Medicine subspecialty experiences?

[Christina Wright]

Hey guys!  I have to rank my subspecialty choices for medicine, and I was wondering what your guys' subspecialty experiences have been thus far (for those of you who are doing medicine first).  Thanks! 

[Hao-Hua Wu]

Hey Christina,

I haven't done my subspecialty yet but I've heard that solid onc is pretty chill (residents are friendly, rounds are not too early). I haven't really heard anything bad about any of the other subspecialties with the exception of ID, which can be complicated if you don't have a good resident to teach you. Do you have any advice for psychiatry sites (Pennsy spruce 4 vs Pennsy spruce 6 vs VA)? 

Best,

Hao-Hua

On Sun, Feb 16, 2014 at 6:19 PM, Christina Wright <christina...@gmail.com> wrote:

Hey guys!  I have to rank my subspecialty choices for medicine, and I was wondering what your guys' subspecialty experiences have been thus far (for those of you who are doing medicine first).  Thanks! 

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Hao-Hua Wu
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Perelman School of Medicine at the University of Pennsylvania

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[Kendra Moore]

Hey Christina,

So crazy that we are already ranking our next rotations! For the medicine subspecialties, I wouldn't stress too much about the rankings. I'm pretty sure they mean nothing, as I got one subspecialty and it was my 3rd choice. That said, I will tell you about my experience with GI:

I think GI (but really I mean liver) is a really great service to rank highly. It's a manageable amount of material, and you see very similar issues cropping up in patient after patient. The patients are extremely sick, but have really interesting situations and histories. You also get to learn a fair bit about the transplant process, because one of the RNs from the transplant program rounds with the team every day and you hear about if/why patients will be listed, what they have to do to get listed, and how likely they are to get a liver.

Additionally, there's the opportunity to do some fairly simple procedures on the service, which is always nice for variety's sake. Unfortunately during my two weeks there were a reduced number of paracenteses, so I didn't get to do one myself, but I did see one and feel like next time I have a patient who needs one I can step up and ask to do it. I did get to drop an NG tube and help with a couple of arterial sticks, which, for my first block felt like something. I think that generally students get to do at least 1 cool procedure in the two weeks.

The schedule is a bit grueling- every other day is an admitting day on this service and it's a busy service with ~20 patients. I would say that I was there usually until 8 on admitting days. The off days are better schedule and work wise- primarily because the residents have more time to actually let you do stuff besides perform a futile history and physical that's already been done by someone else. You also get out a little earlier. On non-admitting days I got out between 5:30 and 7.

Lastly, I'll say that I think it was a good rotation to do because the liver is a fucking black box (what the hell goes on in there?) and it shed a little bit of light on that for me. Liver dysfunction causes so. many. systemic issues that you get a good sense of the role of the organ and how things work together.

So, overall, I'd recommend it highly! Though, of course, at this point I have nothing to compare it to. 

In terms of what I've heard about other services, it sounds like Pulm and ID/Renal are both tough because they are split services with two attendings- but Jared can definitely tell you more about that. 

Folks who are on CCU and Heart Failure seem to really like it- and they kick ass at reading EKGs, which I'm fairly convinced I'll never be able to do. You would, of course, shine at this one!!

Also, don't be fooled by geriatrics being on the list- I assumed it would be a depressing inpatient ward, but now wish I had ranked it highly. You end up on the ACE unit, which is a really cool combo of outpatient and inpatient and has a lot of comprehensive services for the elderly. I've heard good things from people who did it.

Ok, there's the novel- let me know if you have any other questions about GI!

Have a great evening,

Kendra

Kendra A. Moore
(916) 718 3779 (mobile)

[Christina Wright]

Thanks so much, Hao-Hua and Kendra!  This is really, really helpful! 

Hao-Hua, for psych I did Spruce 4 and really liked it. I think it probably gives you exposure to the broadest range of different patient populations - 3 weeks on inpatient psychosis, 1 week of child at CHOP inpatient and outpatient, and 2 weeks of consults at HUP.  The hours are great (we got a few afternoons off during inpatient, and for the other weeks we got in at around 8 and were usually out by 5-6 - the residents really emphasized getting us out on time!)   The patients on Spruce 4 are some of the sickest, psych-wise - a good number of them were homeless - it was really interesting to see the process of getting them back on their feet, & watching the people on the unit work with case managers to find them housing or a place to stay.

That said, of all three of the psych rotation options, the Spruce 4 rotation probably gives the least amount of experience actually interviewing patients.  Part of the problem is that Pennsy 4 is a psychosis ward - some of the patients have been involuntarily committed for homicidal ideation, or have had SI/HI in the past -- and the emphasis is strongly on student safety.  The residents and attendings always rounded with us and usually conducted most of the initial interviews themselves, although we followed up with patients and presented them at rounds.  We did go to outpatient clinics during some of the afternoons at Spruce 4 (three afternoons at VA outpatient, two afternoons at a bipolar disorder clinic) and were able to interview and present patients there.  The week of child psych was basically shadowing, but we saw some really interesting cases.  The two weeks on HUP consults were fantastic - the residents gave us a lot of independence and would basically send us off to various parts of the hospital to interview patients, and then we'd present the cases about an hour afterwards.  The cases at HUP were also pretty interesting -- everything from delirium to anxiety to conversion disorder.  

In terms of the other sites, I know the VA is supposed to give you a LOT of independence.  You get tons of experience interviewing, doing writeups, and managing patients -- I've heard you are basically expected to assume the duties of a resident-- but students at the VA sometimes complained that they didn't get as broad of an experience in terms of patient population.  You're at the VA the whole time, and I think you're mostly working with PTSD/substance abuse/psychosis/mood disorder patients.  The hours are longer than Spruce 4. I don't know as much about Spruce 6, but I think it's somewhere in the middle in terms of independence, patient breadth, and time commitment.

Hope that helps!

On Sun, Feb 16, 2014 at 6:28 PM, Hao-Hua Wu <haoh...@gmail.com> wrote:

[Jared Huber]

Thanks for the heads up on Psych. Here is my scoop on Renal/ID. 

Like Kendra, I ended up with just one subspecialty--luckily mine was my first choice. However, one of my weeks I spent on night float, which was a good learning experience in itself, but made it so that I only had 4 days on the actual Renal/ID service. You work with and are evaluated by 2 attendings, one Renal and one ID. The big advantages that I have seen is that you will most likely have somebody who is HIV+, and those patients provide an incredible learning opportunity and are often incredible and humble people. There have been quite a few HIV related questions on UWorld. I didn't learn as much about Abx as I thought I would. Renal also was a good experience; you think through a lot of electrolyte problems (something I didn't get during Mod 2) and intrinsic renal problems. 

From what I can tell, Cardio and GI have the most complicated patients. Their problem lists are pages long and many have multiple admissions. It makes it so you have to put in a lot of time for each H&P, but you also learn a lot from each patient. I don't think you can go wrong with any of the services though. It is all relevant to the shelf, it is all interesting, and there is no way any one service will teach you everything. The point isn't to learn it all, just to be exposed and to learn what you can.

Hope that helps.

[Zachary Hostetler]

I have only done one day of Solid Onc so my experience so far has been pretty limited. From what my resident told me, the Solid Onc service only admits patients with a previous diagnosis of cancer, and only then for management of medicine-related issues (like a melanoma patient with pyelonephritis). The Solid Onc service will also accept overflow patients form the Liquid Onc teams too, since they are always overcapped.  We also work with patients and families who must deal with questions about end-of-life care, which can be very challenging and rewarding.  What the team doesn't do is work up patients with a suspected, but undiagnosed, malignancy.

From what I can tell so far, it's a lot less crazy than the Martin service, which was my previous experience. I picked up a patient today and still had plenty of 1 on 1 time with my resident, which translates to more teaching -- definitely a plus!  If you have questions about the subspecialty, I should be able to answer them after a few more days on the floor.

Zachary Hostetler

zhost...@gmail.com

610-348-6751

The University of Pennsylvania

Perelman School of Medicine

M.D./Ph.D. Candidate, MS2

The Pennsylvania State University
Schreyer Honors College, Eberly College of Science
B.S., Biochemistry and Molecular Biology

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