What are clinical rotations in medical school?

 

Clinical rotations form the second half of a medical doctor (MD) program. Years 3 and 4 of the MD program uses clinical rotations to turn the theory learned in the first 2 years of classroom-based learning into practice.

What are clinical rotations?

In year 3, medical students are placed into hospital settings in the US and Canada to complete 72 weeks of clinical rotations. There, the trainee doctors will spend 42 weeks on required core rotations and 30 weeks on elective clinical rotations, which may be in any medical specialty, depending on their future aspirations. Completion of the clinical rotations will earn students the Doctor of Medicine degree, before they head off to work on a residency placement.

Types of clinical rotations

Clinical rotations are utilized by top medical schools in the US. MUA follows the same integrated, systems-based approach. Following two years of classroom-based learning on the Caribbean island of Nevis, MUA students will return to Canada and the US to complete their clinical rotations at teaching hospitals.

There are two types of rotations in the MD program: core and elective. The core rotations are undertaken in year 3 and elective rotations in year 4.

Core rotations

Core rotations are taken by all 3rd year medical students and are as follows:

Internal Medicine

Improves skills learned during physical diagnosis and includes the completion of a comprehensive history and physical examination of adult patients under the close supervision of a preceptor. Instruction includes the management of commonly encountered disease processes and the use of diagnostic procedures.

Surgery

Introduction to disease processes requiring surgical intervention. Observe and assist during various procedures in the operating room and become familiar with operating policies and procedures. Participate in follow-up and treatment of post-surgical patients.

Obstetrics and Gynecology

Introduction to the normal course of pregnancy to include pre-natal care, labor, delivery and the postpartum period. Fundamentals of proper obstetric and gynecologic history and examination are taught. Observation and participation in a number of live births are provided. Various disease processes and complications of pregnancy and delivery are discussed. Family planning and sexually transmitted diseases are covered.

Pediatrics

Introduction to the medical treatment of infants, children and adolescents. Learn to take histories and perform physical examinations on healthy infants and children. Diagnosis and treatment of common illnesses. Opportunities to learn about rare congenital, as well as acquired disorders.

Psychiatry

Learn about the major psychiatric illnesses such as schizophrenia, affective and anxiety disorders. Understand the difference between organic and functional mental illnesses by taking a psychiatric history and performing a mental status examination. Instruction in the judicious use of major classes of psychotropic medications.

Elective rotations

Electives allow fourth-year medical students to focus on their chosen specialties. Highly recommended elective rotations include:

 

  • Primary Care Medicine (required)
  • Cardiology
  • Dermatology
  • Emergency Medicine
  • Anesthesiology
  • Intensive Care Medicine
  • Neurology
  • Pathology
  • Plastic Surgery
  • Radiology
  • Urology
  • Vascular Surgery

More details on the curriculum and a list of hospital teaching sites can be found on our Clinical Medicine page.

How long are clinical rotations and what are the goals for clinical rotations?

Each clinical rotation varies in length, from 4 to 12 weeks. A single rotation will be the focus for several weeks, before rotating to the next subject area.

At MUA, clinical rotations last for 72 weeks. The first 42 weeks in year 1 are segmented into the core rotations of Internal Medicine (12 weeks), Surgery (12 weeks), Obstetrics and Gynecology (6 weeks), Pediatrics (6 weeks) and Psychiatry (6 weeks). The final 30 weeks of elective rotations will vary in length for each, depending on the rotations selected. Electives tend to be shorter than core rotations, lasting between 4 and 8 weeks each.

Standardized tests called shelf exams are held at the end of each rotation, which must be passed before a student is permitted to advance to the next rotation.

Medical students undertaking clinical rotations will need to work shifts as would any practicing doctor. Shifts last between 8 and 12 hours and can be scheduled during the day, night-time or weekend. Students may also be asked to be on call, depending on the medical setting.

How to prepare for clinical rotations

There are no two ways about it, clinical rotations are tough. Their real-world context and substantial workload can become stressful, so students will need to prepare for their rotations effectively. Here are 9 tips for preparing for the final two years of medical school:

 

  1. Start thinking about your specialty early on. Use the theory of your Basic Science semesters to identify and explore what your specialty might be. Even if you can only narrow it down to a few options, that will help you to target your learning and to make informed decisions when it comes to selecting your elective rotations.
  2. Students sit their most important exam — the USMLE Step 1 — prior to their clinical rotations. Gaining the best possible score in this exam will help you to take your pick of rotations.
  3. The students who do well in their rotations are always organized. Be meticulous about your scheduling, understanding which rotations might pose a challenge and spreading them between less demanding rotations. Schedule preparation time before shifts and time to write up any notes afterwards. Understand your shift patterns and what research needs to be carried out in advance. Know where you have to be and be there early.
  4. It can be a good idea to schedule your favoured subjects towards the end of your rotations. It’s likely that you’ll perform well in your preferred subjects, so bring experience gained from previous rotations to help yourself stand out from other students in your best rotations. This will increase your chances of receiving a recommendation letter for the next stage of your MD journey: the residency application.
  5. Study whenever possible; there won’t be time to procrastinate. Always have something to read, as you’re bound to be waiting around at the hospital on occasion.
  6. Make time for self-care. Sleep, exercise and eat a balanced diet. Plan your days off, making time for friends or programming in some downtime.
  7. Now is the time to develop professional habits. Dress well and groom yourself, be on time, use language appropriate to your setting, handle criticism in an adult manner, work well in teams, be enthusiastic. Your reputation can take you a long way, so don’t let yourself down.
  8. Immerse yourself in every rotation, regardless of whether or not you think it might be useful in the future. Commit yourself fully even if you don’t see any point; your two years on rotation will be over in a flash, so make the most of them. If you’re not enjoying a particular rotation, just remind yourself that the next one will be better.
  9. Remember that you’re there to learn. Forget about networking and competing with your fellow students. View your patients as your biggest teachers and get to know them as individuals. Find out what attributes they value in a doctor. They can help you to hone your bedside manner. A positive word or two from patients can go a long way to lifting your spirit when you’re having a bad day.

 

What questions to ask during clinical rotations?

There’s no particular set of questions to ask during your rotations, but asking questions will demonstrate your interest in medical conduct and patient care. While asking questions is a great way to show your enthusiasm, be sure to only ask questions that are intelligent and relevant. Your attending will be incredibly busy and won’t have the time or patience to answer questions that you should have known if you’d done a bit of research. Note down some sensible questions from your research and raise them at the end of your session if they haven’t been answered. Get the balance right and be prepared to learn from anyone and everyone.


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