Third Year

You'll find the following sections below:

I) Thriving in Third Year
II) Wards
III) Planning for Electives
IV) Scheduling a Sub-Internship (Sub-I)
V) Why a Family Medicine Sub-I?

I) Thriving in Third Year

Third year is a little like a round-the-world tour. Every country you visit will have its own distinct culture, local pride, and sometimes rivalry with or disparagement of the other countries on the tour!! This can be stressful for students who may feel that in order to be seen in a positive light and get a good educational experience, they need to say they want to go into whatever specialty they happen to be rotating in at the time. All of us in medicine can do a better job recognizing the contributions of our diverse colleagues; unfortunately, students may encounter faculty, residents, or even other students who show disrespect towards other specialties. It can even make you doubt your own career interests! If you feel you are encountering negativity about family medicine, be vague about your specialty choice and focus on the skills you can learn in each rotation: procedures and suturing in surgery, delivering babies and providing prenatal care and gyn procedures in OB-Gyn, taking care of complex medical patients in medicine. You can use the generic ‘primary care’ rather than ‘family medicine’ if you think you need to, but please consider saying family medicine and being proud of it. Clearly, our country has a shortage of primary care physicians, but being a happy, effective family doctor requires a network of specialists for referral and consultation. Whether the people you encounter in your third year rotations recognize it or not, we’re all in this together.

II) Wards

Just when you have the pre-clinical years figured out you transition to clinical rotations. The good news - you get to see patients. The bad news - there is still a lot to learn. Here are some tips for successful rotations; some are very practical and some will help you be the best clinical student possible.

  1. Don't be late. Ever.
  2. Dress appropriately. This means professional attire that is clean (including your white coat, which will get very yucky, very quickly). You want your team to remember you, not your outfits.
  3. Be an asset to your team. This can take many forms. Remember all that stuff you just learned for Step 1? Some of that can actually be useful on the wards and you may be asked about it. Be complete in your patient interactions - take a comprehensive history and perform a complete exam. Present what information is needed but always make sure you know everything about the patient. Become the expert on your patients. Finally, help out with SCUT (Some Clinically Useful Task). This does not mean you should spend all day calling the nursing home to get the med list and ignore your learning. However, there is a lot of work to be done in a small amount of time. Your intern and resident will appreciate your offers of help to improve team efficiency.
  4. If you don't know the answer to a question, at least guess. Your team knows you don't know everything. It's okay that you don't - that's why you’re still in school. But always give each question your best guess. Why? Because if you are right, you learn that you are right and you look awesome. If you are wrong your team will correct your thinking/knowledge and you learn something and can look awesome the next time. Often you will be partially right and your fund of knowledge will expand through feedback from your team.
  5. Ask questions, but only if you don't understand something after looking it up yourself. If you encounter something you don't understand, take a stab at it yourself. Look it up or research the topic or question. Even if you figure out the answer to your original question, you will likely encounter something that requires some explanation from one of your team members. Then you can ask, "While I was looking up X I found Y and although I now understand X, can you help me understand Y?" This will make you ask more intelligent questions.
  6. Understand the culture of your team. Every group is different and different specialties have different ways of doing things. Some favor a hierarchical approach (e.g. the MS3 asks the MS4 and if they don't know, then both ask the intern and if the intern does not know then they all three ask the senior resident, and so forth). Some teams want all questions asked to the attending or senior resident so everyone can learn from the question. Abide by the unwritten culture of the team/specialty you are with.
  7. Don't accept abuse. Report it immediately. If people don't get the feedback that they are acting inappropriately, they won't change.
  8. Be explicit about when you would like to receive feedback. At the start of each rotation, make a plan for when you will exchange formal feedback. Request informal feedback frequently.
  9. Be genuinely interested in your patients. They are your best teachers.
  10. Be safe. Don't ever feel bad about asking questions about patient care issues or reporting your concerns. Your team would far prefer to hear about your concerns early than when your patient is going south. Also, there are times when you will be up all night long. Be safe the next day when you are caring for patients and when you are getting home for some much needed rest.

III) Planning for Electives

Although 4th year seems dominated by the all-important residency application process, it is an important part of your medical education and an ideal opportunity to take the initiative in directing your own education. Students will have different philosophies about how to choose 4th year electives; programs will want to see that you are an engaged learner. So, it’s up to you to decide to focus on electives that will further prepare you for what you need to know as an intern and resident (medical subspecialties to prepare you for inpatient duties, electives in psychiatry, pediatrics, dermatology, palliative care, for example) or you may choose to explore areas that will not usually be a direct part of family medicine residency training but will be specialties where you might refer your future patients (Hematology/oncology, specialized HIV care, for example). The 4th year is also a great time for well-designed international rotations.

The "Choose Your Own Adventure" attachment at the bottom of the screen can help you determine what electives meet your needs.

IV) Scheduling a Sub-Internship (Sub-I)

A sub-I in family medicine allows students to participate on an inpatient family medicine team with an advanced degree of independence and responsibility compared to a third year clinical rotation. Rotations take place at one of the WWAMI regional affiliated Family Medicine Residency Network programs.

It is important to be aware that registration for Sub-I's work slightly differently than other fourth year courses. Below we offer a timeline of events and some tips for getting the Sub I experience that you want.

January: You will be given the opportunity to rank courses you most want. In the case of Sub Is you will list the course AND the location (Sub I at Swedish First, etc) You will also be able to list your time preference for each course. Here are four things to consider when ranking a Family Medicine Sub I:

  1. Sub I rotation slots are typically highly competitive at the Seattle sites in the first three rotations slots (July, August, and September). In order to have a decent shot at one of these rotation slots, you will likely have to rank them as one of your top choices in E-Value. Ranking a Seattle Sub-I anything lower than a "3" for these slots will likely render you uncompetitive.
  2. In order to guarantee your Sub I rotation will be included in your MSTP/Dean's letter you will need to rotate in either the July or August Sub I slots.
  3. If you are just concerned about having a Sub I experience before a potential residency interview, we suggest ranking sites in the October, November, and December time blocks. These time blocks tend to be less competitive- particular for Seattle locations.
  4. If you absolutely want a Sub I experience, you should consider ranking rotations that are outside of Seattle proper.

February: You should expect to be contacted by our Sub-I Program Coordinator, Toby Keys, to confirm your Sub-I rotation. Because residency programs typically have a waiting list of visiting students interested in their program, we need to quickly confirm your Sub I rotation. As a result, you will have up to 3 days to consider whether or not you want to commit to the rotation you are offered. We ask that only students who are committed to the rotation should accept a Sub I slot. Please keep in mind that, once committed, you will only be able to drop the Sub I by appealing to the course coordinator.

Mid to late March: You will receive your preliminary student schedule from the Dean's office. If you still want to add a Sub I to your schedule you will first need to get permission from the residency in which you want to rotate. Keep in mind, at this point, residencies may already have a waiting list of UW and visiting students wanting to rotate at this site.

Our Department of Family Medicine is very invested in satisfactorily placing UW students into the limited number of Sub Internship experiences offered by our residency network each year. If you have any questions before, during, or after the registration process, please don't hesitate to contact Sub I coordinator, Toby Keys, at tkeys@fammed.washington.edu

V) Why a Family Medicine Sub-I?

There are many reasons to do a sub-I in family medicine and a recent survey of program directors in the UW Family Medicine Residency Network indicated a vast majority of them viewed a sub-I in family medicine as necessary to be a competitive applicant into their residency. The timing of your sub-I is important and should reflect your main reasons for completing the experience.

Help you decide on Family Medicine
Some students are still deciding on what specialty is best for them. A sub-I in various specialties can often help them determine what they want to go into. If you are in this category it is best to do a sub-I early in fourth year so you have time to decide on a specialty and complete your ERAS application.

Gain Experience
Students sometimes want to gain further experience in family medicine before starting residency. This can be especially true for gaining further inpatient experience. If this is the reason you want to complete a sub-I, you could do it anytime during the academic year, although, it may be more useful to complete it towards the end of fourth year so the knowledge you gain is still fresh in your mind when you start residency.

Get Letters of Recommendation
Competitive applicants to family medicine residencies have strong letters of recommendation from family medicine physicians. Some students complete a sub-I to get a letter from the family physicians they worked with during the sub-I. If this is your main goal for the sub-I, you will need to complete it VERY EARLY in your fourth year, as letters of recommendation are typically due very early in the fall.

Investigate a Program
If there is a specific residency program you are considering applying for, completing a sub-I is a wonderful way to find out more about the program to see if it really fits you well. In addition to learning about the program, the people in the program will learn about you and remember you in the application and interview process.