This is a very busy service. As with most electives, how much teaching you get is very fellow-dependent. Students rotate consults equally with second year BMC medicine residents- this is good and bad because sometimes the level of discussion is frustrating for 4th years vs. PGY-2’s (i.e. too easy vs. too advanced). Small talk required at the end. Rounds can sometimes go painfully late depending on attending.

This is one of the most highly-coveted fourth year electives, since Cardiology is one of the specialties that one will encounter in almost any field of medicine. At BMC, one Cardiology team (attending, resident, 4^th year student(s), +/- medicine resident) covers the consult service on both sides, so be prepared for some walking. There is no clinic. The patient volume is variable, as is the number of students per month—as you know by now, these are the factors that affect how much work you do. Generally, the fellow is very good about teaching and reviewing EKGs with the students. There are also noon conferences every day (with food), and though some are more interesting than others, students should always try to attend. Usually, you are left to entertain yourself until the fellow pages you to tell you about a new consult. While you will see many peri-MI patients and make recommendations for their management, you will also see interesting cases (even those that perplex the attendings!) and become involved in peri-operative management of cardiac cases. If the schedule allows, you will also be able to see Caths. The team usually rounds in the afternoon. Though Cardiology rounds are notorious for their late hours, most older and busier attendings tend to be more humane and make late hours worthwhile in terms of teaching.

Cardiology is a rotation that everyone should take no matter what field of medicine he or she chooses. This is a rotation where you learn how to read EKGs and become comfortable at doing it. The patient spectrum ranges form heart failure and arrythmias to pre-operative evaluations. Conferences are very informative and directive at student and resident learning. When I was there I was able to watch catheterizations; however with the CCU and Cath lab closing, I am not sure what the outlook is for this rotation at the VA.

Alysa R. Herman ‘99

In addition to those who wish to enter the field, dermatology is a great rotation for anyone interested in primary care or emergency medicine; the rotation exposes you to many common skin conditions and gives you a better understanding of the basic derm meds (topical steroids and antibiotics). You will learn both the nomenclature and how to describe lesions in a way that will be useful if you ever need a derm consult. The schedule is as follows: clinic at the HAC runs from 9:00 AM-12:00 PM every day except for Wednesday, when the morning is spent in Grand Rounds and other conferences, and every afternoon from 1:00 PM-4:00 PM. Because this is a combined Tufts/BU residency, the Wednesday mornings alternate between BU and NEMC. In addition to clinic, students may also accompany the derm resident who is assigned to the consult service. The consult service will enable you to see many acute and often complicated dermatologic diseases. Do not skip the resident teaching-the residents are excellent teachers. Finally, you will be expected to give a presentation on a topic of your choice; the residents will assist you in obtaining slides once you have chosen a topic.

The clinic has some down sides. You will never see a patient by yourself. The derm residents see the patients, present them to the attending (and everyone else), and then the group sees the patient together. Unfortunately, because there are so many people (usually 3-4 students and 2-3 medicine residents as well as several of the derm residents not in with patients), as many as ten people can enter the exam room to look at the lesion, making the patient uncomfortable and the students feel like they are at the zoo.

I opted to take this elective on the strength of the recommendation of a resident, who had taken it when he was a medical student here. He said it was "one of the best electives that BU has." I agree. The Emergency Medicine elective is not only for those who choose this field as a career. It is applicable and appealing to those who want to pursue all of the other specialties of medicine (except for Pediatrics…there’s a separate elective for that).

This elective is the most flexible that I have encountered in terms of scheduling (depending on the total number of students), the number of patients seen, and the types of cases seen. For example, if you have an interest in OB/GYN, you can choose to see all of the cases that sound like OB/GYN ones. However, you do have a responsibility (theoretically, at least) to see all types of patients and to help the ED function smoothly and efficiently.

The fourth year student in the ED has an incredible amount of autonomy. This fact by far is the biggest advantage of the rotation (followed closely by the accommodating schedule…keep reading). You essentially function as an intern or resident while you are there. Depending on the particular resident and attending that are running the shift, you may report either to the resident, or directly to the attending. In my opinion, the latter arrangement is better. The most fun I had was while suturing. The best way to set yourself up for maximum suturing time is to find out who the "procedure person" is, and tell him what you want. Honestly, I did more suturing here than in my entire surgery clerkship. There were also a fair number of pelvic exams to be performed (almost every female with abdominal pain warrants one), so being comfortable with them is an advantage.

The rotation is organized as follows: at the beginning of the elective, the students are given a master schedule for the entire month, with each student represented by a letter of the alphabet, and each student picks a letter that is compatible with his own personal schedule in terms of the arrangement of the day shifts, evening shifts, and night shift. Each person works sixteen 8-hour shifts (this speaks for the Emergency Medicine lifestyle, doesn’t it?). Some people try to calculate and count out the particulars of the letters, but the only way that the schedules really differ is in how much time each person spends at HAC (Acute/Non-acute), and at ENC. In general, while the ENC ED can be full and busy, the pace is more relaxed than that at HAC. If you want to see cases ranging from trauma to the bread-and-butter to the exotic (which is typical of a big city hospital), the place to be is HAC. On the other hand, if you prefer the more sedate types of cases, then ENC is for you. Also, since the CCU and Cath lab are at ENC, many high-risk R/O MI or cardiac patients go there.

Some students, while on the Acute side, have been able to incorporate themselves into the Trauma team. However, when I was there I had to be content with watching. I might be able to attribute that to a few things: (1) I was there in July, and all of the new residents/interns wanted the traumas for themselves; (2) my own not-too-aggressive personality, (3) the other students’ pursuit of EM careers, or (4) previous trauma experience (as EMS/EMT personnel).

You are graded on the basis of evaluations that you give to the resident and/or attending at the end of each shift. While it makes no sense to give an evaluation to someone you don’t get along with, it works to your advantage to hand out as many evaluations as possible.

Tuesday mornings are the department lecture days, and there is usually a student lecture every afternoon. One of the do-not-miss lectures is Dr. Arnold’s suture workshop. In addition, other responsibilities of this elective includes an ambulance ride-along, a day-trip to Hanscom AFB for a MedFlight lecture, and an end-of-rotation talk. You will come to realize (if you have not done so already), that almost all electives require a "talk." This one ranks on the low end of the stress scale. It is case-based, so if you come across an interesting case during a shift, take some notes or jot down the medical record number. One tip: try to present early in the day, or everyone (including the person evaluating you) loses interest.

Anonymous

Attendings to work with:

This is one elective that is overlooked by most of the fourth year medical students. Unlike most electives, this is one that is appropriate and useful for students that are going into Medicine, Surgery, or Anesthesia. For those of you who have not had a run-in with the Med Consult service, it serves as a liaison between Medicine and other services, and as an advisor on peri-operative cardiac risk stratification/management.

For those who are surgically or anesthesiologically inclined, Med Consult helps you to understand the peri-operative management of common medical conditions such as diabetes, asthma, and hypertension. For the medicine people, Med Consult provides an opportunity to follow these same common medical entities in uncommon situations, and also when complications arise. In addition, Med Consult sometimes overlaps with Cardiology in that you are asked to risk-stratify patients prior to undergoing various procedures.

The team consists of two third-year Medicine Residents (who are SO much smarter than we are) and an attending. There is a pre-op clinic most mornings where patients are "cleared" for surgery, and team rounds in the afternoon. There is usually a pre-clinic talk, which the residents or attending present, based on an article (or two) in the syllabus handed out to you (arrange to pick it up about a week before the elective starts, and just hold on to it). The student is expected to prepare a ~30 minute talk to be given at one of the pre-clinic sessions. Initially, choosing a topic was challenging, because I thought, "What do I know that two senior residents and an attending don’t know?" The answer lies in the fact that as a student, you are much closer to the other disciplines in medicine than they are.

One drawback to this elective is the fact that the attendings are not used to having students on the team, and sometimes tend to forget about you. However, they learn quickly. Dr. Halle is the person "in charge" of the elective, and he runs the pre-op clinic on the HAC side. He was a Medicine chief resident here a few years ago, so he enjoys teaching and having students around.

I think Med Consult is an excellent opportunity to work closely with the senior medicine residents. Away from the day-to-day grind of running the medicine service, they enjoy teaching and do it well. The biggest advantages of this elective are the opportunity to see the intersection of Medicine, Surgery, and Anesthesia, which ordinarily occurs "behind the scenes," and to manage medical conditions that tend to become complicated in special circumstances.

This is primarily aimed at students interested in Ophthalmology as a career. There are two-week electives for those who simply want to gain some exposure. The traditional rotation is divided into two weeks at HAC clinic and two weeks at VA clinic, although the clerkship director is flexible if you have specific requests. This rotation can be extremely dull if you allow yourself to be content with shadowing. The residents and clinic attendings will be happy to let you see patients on your own if you show interest. There is opportunity for operating room exposure at both sites.

Highly recommended for people going into Otolaryngology (ORL), Pediatrics and Internal Medicine. This is a region of the body that medical school somehow missed. For pediatricians, I recommend trying to do 4 weeks at Children’s Hospital. They have an excellent staff, friendly fellows, and will teach you much about middle ear infections. Considering that much of your career will deal with this topic, spending 4 weeks learning about the surgical management of the disease is reasonable. Further, the atmosphere and array of diseases at Children’s is amazing.

If you are entering ORL, your electives should be arranged with the help of your advisor in the field. Your goal is to gain exposure to the field and verify your choice. In addition, you need to earn letters of recommendation. The rotations are HAC-ENC or Children’s-VA. ENC allows you more exposure to Dr. Fuleihan, the Chairman, while the VA allows you more exposure to Dr. Vaughn, an excellent instructor and respected figure in ORL. The subject matter varies with hospitals and you should adjust your reading accordingly. On your rotation, try to give a presentation--usually they are assigned at HAC-ENC. Be concise and insightful.

If you decided that you liked your ENT elective in third year or did not have the chance to do one and want to see what it is all about, you should do a fourth year elective very early on in the year. If you are considering an ENT residency, please see the section on applying for ENT residency for more advice on planning your fourth year schedule.

You have several options here at BU for an elective that you may tailor to your needs. There are two specific rotations, one at BMC and one at the VA/Children’s Hospital. However, people have spent 2 weeks at BMC, then 2 weeks at Children’s or all 4 weeks at Children’s, etc.

The rotation at BMC is very much how I described it in the section on the third year electives. The advantages to doing a rotation at BMC are many. You will get great exposure to all of the attending staff. The acting Chairman, Dr. Grillone, is very nice and approachable. For obvious political reasons, you should get to know him if you are interested in the field. Dr. Stram loves medical students and will teach you a great deal and you will get to work with a fellowship-trained otologist in Dr. MacDonald.

The VA/Children’s rotation is also a rewarding one. You will work with Dr. Vaughan, a respected and friendly figure in Otolaryngology, and with Dr. Gooey, a young and energetic surgeon. While I have never rotated at Children’s, I am sure that you will see many cases and get exposure to big names in the field, including Dr. Healy, the chairman of pediatric otolaryngology at Harvard.

At any fourth year rotation, you should ask to give a presentation on a topic suggested by the residents or attendings. This will help you express your interest and get you noticed by all. For textbooks, I suggest ENT Secrets, De Weese and Sauder’s Otolaryngology, Lucente's Essentials of Otolaryngology, and the flexiform series Ear, Nose, and Throat Diseases. For preparing for complex cases, Bailey edited the big head and neck surgical atlas. For more detailed information on any ENT topic, refer to Cumming’s four-volume work, Otolaryngology-Head and Neck Surgery.

     The Pathology rotation at the Mallory gives an excellent opportunity to dredge out all that second year path material you wish you remembered, and the chance to see how it applies to your future practice. The most valuable part of the rotation is the daily sign-out rounds that run from about 8 AM to 11 AM or 12 PM. You will be at HAC for at least a week and ENC for at least a week, depending on how many students are rotating through at the time. At HAC, the most common procedures are conizations and loop excisions for cervical dysplasia. You can also get good exposure to pap smear reading in cytopathology. At ENC, future surgeons will also benefit from seeing how specimens from the OR are dealt with. For those entering all fields, the pathologists at the Mallory are extremely knowledgeable (i.e. O’Hara, O’Brien and of course, Kaznica) and generally very willing to teach.

Overall, this is a very informative rotation. Autopsies are done at ENC basement. If you wish to pursue any interests in forensics pathology, arrangements can be made where you can rotate through the medical examiner’s office for one week of your four week long pathology elective. There is little demand on your time (another good interview season rotation), and you will feel much better about your histopathology skills once the rotation is over. Not only will you be able to identify the organ, but you may also actually be able to give the diagnosis by the end!

Pulmonary is an excellent department at BU, so you usually have excellent fellows. Consult volume varies depending on time of year. Students see and evaluate patients first and then present the information to the attending. Students read and interpret pulmonary function tests. Lots of time is spent watching bronchoscopies; nonetheless, I had a great month.

    This is an excellent rotation. Actually, this and cardiology should be included in the required rotations, as opposed to some of those already there. Regardless of the field you enter, from medicine to psychiatry to neurosurgery, you need to understand the function of the kidneys and the heart. I will now get off of my soapbox and write about the renal elective. First off, it does not matter where you are assigned for this rotation. The faculty at each institution is outstanding, and the diversity of pathologies is remarkably similar. At each hospital, you will be a part of the consult service, and you alone will see and work-up an average of one patient a day. You present your findings and plan to the fellow and/or attending, and then make the appropriate recommendations to the requesting service. "So," you may ask, "what will I learn?" Well, for starters, you will learn a tremendous amount of electrolyte physiology, and also about the complications of hypertension, diabetes, cardiovascular disease, auto-immune disease (start to see why this may be a better choice for a required rotation than say, HMS?), etc. Not to mention the renal effects of various medicines. In short, you will learn a great deal of medicine. By the end of the rotation, you will have a much better understanding of renal disease, dialysis, and all of the associated complications. If you have the time, schedule this one in!

Ira Galin ’00

This is a great rotation. You work with the fellow on the consult service and get one- on one attention from an attending assigned to the service for the month. It was a great review of renal pathology and physiology.

John Pak ’00

The consult service at HAC is not labor intensive. Typically, the student was expected to round and consult with the fellow from 9 AM to 3-5 PM. The patient load is not heavy (2 new consults per day tops) and the teaching, in general, is pretty good. Lots of urine spins, I/Os and BUN/Cr. No presentation or talk is expected from the students. This elective is highly recommended.

Remember all those connective tissue diseases that you read about, but never thought that you would see…they are all here in the Rheumatology elective. Although this rotation is a consult service, 99% of the time, however, is spent in clinic seeing patients. Keep this in mind if you expect to get a letter of recommendation from this rotation. You spend a lot of time with a lot of attendings. Unfortunately, it is difficult for one of them to get to know you well enough to write you a letter. Otherwise, you get to do a lot of procedures (tapping joints, injections, etc.). Thursday mornings there is clinic at the VA.