Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

John H. Stroger Hospital of Cook County is a county hospital which offers a totally unique experience.  It is a good idea to do at least one rotation at County as it is an excellent resource.  In general terms, one may say that you have more autonomy at County than other sites.  The experience of working at County, however, requires that you learn to function in the County system.  This can be a chore and can be extremely frustrating until you learn to accept that things (everything) takes time (a lot of time) at County.  If you can become comfortable with the system, you will have patient care experiences that simply cannot be found in other hospitals.  There will be many times that you have to do things for your patients that you may not feel is “your job”, such as transporting patients and drawing blood.  You can take these experiences and be annoyed by them, or you can take them and learn something.  You can master your phlebotomy skills and you can talk to your patients as you move them from place to place, and keep up on the tests that they are having.  Some advice:  find a tourniquet at Rush (from one of the phlebotomists) and bring it with you to county.  The only tourniquets at County are gloves and these do not reach around everyone’s arm.  This will make things much easier!  Remember that most patients seen at County have no insurance and would get no medical care if it were not for County and they are very appreciative of everything you do for them.  You definitely get a sense of fulfillment from working with the patients who come to County. 

Probably the biggest complaint about County is the difficulty in getting your ID.  The County requires all students to get a new ID at the start of each rotation.  Unfortunately, this is a major production which requires at least 2-3 forms to be filled out and trips to two separate offices.  You first need to go to 815 Heckton to fill out papers that give you permission to get an ID.  Then you need to go to Human Resources located at 759 S Westminster (on the north side of the old Nursing Building behind the County) to get the ID printed.  Human Resources for County will only make student ID’s Tuesday to Thursday, and only makes 35 ID’s per day, so go early (like 8am when HR opens) and expect to wait for them to get to you (about 30mins).  For the foreseeable future, this is how ID’s will continue to be handled.  Perhaps some day they will figure out a way to give us an ID for an entire year.  In the meantime, just know that it is a pain and you have to deal with it. 

Another piece of advice – always bring a copy of your immunizations with you when you start a new rotation at County.  Even if you were just on rotation there for the last eight weeks and you know they had a copy when you started then, that doesn’t mean that they’ll be able to find it now.  Save yourself the headache and just carry a copy with you!  To get a copy, you need to go to the Dean’s Office (OMSP) located on 5^th floor of the AcFac and ask for one. 

Contrary to what you might guess, the teaching is also pretty good here.  There are many foreign grads going through their second training.  They can have more experience under their belts because of it.  In addition, there is protected teaching time on most rotations at County, scheduled throughout the day, so that students and residents have the opportunity to learn, and some times to teach.  Several of the attendings on the various rotations will require students to present topics of interest to the group for both individual and group learning. 

Clinical Site: Rush

Rush is a university hospital and tertiary care center.  This is where you are more likely to see zebras (uncommon diseases or conditions) because they will be referred to Rush.  There are also more sophisticated technology and resources at Rush than at other sites.  In general terms, one could say that at Rush the attendings and residents are geared towards academics and teaching, and, in general, you may do fewer procedures and hands-on work at Rush than your colleagues at a county hospital.  This does not mean you will not get any hands-on experience; you may just have to seek out opportunities more than at a place like Cook County.

Rush North Shore

Rush North Shore is a university-affiliated hospital located in Skokie which is north of the city off of I-94.  It can be a commute if you live near Rush or in any of the western or southern suburbs, but not too bad if you are already somewhere north of the city.  Advice: the 90/94 merge always seems to have rush hour traffic so take the local route via Lincoln Avenue, Crawford Avenue and Golf Road to decrease your travel time.  Parking is free at “The Shore” and you only need your Rush ID to work there.  The patient population consists of mostly middle class folks with many older patients (as many nursing homes are located nearby).  The real bonus to this site is the surgery rotation’s OR and procedure experience you will get as compared to Rush University.  You WILL be suturing and cutting patients daily whereas you may not get that experience as readily at Rush.  The flipside is you will also work longer hours.

Clinical Site: Anchor – Lincoln Park

An advantage to the Rush Prudential-Lincoln Park Anchor Office is the student is paired one-on-one with an attending each of the 4 workdays each week. You will spend 2 days with one attending, and 2 days with a different attending. This is a bonus because you will have the chance to work closely with 3 very different physicians. Each physician has their own focus of family practice training such as herbal medicine and spiritual wellness in addition to general family practice and gynecology. Pediatric exposure is limited. Work hours are pretty easy, but there may not be as many office procedures as some of the locations.

Clinical Site: Hinsdale

    Hinsdale is a community hospital located about 20 miles west of Rush off I-294.  They have a Family Medicine residency program, thus most of your time is spent working directly with the residents and presenting to attendings.  You will either be assigned to work in the clinic in Hinsdale or at the satellite clinic in Bolingbrook.  You will also have 2-3 half days scheduled to work in the ER, two afternoons in the nursing home, and approximately two visits to a community clinic over the course of the clerkship.  Hinsdale is known for being extremely organized; you are given your schedule the first day and always know when and where you are supposed to be.  In general, you have a lot of freedom to see patients and opportunities to participate in pelvic exams, colposcopy, circumcisions, flexible sigmoidoscopies and even vasectomies.  Teaching is excellent from both residents and attendings.  The patient population is diverse with plenty of peds and ob/gyn patients.   Also, there are a good number of Spanish speaking patients at the Bolingbrook clinic if you’d like to brush up on your bilingual skills.  The hours are mostly 8:30 – 5:00 p.m. with a couple of evening clinics scheduled during the course of the four weeks.  However, you will be compensated for working an evening clinic with a morning off on another day.

Clinical Site: LaGrange

The family medicine program at LaGrange provides a wonderful opportunity to learn about what a family medicine residency is all about. You spend most of your days with one of the 3rd year residents, but also have ample opportunity to work with attendings as well. Hours are generally 8:00-5:00 p.m. Monday-Friday (no weekends). The LaGrange rotation schedules many off-site days at various private offices and indigent care clinics. Additionally, on Friday mornings you will go with an attending on tours of nursing homes, senior centers, and community health centers to learn about the wide variety of resources available to seniors in the community. Additionally, you will spend one half day with a visiting nurse doing home health care as well as work one afternoon in the ER at LaGrange Hospital.

Most days you will be at different sites in the morning and afternoon so having a car is essential (and knowledge of South/West suburbs is helpful but not necessary because they provide excellent directions to the various sites and you can easily get directions from mapquest). Your experience will be very resident dependent, but all of the residents are happy to work with students. You will also have one or two days per week where you will work with an attending in either the morning or afternoon in their private clinics. Lunch is sometimes provided during weekday noon lectures (pharm rep). There is a cafeteria onsite at LaGrange which gives employee discounts to students, and since most days you're driving between sites at lunch there's ample time to grab fast food on the road. Some days at the LaGrange clinic are set aside for specialties such as Derm or Ob. You will also spend a few mornings at Des Plaines Valley Health Clinic, which offers gyn days and peds days. There you get a lot of independence, if you take the initiative. You can see patients on your own, present directly to the attending, perform many pap smears, and do well-child visits and school physicals. Overall, LaGrange provides a wonderful opportunity to learn about family medicine in both the clinic and hospital setting.

Clinical Site: MacNeal

MacNeal hospital, located in Berwyn, has one of the largest Family Practice residencies in Illinois.  Time at MacNeal is divided between a resident clinic at the hospital and a community clinic with your preceptor.  On your resident clinic days, you are assigned to a resident for each half-day and you see most of his or her patients.  There is a hospital-wide noon conference on most days, and lunch is usually provided.  You will have the opportunity to practice or observe some procedures at the resident clinic.  Students park in an offsite lot where a shuttle runs every few minutes.  The days you spend with the community physician have variable hours, so be sure and call ahead.  Lunches are sporadically provided.  Many patients speak Spanish, but most of the office staff is available to interpret if needed.  The volume of patients will be much greater at the community clinic, so try not to spend too much time with each patient there.  You will see more OB patients at the resident clinic, but more peds and adult patients at the community clinic, so it is a good mix overall.  There are no weekend hours at this site, but the community clinic occasionally schedules patients until 7pm (but you will never leave later than scheduled).

Clinical Site: Rush University Family Physicians (formely Pilsen)

This clinic is located right across the street from the hospital. The practice consists of a diverse population of patients. Your primary attendings will include Dr. Rothschild, Dr. Brown, and Dr. Kring. Your autonomy with the patients varies with each attending and their own personal style. Student notes are not recorded in the patient chart, but documented in your own personal notebook. You will work Monday thru Friday and every Saturday morning. Additional opportunities such as volunteering at Pilsen Homeless Shelter or Misercordia are available.. There are a number of Spanish Speaking patients for those of you eager to practice your medical Spanish; however, Spanish is not a necessity.

Clinical Site: Rush-Copley (Aurora, IL)

  This is a resident clinic so you will have the opportunity to work with both residents and attendings.   You will be working with several different residents and attendings over the course of the rotation (~7).  All of the staff are very friendly, and the nurses are willing to teach you how to give immunizations if you ask.  The patient population is quite young so you will be seeing a lot well-child checks.  You will also see some OBG cases. The attendings enjoy having students around and are good teachers.    Hours are 8:30A to 12N, 1P to 5P, Mondays through Fridays, although you will most likely have 3 days where you cover the evening clinic in which case your schedule will be 1P to 5P then 6P to 9P.   The Kane County STD clinic is run out of the office on Thursday afternoons which is a great learning experience and provides opportunity to talk to patients about their high risk behavior, do a pelvic exam, and administer injections.  Some of the patients are Spanish speaking only, but many of the nurses will interpret for you if you do not know Spanish.

Clinical Site: Stroger/Cook County

(This site is up in the air because of the changes at County, please check with the course director if you are interested).
Depending upon preference and availability, students have the opportunity to work at either the Englewood Clinic, about 20 minutes south of the city, at Fantus Clinic at Stroger, or one of several other sites, including Prieto, which is exclusively Spanish speaking.
Englewood Site
The facility at Englewood was especially well maintained, equipped, and staffed for a county clinic. The typical day begins at 9:00 am and ends between 4:30 and 6:00 pm, generally ending around 5:00. There are a total of 6 half days of work per week providing that there are no official holidays, which are observed at all CCH clinic sites. You work exclusively with attendings, most of whom are committed and excellent teachers. There is one primary attending with whom you work 2 half days each week, and four attendings with whom you work 1 half day each week. There is generally not a lot of downtime, except while waiting to present directly to the attending, who is seeing patients in parallel with you. You should have plenty of time to eat lunch and relax between the morning and afternoon sessions.
In addition to Wednesday lectures at Rush, students attend Resident lectures beginning at 8:00 am on Thursday mornings (located at Stroger Hospital on odd months, Provident Hospital on even months). Lectures last until noon, and then you go to the Englewood Site. A few of the residents also see patients at Englewood on Thursday afternoons, so you shouldn't feel that you are being rushed to get from the lecture to the clinic. On Friday afternoons you are relieved of clinic responsibilities beginning at noon to attend student lectures in the Academic Building at Stroger. These lectures last from about 1:00 pm until 2:30 or 3:00, and the rest of the afternoon and weekend are free. These lectures are generally useful for both the rotation and the miniboard. At the Englewood site there is also an opportunity to spend a day working in the Cermack Jail, one of the CCH sites. Half a day is spent in the general clinic, and half a day is spent in the TB clinic.

Clinical Site: West Suburban Hospital

The clinic is located near Lake and Harlem in Oak Park (15-30 minute drive from Rush depending on the time you leave and traffic). There is free parking, but the site is also accessible by the Harlem Green line. The hours are typically 8:00 – 5:00 p.m. You will be scheduled to work a few evening clinics and you will schedule your own two calls. You decide if which service you want to do your calls with: family medicine service, the maternal-child health (essentially labor & delivery) service, or one of each. There is usually at least one other Loyola medical student there doing a rotation. You work primarily with the residents; however you have scheduled times to work with attending physicians as well. You definitely work harder at West Suburban than many students do at other clinics, but you have the opportunity to observe many procedures (colposcopies, wart removal, toenail removal, suture removal, etc.) and to do pap and breast exams. The West Suburban Family Practice Residency has a strong focus in ob, so if you’re considering family and like ob, this is a great site to get a feel for what residency would be like.

Clinical Site: Worth

The teaching at Worth is excellent as the majority of the time is spent with Dr. Waickus and Dr. Schwer, who are the heads of the Family Medicine Department at Rush and very willing to teach. This can be beneficial for those who are interested in going into Family and are in need of a good letter of recommendation. There are four attendings at the clinic, and you will work with all of them. Students usually end up seeing patients on their own and presenting to attendings, who then see the patients again with the student. Previous students saw a range of patients from pediatrics, prenatal/ obstetrics, gynecologic, and general medicine. Attendings are also good at involving students in any procedures they may have. Hours are usually around 8 AM to 4 or 5 PM depending on the patient load. Students are usually asked to work one Saturday, and get the opportunity to work in two community outreach clinics. Worth is a bit of a distance from Rush (about 25 miles) however, an can take anywhere from 35 minutes to an hour both ways.

Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

Surgery at Cook County is divided into one four-week block with Pediatrics, Vascular, and General Surgery sub-specialties. As with all rotations at County, you will have plenty of opportunities to do procedures and blood draws, including I&Ds (incision and drainage), Foley catheter placement, nasogastric tube placement, suturing and maybe even a central line. Rounds are typically at 6 am or earlier if there is a morbidity and mortality (M&M) conference that day (Thursdays at 7:30 am @ CCH). Clinic is two afternoons a week and gives you more one-on-one attending contact as you have to present all patients to an attending. Students take call approximately q 6.

Clinical Site: Rush

General surgery at Rush is subdivided into several services based on attendings. Service 1 generally does a lot of colorectal surgery, Service 2 does mostly everything and includes Dr. Butsch and Dr. Bines. Service 3 does a lot of everything (breast, endocrine, thyroid) and covers all pediatric surgeries (with Dr. Bass) and includes Dr. Prinz (Chairman of Surgery and an excellent teacher), and Service 4 also does a lot of everything and includes Dr. Millikan and Dr. Doolas as attendings. Services rotate ER call, so the quality (and quantity) of your call depends a lot on whether your service is covering the ER or not (Service 3 always covers the Peds ER).

Learning your way around the OR suites will be your greatest challenge during the first few days. Your responsibilities will include prerounding on your patients (get vitals, labs, I&Os, and outline SOAP note), then attend floor rounds which typically begin between 5:30 and 6:00 a.m. You do not need to do a physical exam on pre-rounds. Also, pay close attention during floor rounds, as you can get most of your plan for your patient at that time (and fill it into your SOAP note). Fortunately, surgery progress notes are short and simple and you will learn to do all your prerounding in 5-10 minutes/patient. Rounds usually are fast paced and it works well to have gauze pads, scissors, tape, etc spread out among the students so that you have some pocket space. OR cases begin at 7:30 a.m. and don’t be late to the OR (from floor rounds) if you are covering the first surgery of the day. Students are also expected to attend clinic, although they are not specifically assigned. It’s a good idea to talk with the students on your team the day before to figure out who will cover what cases and who will attend clinic. If there are a lot of cases, then it is not necessary to attend clinic. Some attendings and residents love pimping students in the OR. Glancing at Surgical Recall is a great idea before entering a case.

Clinical Site: Rush North Shore

Fortunately, your days start early, so you don’t have to worry too much about traffic. Expect a 20-25 minute commute time from Rush at 5:00 am and a 60-70 minute commute time back to Rush at the end of your day around 5:00 or 6:00 pm. Parking is easy and free at North Shore. Rounds generally start at 6:00 am. Be sure to get there early enough to preround on your patients (get the “numbers” - vital signs, I&O’s, drain outputs, etc). The residents are Rush residents and include two interns, one second year and one senior resident. There are approximately seven attending surgeons at North Shore. The student on call spends the day with the on call resident managing patients on the floor. You may end up in the OR on call if there are more than two ORs running. The post-call student usually gets to choose which OR cases they would like to scrub for the next day. At North Shore, you don’t follow “your” patients like some of the services at Rush. Generally, the whole team pitches in to cover all the surgery patients (like one giant service). Keep up to date on the plan for each of the patients so that you can inform the rest of the team. As with any kind of surgery, read up about the procedure before going into the OR if possible, see the patient in the holding area to do a quick history and physical, and attempt to anticipate the surgeon’s next move in the OR. Remember that Thursdays you will be at Rush for lectures but you will still need to go to North Shore and round on your patients (and attend any scheduled surgeries) in the morning IF lectures at Rush do not start until the afternoon.

Clinical Site: Ambulatory

The four weeks of outpatient medicine is very different from in-patient. On one hand, there is no call, and your weekends will be free (unless your preceptor has weekend hours). On the other hand, it is mentally challenging seeing a large volume of patients, often flipping from CHF to athlete’s foot in five minutes. All in all, however, it can be an exciting month with tons of learning packed into it. Sites are found all throughout Chicagoland, some are quite a hike, but most students say it is worth it. You will be assigned to your site on the first day of the rotation. You can request a preceptor beforehand, but try to request early, since requests are honored on a first-come-first serve basis. Not all sites are available every month. If you speak Spanish let Laurel, the clerkship coordinator, know. Wednesdays are dedicated to lectures on a variety of topics. You will learn about smoking cessation, obesity, and get first hand experience with breaking bad news to mock patients. You will also be expected to do a “debate” on screening for various types of cancer. This will be assigned to you early in the month.

Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

At County you will see all sorts of pathology and tend to have more autonomy here than anywhere else. Your residents (and attendings) assign patients to you, and they hold you accountable for their care (with supervision, of course). This is both an exciting and scary feeling. It can be difficult to get things done here; things seem to move more slowly here than elsewhere. You can make things move more smoothly by helping out your team with the less glamorous tasks of drawing blood, filling out papers, and transporting patients. The tradeoff for helping with these tasks will be that your residents will think you’re the best, and let you help, not just watch, with procedures. Students may actively participate in LPs, thoracentesis, paracentesis, and placements of femoral lines all in a single month. There is a “Procedure Service” now at county that is run by attendings. Their job is to teach you how to do the procedures and ensure the safety of the patients. So relax because there is someone very knowledgeable to teach you how to do all major procedures. Although at times the ancillary staff can be frustrating, remember that they are there for the patients, and should be treated with with respect. Period.

Your morning starts early - rounds at 7:00 a.m. if you are post-call, or 7:30 if not post-call. That means you arrive at 6 or 6:30 to pre-round on your 1-4 patients. It is not uncommon that each patient remains in the hospital for a week or more, since things work slower at County, and very frequently patients are previously unknown to the system so the workup is more extensive than at other sites. This gives you the opportunity to really know your patient. It also helps you become better at presenting, since you will be presenting the same patient over and over. During rounds, your attending will likely pimp you on patient matters. Some attendings like to use physical exam findings on patients as a chance to work on your physical diagnosis skills. During the rest of the morning you will work on your patients, and maybe perform a procedure. Regarding scut: there is too much to go around. Although it may be difficult, feel free to say “no” to scut that is not relevant to your patients. Most residents are very respectful and will not put you in this situation. During the day, there are several lectures for students and residents alike. These lectures are generally very good, and can be high yield for the mini-board. You will also have a preceptor, an attending, who you may meet with weekly to discuss H&Ps and learn to formulate differential diagnoses. Like your residents and attendings, this preceptor will also submit an eval for you (worth 30% of your grade so take it seriously).

Like Rush, call is q4, but it is not overnight. Your team stops taking patients at 6 PM, but the workup of those patients continues on into the night. You should use call nights as a time to work hard for your residents. If you have any down time on call, help out with labs, food orders, blood draws, or looking stuff up for your residents (and yourself). Expect to be sent home after you get your patients, usually 6PM- 10PM, depending on the night. Most residents will let you go after you have completed the H&P’s for your patients. There are templates in PowerChart to help with writing the H&P; your residents can show you where these are. Be sure to use the Rush security service (just give them a call). They will escort you from County back to the Rush parking lot or to Center Court, when you are done with your call, late at night.

Clinical Site: Rush

On medicine, you will learn how to read EKGs, chest X-rays, lab results, how to use various diagnostic tests, how to improve on writing SOAP notes, H & Ps, and orders - basically skills that you need for any field of medicine. You will work with a team that typically consists of 2-3 students +/- a sub intern, 2-4 interns, and 1-2 senior residents. You will manage 1-4 patients under supervision. You may be getting new patients all the time, since patients are frequently discharged and you need to keep your patient load at around 3-4. The day at Rush usually starts at around 6:30-7:00 a.m. when you pre-round on your patients. Pre-rounding consists of checking your patients’ vitals, going over any new complaints/problems, doing an abbreviated physical (heart and lungs, bowel sounds, etc.), and reviewing their ins and outs. The patient’s nurse may fill you in on anything that happened overnight. Depending on how complicated your patient is this should take from 10-15 minutes/pt. Start your SOAP note and wait for rounds. At rounds your team will give you insight into the assessment and plan. You may have daily attending rounds or you may have rounds only twice a week, depending on whether you are assigned to the “Bone/Herrick” team or a “Campbell/Schwartz” team, respectively. In general, the “Bone/Herrick” teams have much less time with attendings because they can be outside private attendings than the “Campbell/Schwartz” teams which are managed by hospitalists. During rounds the attending or senior residents will pick out important teaching points to elaborate on, and sometimes looking up something about a specific patient’s condition will become your homework assignment. If you are lucky you will have time to check labs and do miscellaneous work before noon conference. Noon conference is optional everyday except Wednesday, when it is Grand Rounds and mandatory. The conferences are on a broad range of topics, and vary in quality from day-to-day. Coincidentally, there is free lunch for conference every day except Wednesday. Dr. Baker encourages you to attend conferences on other days, but does not force you. Just don’t let her see you walking around with a free sandwich if you are not at conference. At 1:00 you meet with Dr. Baker and discuss cases, teaching points, or have student presentations. The rest of the afternoon is for finishing up patient work or sticking around if you are on call.

Call is q4 and overnight. You will pick up either 1-2 patients/call depending on the patient flow and your load. How much you sleep depends on your residents and how busy your service is. Your weekends should be free if you are not on call or post-call (however this is team dependant, so double check). The “Golden Weekend” happens when you are on-call on Thurs, and have Sat/Sun. off.

Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

Cook County is a great place for Neuro. The hours are longer than at Rush but, there is a great potential to see interesting pathology. Your overall experience is very dependent on your attending. Some attendings are known for their great teaching, which happens to take place late into the evening hours. Other attendings do less teaching and consequently your day ends a bit earlier. Be forewarned - the stereotypical CCH neuro rotation has long hours!

The neuro service at County is a consult service. There are two teams that take call every other day, so you will basically get new patients every other day. There is no overnight call. You are expected to work one day each weekend. There are two half-days of clinic each week, which are long and usually run over their scheduled time. However, you become quite adept at obtaining a good history pertinent to a patient’s neuro complaints. You are expected to preround on your patients (you’ll probably carry 4-5) and round with your attending at different times each day. Rounds can be extremely long if the service has a lot of patients or if there is a lot of teaching points for the cases. It is not unheard of to be on rounds until 8 or 9:00 p.m., especially if Dr. Pierre-Louis is the attending..

You will meet with Dr. Fox (Chair of Neurology at County) each week while you’re at County. Each student will present a case to him and then the team will go see the patient where Dr. Fox will perform a pertinent neuro exam. These can be good teaching sessions.

Clinical Site: Rush

Neuro at Rush is divided into two two-week halves, stroke and general neurology. You may be assigned to do either rotation first. Morning rounds usually begin at 8 am on inpatient service, but you may have to carry up to 4 patients. Days end around 4PM, but can go until 5 or 6 if you’re carrying a heavy patient load. Call is short call (until 10:00 pm) and varies between q4 and q5 (once per week and students make their own call schedule). During call, you will work up new patients, or just help your residents with miscellaneous work. Your two weeks on Stroke are good for learning all about CVAs, locating different lesions, understanding a bit of cardiology (learning about thrombolytics and arrhythmias), and understanding the relationship between neurology and neurosurgery in the treatment of these patients. Your two weeks of general service will be a mix of whatever comes in the door during that time. Rush has its own MS and epilepsy teams, so don’t plan on seeing those two diseases very much on service. However, you can still ask the residents from those services to show you around if you are interested. Also, patients that have not yet been diagnosed with MS may pass through the service to R/O that disease. Diseases that you might encounter during general include migraines, myasthenia gravis, tuberous sclerosis, Parkinson’s, etc. Rounds (with the stroke and general attendings) are usually over by noon and you spend the afternoon doing floor work, reading on patients, and working up new consults (with or without your intern). Attendings are generally good teachers and there is a good amount of structured teaching throughout the rotation. Residents may conduct their own lectures for the team. If you are interested in Neurology, you should try to see as much as you can, since most residents are willing to show you stuff if you exert the effort.

Clinical Site: Rush

On labor and delivery (L&D) and night float, the attendings at Rush do a lot of high risk Ob, so you will see plenty of C-sections and assisted vaginal deliveries (suction, forceps). On the flip side, you will not have as many opportunities to catch babies. Working in triage can be a very good learning experience, but like all of your third year time, will be dependent on the residents you work with. Because there are a lot of private patients at Rush, the attendings tend to be rather protective of the patients, but you should be able to at least do cervical exams on patients with epidurals. Remember to be proactive – let your resident know that you are there to learn, not just to coat-tail.

In addition to L&D, you will also be watching a lot of benign gyn surgery (hysterectomies, tubal ligations, etc.), gyn onc surgery, and have different clinic days. The exact schedule is still up in the air since as the course has been under constant change over the course of the 06-07 school year and undoubtly will be different for you. Gyn surgery is very much like general surgery in terms of hours and a typical day in the OR. There are a lot of gyn surgeries at Rush, so expect to be busy. There are a lot of laparoscopic and hysteroscopic procedures, which may help you familiarize yourself with anatomy and with the use of the endoscopic camera. Gynecologic oncology is generally busier than benign gyn surgery but depends on the patient load (and the vacation time of the attendings on service). Even if you aren’t interested in Gyn-Onc, you will probably enjoy operations with Dr. Yordan. However, watch out for Dr Rotmensch; he may not even acknowledge that you exist, and is more likely to yell at you than any other attending; on the other hand, if you get him talking about something that he likes (such as his daughters), then he may be civil to you. Other attendings may critique your skill with using heavy scissors so start practicing now. Friday’s tumor board session is typically very good and a good chance to review gyn pathology slides with Dr. Bitterman if they have the tumor board, which also has been up in the air. The clinic days have great hours and you can learn a lot (and do a lot i.e. pap smears) during this time as well.

Lectures at Rush are usually Wednesday afternoons (students only) and Thursday mornings with the residents (after 7:00 am Grand Rounds and Morbidity/Mortality Conference). In addition, you will be matched with a preceptor through your entire six weeks of Ob/Gyn. This experience is variable; some students mostly coat-tailed, some were able to do a significant number of exams. The preceptor experience has had mixed reviews depending on what field your attending is in and what your interests are. Some preceptors are straight OB / Gyn, while others specialize in areas such as maternal-fetal medicine. Obviously you will have a greater chance to perform procedures with the former while the latter affords you an opportunity to learn about an area of medicine you may otherwise not be exposed to. In either case your experience is definitely what you make of it.

Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

The Cook County Peds rotation is divided into 2 blocks of 4 wks each - 1 block of outpatient and one block inpatient. The outpatient rotation is actually 4 different “mini-rotations” of 1 week each: Newborn Nursery, ER, Specialty Clinics, and preceptor (offsite-arranged by Rush). Each “mini” is Mon.-Fri with varying hours, but generally only two nights of call in the Newborn Nursery until 10PM. Your workload will depend on the number of births that occur during your brief, one week tenure. You should use the newborn experience to get your physical exam skills of the newborn down cold, as you may not have exposure to newborns again on the peds rotation. To handle the clinics, you need a nimble mind - you go to one clinic in the morning, another in the afternoon - and each day is different! Fortunately, at the end of the week, you have had exposure to 5 - 6 different peds subspecialties. Be aware that sometimes the clinics may be cancelled or rescheduled so you may miss out on some of the experiences.

The inpatient experience is much like other inpatient rotations. You are assigned to one of 4 teams, you round with your team, and see patients that are assigned to you. The day usually begins with pre-rounds at 7 or 7:30, followed by morning conference at 8:00, rounds at 9:15, floor work until 12:00, when noon conference takes place. During the afternoon, floor work continues until you are finished with your work. The amount of scut that you do depends on your senior. Many of us have been assigned to do scut that has nothing to do with our patients, so how you handle that will depend upon you. You are on call q4 until at least 10PM - often later since patients frequently do not come up to the floor until evening. (Currently students do not stay overnight because there are no call rooms available to us.) You will be assigned 1 or 2 patients each call, depending upon your current patient load, and be expected to do an H&P. The following morning, at 8:00 a.m. conference, the team that is post-call will present 1 or 2 cases from the night before. Students are expected to present the H&P only - the residents go over the differential and plan. However, you should know your patient well, because attendings and residents may grill you on the minutiae of the patient’s history. This can be fairly stressful since there will likely be a roomful of people listening, but it helps you learn the format of presentations and stick to it. These presentations will also help prepare you for the 10 minute presentation that you do for the site coordinators, Drs. Rastogi & Barrow. This presentation will be on a topic that the site directors thinks is relevant to current patient issues. It is generally informal and laid back, with Drs. Rastogi & Barrow and your classmates asking questions as you go.

Clinical Site: Rush

Rush is a tertiary care center and thus the variety of patients enormous and fascinating. You will have the opportunity to participate in the care and management of sickle cell disease, hemophilia, Ewing’s sarcoma, osteosarcoma, cardiac malformations, congenital syndromes, Crohn’s disease, eating disorders and more. Rush provides a quality team environment typically consisting of a senior resident, two interns, possibly a fourth year subintern and two medical students. You will be given the opportunity to learn skills in admitting, presentation and day-to-day management and diagnostic procedures on your patients (typical patient load is ~4 patients). You will also have exposure to critical care in the “intermediate” section of the Peds ICU. A typical day begins with prerounds on your patient around 6 or 6:30 am (the nurses take the doorside charts where the vitals are recorded at 7 am on the dot for their signout, so get vitals on your patients before 7 am). Morning work rounds (with residents and occasionally attendings) usually last about an hour. Morning report is at 8A. This is a great opportunity for learning clinical decision making skills. Plus, the patient they are talking about may be yours, in which case, you may be able to add valuable information that the senior resident did not have time to obtain. The remainder of the morning will consist of attending rounds (which may be doorside or sit-down) and floor work (writing notes and daily orders). During attending rounds you will be expected to give the 5-minute oral presentation on the patients you are carrying. There is a daily noon lecture (lunch is provided) which may be a case presentation, journal club, ethics lecture, etc. Afternoons consist of more floor work, teaching sessions or admitting patients. Depending on your senior resident, you may or may not need to stay for the afternoon checkout around 5 pm. Be enthusiastic and knowledgeable about all your patients. Check for labs and consultants notes throughout the day so that you can keep your intern and resident fully updated.

The outpatient month consists of a very complicated schedule and includes: one week of outpatient office experience (very similar to preclinical preceptor experience); one week of mornings in the newborn nursery. Afternoons for the nursery week as well as the remaining two weeks are spent in some combination of the following: 3 half days at Acute care clinic at Rush resident’s clinic (this is a great experience); one full day in the NICU (which really only gives you a quick exposure to NICU care); 5-6 ER shifts with hours extending to 10 pm and on weekends; 5-6 half days at sub-specialist clinics either at Rush or at Shriner’s Hospital in Oak Park (you may be with the same sub-specialist each time or you may be with 2 or 3 different people). You are given the opportunity to make requests about physicians you want to work with or the order of your rotations. Some people felt it was easier to study for the mini-board during inpatient because your schedule is consistent, if you are on-call there is usually some time to get studying done and if you’re not on call you are free. Others felt it was easier to study during outpatient month because you are not on Q4 call and there are breaks in the schedule to study. Decide for yourself! Understand that if you request your preceptor or sub-specialist, you are NOT guaranteed to work with that person, but it doesn’t hurt to ask!

Clinical Site: County (aka John H Stroger Jr Hospital of Cook County)

If you are assigned to County, you will be spending two weeks in the 2nd Floor Fantus Clinic with an eclectic team of psychiatrists. There are no residents, and medical students essentially function as residents, since you will be presenting directly to the attending and assisting in formulating the treatment plan. Each day of the week is different, with the typical day starting at 8AM and ending at 5PM. Most days have some time reserved for follow-up clinic, a clinic for patients who are continuing patients of the team of physicians. Your role is to call the patient, review their chart, ask about their psychiatric history (past and present), and inquire about their present medications - side effects, dose changes, etc, perform a mental status exam and a mini-mental. Many patients will be in simply for refills, others will require new medications, dose changes, or referral to psychotherapy. At times, you will do intakes - that is, the first appointment for a patient. These appointments can last upwards of an hour, and an extensive history is required. For both F/U and intakes you will then present to the attending, and the patient will be called in with both you and the attending. You may be asked what your A&P is, even during the patient’s time with the attending. Wednesdays are for “Fast-Track”- quickie appts. for patients who have been referred to psych either from the ER or the Ambulatory Clinic. You have to be lightening fast, get the essential details, and move on. The point is to treat these patients temporarily until they get an appointment for an intake and a solid diagnosis is established. For this clinic, your brevity will be appreciated greatly.

The attendings are an interesting bunch (read CRAZY!), and sincerely appreciate the hard work that you do while in their clinic. Take advantage of the psychology externs, they have year-long positions, so they really know their way around. Also, they offer an interesting perspective on psychiatric illnesses. If you speak Spanish, you may want to contact Dr. Miles before the clerkship and request to be at County, since a significant number of patients are Spanish speaking only.

Clinical Site: Rush

In-patient psych at Rush takes place on the 12th and 13th floors of Kellogg. While on this service, you will be involved in the care of patients requiring hospitalization for their psychiatric conditions. Your first days on the ward may seem overwhelming, because you will be surrounded by a hall full of patients that are very different from patients that you have seen on medicine and other rotations. Most patients are very amenable to students talking to them, and the breadth and depth of pathology that you will see while on in-patient is vast. Rounds typically start at 9AM, and you can pre-round, although seeing your patient is sometimes saved for after attending rounds. The attending rounds are usually didactic, with the attending reviewing a case or lecturing on various topics. Residents may also give lectures, and you may be asked to give a short, 5-10 minute presentation on a topic of your choice. After rounds, you will frequently meet with your intern or resident to discuss your patients. Sometimes, with difficult patients, it may be helpful to have your resident see the patient with you the first time to show you how to approach the patient. Make sure to do a mental status exam, and mini-mental daily. You should be familiar with the psych meds that the patient is taking, and learn the major side effects of each. Typically, you will carry 1-4 patients, and some patients will remain with you the entire 4 weeks of service. Depending on whether there are lectures or conferences on a given day, you may be finished with your work and able to leave by 11 or 12:00. Students on the inpatient service also have the option of visiting Cook County Jail’s Psychiatric hospital for a morning. It is the largest psychiatric hospital in the country and is a great opportunity to see another side of medicine.

While on the consult/liaison service, you will be consulted to see patients who are hospitalized with medical conditions who have concurrent psychiatric issues. You will be assigned to work with one of the residents and will follow all of his/her patients. You may see new patients each day. Consults begin at 9:00 so you should be at the hospital no later than this. However, it may be helpful to see some of your existing patients a little earlier depending on how busy the service is and how your resident prefers that you do things. After you see your patients, you essentially wait to be paged for new consults throughout the day. You will generally have some time for reading during the day. Consults are taken from 9:00 to 4:00 p.m. You will round with an attending each day (except Tuesdays). Also, you will be asked to present two journal topics during rounds over the course of the three weeks that you are on consult. There are very brief, informal presentations.