or write a comment if you have any questions about Phase III that I did not address. If I don't know the answer, I'll probably want to figure it out just as much for myself as for you. I may write a follow-up post on Phase III if there's a need for one.