Electives & Selectives
Electives:
-Four week courses designed, ideally, to approximate the variety and range of
electives available to fourth year medical students.
-Available at the same time for everyone (typically May): the four weeks before
your final 8-week rotation block of MS2.
-Graded H, HP, P, F.
Selectives:
-Two week courses designed to give you an informational overview of a
field/topic.
-Smaller list of choices than electives.
-You get one selective following your OB/GYN rotation and one following your
PEDS rotation, so everyone has them at different times throughout the year.
-Graded P, F.
For elective and selective registration, timing is everything. No matter which rotation you are
on or when the registration window opens, be at a computer because most courses in high
demand will fill up within the first 30 seconds. I’m not kidding.
For the electives, a complete course bulletin, with contact information for course directors, is
available on the registrar’s website: http://registrar.mc.duke.edu. You can do 4- or 5-week (if
you count spring break) international electives in MS2 during the May elective period. Unless
you are in the military or you choose a location on an Indian reservation, electives at non-NC
locations in the US are generally not possible in MS2 due to risk management issues. Electives
at other NC medical schools (UNC in Chapel Hill, Wake Forest in Winston-Salem, and ECU in
Greenville) are permitted.
You may ask yourself, what does UNC have that Duke doesn’t?
- a burn unit
- a physical medicine and rehabilitation program (a residency program that Duke doesn’t have)
- additional residency programs (for people who want to improve their chances in competitive
fields, e.g., radiology, dermatology)
Previous MS2 international electives have included general internal medicine in Ecuador and Sri
Lanka, general surgery in Thailand, hematology/oncology in Poland, and radiology in Germanspeaking Switzerland.
For more information, contact Dr. Caroline Haynes
(hayne001@mc.duke.edu, 919-684-6406). See also the Hubert-Yeargan Center for Global
Health’s
medical
education
page
for
international
elective
ideas:
http://www.dukeglobalhealth.org/education/index.html.
As of April 2006, the following statements are valid:
Dr. Haynes says that any four-week ICU, ER, or anesthesia rotation taken during MS2 will fulfill
the MS4 critical care requirement. This includes neurology if done in the neuroscience intensive
care unit (4200). This does not include pediatric emergency medicine.
Dr. Sheline says that approved courses taken during MS2 will fulfill the outpatient clinic
requirement (usually done in MS3 with a clinic; however, some mentors or scholarships may
restrict participation). For a list of approved courses, see the MS4 elective course catalog
available on the registrar’s website.
There is an MS3 practice course clinic requirement of 34 half-days. You are strongly
encouraged to complete this requirement during MS3 if possible. Also, you have a wider range
of clinics to choose from if you do MS3 clinic; e.g., possibly subspecialty clinics in fields you
are considering for residency. Furthermore (and Dr. Haynes stressed this), if your scholarship or
mentor does not forbid you from doing an MS3 clinic and you voluntarily choose not to do one,
you will have to complete 36 credits during MS4, not just 32 credits like
(1) people who did MS3 clinic, or
(2) people whose scholarships or mentors prevented them from going to MS3 clinic.
Examples of acceptable reasons to defer MS3 clinic: Hughes, MPH, study away, mentor
who doesn't like your spending a half-day per week in clinic. Note that although you might fall
into one of these categories, you are not necessarily prevented from completing the clinic
requirement.
If your scholarship or mentor precludes MS3 clinic, you can complete this requirement with the
following MS4 courses. The MS4 elective catalog lists only the 4th year course numbers, so if
you want to get this requirement out of the way during MS2, you have to compare the titles of
MS4 and MS2 courses. I believe the following MS2 elective courses will fulfill the requirement.
If your scholarship or mentor does not preclude MS3 clinic, that's a whole different ballgame. I
recommend confirming any non-MS3 permutations with Dr. Sheline (sheli002@mc.duke.edu)
just to be sure.
For selectives, the best bet is to contact the Office of the Registrar. They keep a binder of course
directors for each course. Or go online and search Duke med registrar. Want to know more
about, say, the SICU selective? Call the registrar at 684-2304 and get the course director’s name
and email address (make sure you specify the two-week selective, as many have both a two-week
and a four-week version). Most are more than willing to discuss the class with you if you show
some enthusiasm.
What follows is student feedback from a small selection of electives and selectives. Keep in
mind that the list of available electives and selectives is much longer than this and that these are
student opinions that may differ from your own.
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2010 Selectives Guide
Name: ANESTH - Clinical Anesthesiology
Main contact: Stuart Grant
Where to go on first day: Contact him
Reading ahead of time: None
Hours (generally): Usually you see cases starting at 7am or so and come back around 5-6
General advice: You get to pick the surgeries you want to see (though you'll do a day of
cardiothoracic, neuro, general each). You learn A LOT (intubation, hands-on procedures),
everyone in the department is chill and willing to teach, you'll spend some days in the sim lab.
Recommend it to everyone. Also Dr. Grant is freaking HILARIOUS and anyone who's done
surgery can second that. Most of his jokes center from the fact he's from Scotland and has the
most absurd accent ever. ("My favorite movie's Shrek, not because my kids enjoy it, but because
I sound like him" or "French doctors love to give tylenol suppositories since they love it up the
bum.") By the end you will be expected to know how to run an anesthetic procedure, the drugs
and dosages, and what to do if certain things go wrong, but you pick that up easily.
Name: Child Abuse
Main contact: Scott Snider
Where to go on first day: 4020 N. Roxboro Street
Reading ahead of time: None
Hours (generally): Mon-Fri - 9am-3pm (at the latest); Tuesday - 10am-3pm (at the latest) since
there is case review at 10am in RM 2035. We're learning heavy stuff; they try not to keep us
there too long.
General advice: Very chill hours. You definitely learn about clinical signs, physical findings,
etc. of child abuse (sexual, neglect, physical). You end up watching interviews that Scott Snider,
the clinical social worker, conducts with the kids. Afterwards, you will help Dr. St. Claire with
conducting a physical exam. Beyond this, you may go to evaluate in-patient children with Dr.
Narayan. If there is a court case that week, you will probably tag along. You are mainly
observing, but you definitely learn a lot about child abuse overall (the psychology, the legal side,
the medical side). You're there through the whole process, from the time social services or
parents give a complaint for the child to be evaluated, to seeing how each case ends on the
medical side.
Name: COMMFAM - Occupational Medicine: prevention and populations
Main contact: Carol Epling
Where to go on first day: contact Dr. Epling, but they probably will have you show up at Erwin
Tower on Main st for orientation
Reading ahead of time: they don't expect you to know anything, but if you want you could look
up hazards of the workplace, esp respiratory
Hours (generally): 8-5 ish
General advice: There are several components: working at Employee Health at Duke (where we
did our respirator fit testing), Integrative Medicine, Research Triangle Park, Ergonomics testing,
and the AWNC auto manufacturing plant. It is mainly shadowing, in a lot of different locations.
The fun/exciting part was seeing patterns of workplace injuries and prevention strategies that are
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in place. Honestly, I got pretty bored by the end of the two weeks, but if you ask to get directly
involved they will probably let you.
Name: OBGYN- Introduction to reproductive endocrinology
Main contact: Millie Behera
Where to go on first day: Monday's are generally OR days at Duke North. But, just in case
there is only REI clinic (by Southpoint) that day, contact Dr. Behera ahead of time.
Reading ahead of time: You could read a bit about the most common topics: fibroids, infertility,
and assisted reproductive technologies. Dr. Behera's area of interest is fibroids, so this is an area
that you will learn a lot about.
Hours (generally): Mondays (Duke North OR Day): 7am - 6pm; Tuesday-Thursday REI Clinic
and Minimally Invasive Procedures: 8am - 5/6 pm; Friday (ASC OR Day): 7am-3/4pm.
General advice: Excellent exposure to clinical and surgical gyn. All the attendings and residents
in the REI department are great and really go out of their way to teach/make you feel part of the
team.
Name: OPTHAL - Opthalmology
Main contact: Horace Johnson, Jr.
Where to go on first day: Duke Eye Center, which is next to Duke North, and we just waited in
the lobby until Horace Johnson showed up. The first day he didn't realize we were coming (!!!)
so we just had that day off.
Reading ahead of time: None
Hours (generally): Mon-Fri: 8AM - 4PM (-ish). But the thing is so disorganized that you could
probably just not show up any day you don't want to go.
General advice: Very relaxed. You get a mixture of OR, outpatient clinic, low vision,
optometry, etc. There's a good variety of what you might see in Optho on this rotation. The
days are split in half, so you're only in one place for half the day. You also have a couple noon
lectures to help you learn more about optho. It's a good rotation, but you could just as well do
Optho on your actual surgery rotation if you wanted...
Name: PEDS - Genetics
Main contact: Marie McDonald
Where to go on first day: Contact Dr. McDonald ahead of time if you wish; or just show up at
Genetics Clinic on Monday at 8:30am (2nd floor Children's Health Center).
Reading ahead of time: If you want, read up on the more common genetic disorders: Down
syndrome, autism (questionably genetic), Fabry disease, some of the glycogen storage disorders
like Pompe's.
Hours (generally): Mon-Fri: 8AM-12:30PM - clinic. You may not have to show up right at 8am
depending on when the first patient is scheduled (you can go to eBrowser the day before to look).
Afternoons are for consults - you can hang out in the med student lounge and wait to get paged.
General advice: Not too much is expected of you - draw one pedigree tree, work up consults
(not too busy usually), do a 5-min presentation on topic of your choice each Wednesday. You
can get as involved as you'd like - go in to see patients by yourself then present, or just tag along.
Name: PEDS - pediatric neurology
Main contact: Bill Gallentine
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Where to go on first day: Ask Bill (or fellow Sujay Kasangra)
Reading ahead of time: It's a selective! OK, but helpful reading = seizures, epilepsy, cerebral
palsy
Hours (generally): 8am-noon = inpatient wards, rounding, EEG rounds; noon = noon
conference; 1-5/6pm = clinic (which is rather fun; OR if they're busy, you may get to stay on the
wards to do a consult or admit a patient and then present them the next day. It's cool.)
General advice: This selective is full of incredibly nice faculty and residents. Hours are very
consistent. They do not ask incredibly much of you, but the residents do a great deal of teaching.
The attendings also love to teach. You will preround with them (no need to get there early), write
up a note, and present to the attending daily. In clinics, you get to work up your own patients and
present to the attending. UNLESS there are too many people in clinic, which is usually less than
half the time. In general, I found this selective interesting, manageable, and enjoyable.
Name: RADONC - Brief exp in clinical rad/onc
Main contact: Nicole Larrier (faculty)
Where to go on first day: Subbasement of White Zone. Ask the nurses how to get to the Faculty
room.
Reading ahead of time: Look over how to read CTs and how to recognize some basic anatomy
on them. Also, get some basica info about some types of cancers commonly treated with XRT
(prostate, breast, colorectal, anal, cervical, esophageal, pancreatic, etc..)
Hours (generally): 8am to 6pm when at Duke, and til 3pm on the few days you work at the VA
General advice: This selective is great in that the residents/faculty take a genuine interest in you
since they are not used to having medical students. The residents are really fun to hang out with
too. BUT, if you are not interested in this field at all, I wouldn't recommend it on account of the
"long hours," and sometimes slow days when you are reading CTs. If you are considering it
though, it is AMAZING.
Name: RADIOL - Radiographic anatomy
Main contact: Caroline Carrico (faculty)
Where to go on first day: Radiology Dept, Duke North, 1st floor- Room 1512B2 (Bone
Conference Room) at 9am; there is a brief orientation and a tour of the department
Reading ahead of time: There are modules/quizzes that are posted on BlueDocs every morning
that you have to do before you report to the reading rooms. They don't take long. It may also help
to review some anatomy if you are inclined...
Hours (generally): 1pm- 5pm M-F (yes, only four hours! No joke!) Each day you are in a
different reading room (Vascular, GI/US, Nucs, Chest CT, Chest, Bone, Body CT, Neuro CT,
Neuro MR, Mammo)
General advice: People tend to love or hate this rotation. Personally, I loved it, but some people
found it really boring. The thing to keep in mind is that watching someone read out is extremely
different from actually doing it. I would suggest finding a resident to read out with, not the
attendings, because they spend more time on each case and there are more opportunities to ask
questions. Also, find out from the person who was in the reading room before you who is a good
person to work with. There are some residents that are awesome and explain their thought
process or let you control the images, and there are others who don't teach much. If you get stuck
with someone who doesn't teach, those four hours can seem like a lot longer. Also, there are
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classes for the fourth year students doing the elective around 1pm everyday that are pretty
helpful, so if you don't feel like you are learning anything in the reading room, go to those.
Name: SURG - Neurosurgical intervention in the modern era
Main contact: Mike Haglund (faculty) and Hamid Aliabadi (chief resident) Friedman (Elective)
and Chief
Where to go on first day: Check with resident but 4200 (neuro ICU) at 5:45 will usually do it
Reading ahead of time: "Look over brain anatomy, pathways, etc. The more you know the
better. Read the packets that Friedman provides. The imaging, NICU monitoring, NICU
management, and intruments for the OR are all very good readings that are high yield and
interesting.
Hours (generally): "5:45 AM to late afternoon (anywhere from 3 to 9PM depending)
General advice: They're not going to be too upset whether you stay or go-- the idea is that you
were interested enough to sign up for a surg selective. Have fun with it-- if you show interest,
they'll let you do fun stuff. All the fun of a surgery sub-rotation with none of the responsibility.
Name: SURG - From cosmesis to reconstruction, from infants to the elderly
Main contact: Dr. Hollenbeck (Chief Resident) [this will change....you'll need to contact
whoever is chief resident on service when you're on]
Where to go on first day: Check with Resident, but 6300 is likely spot
Reading ahead of time: Learn the different types of flaps; Also, learn differences btw full
thickness and split thickness skin grafts; learn reconstructive ladder. review anatomy relevant to
cases (esp muscles, innervation, vascular)
Hours (generally): 5 AM to 5 PM (can leave earlier or stay later depending on your interest
level). Note from Rob: Fridays can be really long days, which is great because you will get to do
quite a bit. My last Friday on the rotation we were in the OR until 4 am....not the norm, but don't
be surprised if you're there late...
General advice: Know how to handle yourself in the OR, know about the anatomy for the flaps
or region they are operating on and try to see as much as possible.; It's also good if you try to
look up the procedure or some related study on the Plastic and Reconstructive Surgery Journal.
Ask questions you legitimately want answers to.... don't ask questions with self-evident
answers.....or with answers you could've gotten yourself if you waited 15 more minutes. Also,
become familiar with the contents of the PSU bag....it's this bag they carry during morning
rounds that has dressings, tape, etc.... learn early on what kurlex (sp?) and xeroform are, for
instance, so you can be helpful during morning rounds. Always carry tape, scissors, 4x4's and
maybe even some xeroform in your white coat pockets.
Name: SURG - Modern cardiac surg: from CABG to gene therapy
Main contact: Dr. Shu Lin
Where to go on first day: Check with Dr. Lin - will likely meet his resident at 5:45 am in the
ACU (3200) for rounds
Reading ahead of time: Anatomy (heart, main arterial branches, coronaries, understanding the
congenital malformations if you spend time with congenital heart), cardiac disease and its
manifestations, anything else you think might help; read about the patients' operations you're
seeing and try to look at any imaging available. Ryan - Know how bypass works, the variations
canulation, cardioplegia. CABG is another great thing to read. You should know why they
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choose LIMA, when to go for a peripheral harvest, outcomes of the various graphs, why they do
or don't use Saphenous veins
Hours (generally): 5:45 am to 6 or 7 pm; sometimes later…Can be much later if you do lung or
heart transplant, especially if you do the harvest portion as well."
General advice: This selective is about what you want to see. Dr. Lin will let you have
autonomy in picking a good selection of cases and you'll get out of it what you put in. You can
do both adult cardiac and congenital cardiac if you like, or you can just stay on the adult side.
You can also do clinic, which I would definitely recommend, and there are separate
cardiothoracic conferences and teaching rounds that are held for the residents (and you) to
attend. All of the cardiothoracic residents were great about teaching in the OR and I had the
opportunity to sew and take an active role. I absolutely loved the rotation...but there's bias given
that I want to do congenital heart surgery. I also spent a bit of time in the cardiothoracic/thoracic
ACU (3200) and rounded with them occasionally. If you're interested in heart transplant - ask
about the cardiothoracic resident who is doing transplants so you can contact them and be put on
the chain to be notified if there's a donor heart. You may have the opportunity to procure a heart.
I did and it was a great experience. Also, if you're interested in pulmonary transplant, Dr. Lin
does those. You will not have to carry patients, so enjoy it and take in as much as you can.
I think the transplants are the best part, so I would highly recommend you take the opportunity to
assisst in the procurements or transplants or both if you know you can. The CABGs are very
cool IMO, but after a few you may want to wait and scrub once they have harvested the
peripheral vessels because you really just get in the way of the PA while they are trying to
harvest.
Name: SURG - Early experiences in emergency medicine
Main contact: David Gordon, ED attending and head of selective and ED elective (can also
contact David Massung, an awesome office guy who will help you figure out things you need
to). Both are easy to look up with notes
Where to go on first day: 8AM that first Monday for class that will run till 11-12 regardless of
whether or not you have a shift that day. The conference room is hard to find but they will email
you directions (if you know the ED it’s the staircase between triage and the recess bay).
Reading ahead of time: They give you the book "Intro to Emergency Medicine" on the first day
and don’t expect you to know anything before then. If you really feel you should then here are
some good topics: Chest Pain, SOB, Cough, Toxins, Alcohol/Drugs (how people present and
maybe a little about drug seekers) and How to work up a Fever.
Hours (generally): You have 7 8-hour shifts that you take in the whole selective. They will
assign you shifts that are split between morning, evening, and night shifts but they are pretty
flexible when they have open shifts. You cannot do two shifts in a row but you can do two 8
hours shifts in a 24 hour period if you so choose (not that bad). You have class both Monday
mornings but the second Monday is shorter. On Wednesdays at 8AM there is an academic
conference that you are required to go to unless you had a night shift on Tuesday (after which
you still need to go to the first hour of the conference). Its hit or miss whether they will have
breakfast and coffee but you will almost certainly get lunch. Expect to be there till 1PM.
General advice: If you want to change your schedule, do it as soon as you know because the
schedule can change without them sending a new version out (i.e. if you see a shift you would
like to take email immediately so you have a good chance of getting it). Be ready to give a short
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HPI w/pertinent positives and negatives along with physical exam as soon as you get out of the
patient's room. More often than not, you will be reporting to the senior ED resident (not the
other residents rotating through from gen med, surgery, etc) or the attending. Be sure to be
proactive about doing procedures by telling the nurses you want to do it, it is rare that they come
and hunt you down to do it but they are usually happy to let you try if you seem confident. If
you are positive about how you go about everything, then you will have a great time, you will do
and learn a lot, and still have a lot of free time to do what you want or need to do.
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2007 Electives Guide
Dermatology
The Good:
Learning a little about derm is very helpful no matter what career you pursue. Residents
and attendings are all very friendly and helpful. I found the whole rotation very pleasant
and interesting. You spend 2 weeks working with faculty in clinic, 1 week at the VA, and
1 week of Duke consults.
The Bad:
When you’re in clinic, a lot of the attendings and residents don’t have you do much. It’s
nice that you usually don’t have to worry about writing notes and dictating but it was a
little frustrating sometimes to just shadow people when we’re capable of so much more.
On the other hand, there are some residents/attendings who let you see your own
patients and do biopsies, etc.
The Ugly (call, tests, presentations, etc.):
There’s no call and no weekends!! Hours are usually about 8:30-5 M-F. The earliest
you’ll ever have to be there is 7:30. You’re expected to do a 10-minute presentation on
the derm topic of your choice during the last week. There are no tests.
Neurology
The Good:
For the neurology elective, you could choose to be in the Neuro ICU, on the inpatient
service, or in clinics at the VA depending on your interests. There were lectures given
by attendings almost every day, which provided a more focused curriculum than some
of the other electives. The housestaff were also very willing to teach and excited to
have students around. The student was allowed to take responsibility for their own
patients, but at the same time the overall atmosphere and expectations of the students
were more relaxed than on other rotations. There were many opportunities to perform
procedures, such as lumbar punctures, etc.
The Bad:
On the inpatient service, there were 2-3 students on each team. Given the average
number of patients on the service, student generally only followed 1-2 patients at a time,
which was fewer than I would have liked.
The Ugly (call, tests, presentations, etc.):
In the Neuro ICU, q4 overnight call. On the wards, q4 call until 10 or 11 PM. For clinics
at the VA, there was no call. All students took a 1 hour essay test at the end of the
rotation and were expected to have a member of the housestaff observe a history and
physical and fill out a form on the student’s performance.
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What I would like to have known ahead of time:
It would have been nice to know the three different location options, since each was a
very different experience.
Peds ID
The Good:
You get the chance to work with some of Duke’s best attendings – Ken Alexander, Dr.
Drucker, Samuel Katz (who by the way is the co-developer of the measles vaccine) just
to name a few. The fellows who will run the service during the 2005-2006 year are
awesome, you get to work with Sr peds residents who are normally low key b/c they are
so close to being done they just don’t care about anything but getting drinks at the
Joyce, and you get to eat M&M’s all day long. There’s a lot of teaching going on and
you get to learn all the bugs and drugs you didn’t learn in microbio during first year.
The Bad:
You have to sort through charts that weigh more than the babies you’re treating
because most of your patients are the sickest of the sick and you need to find out what
is going on, what’s been done so far, and what to do next. It can be hard to get it all
sorted out but it’s definitely something that gets easier as you go along. You also deal
with a lot of ICN babies so if teeny tiny tots aren’t your thing, this is not such a good
idea.
The Ugly: (call, tests, presentations, etc.):
- You’re on peds…there really is no ugly.
- The typical day is 8-4….sometimes you get out by 3, other days it’s around 5. No
call or weekends.
- You “should” go to morning conference from 8-9, need to round on your patients
and new consults till noon, “should” attend peds noon conference (read: go if
there is free lunch or an interesting lecture), attend microbio plate rounds from 12, then round with your attending (this may happen earlier in the day depending
on who’s on service). One morning a week will be spent in clinic which is very
straightforward.
- No tests; maybe 1 presentation depending on who the attending is.
Pediatric Cardiology
The Good:
There are a variety of things you can do, including service team, clinic, cath lab, EP lab,
echo lab, and seeing some surgeries. The course is unstructured, so you can do
whatever fits your interests, dividing your time among those offerings. The fellows and
most of the attendings are very nice and teach a bunch. You will likely hear a good
number of murmurs, learn the pathophysiology behind some common lesions, and get
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some practice reading pediatric EKG's. Page/email the course director at least a week
before to find out where/when to meet. If you can't reach the course director, just meet
the team for rounds at 7:30 in the PICU. Things you can do over the four weeks include
the following:
Service team: On the service team, you will go with the fellow and the attending to
round on the PICU patients in the morning, patients on the floor, then see consults or
manage any acute issues (usually with the PICU patients). The fellows teach A LOT
and if not much is happening they will usually take an hour or two during the afternoon
to sit down and teach you about a specific topic – you will likely learn the most on the
service team. Ask plenty of questions, and you will learn a ton.
Clinic: You get to do the most in clinic, and you get very good at taking pediatric
histories and physical exam skills (murmurs, clicks, and thrills, oh my!). Most attendings
are good about teaching even if clinic is busy. Go in the room with the attending the
second time around and they will help you hear some of the more subtle auscultatory
findings (Dr. Herlong is especially good about this).
Cath lab: You don't get to do a whole lot other than watch, but it's a good idea to see a
few caths since they really illustrate a patient's pathology. It is also amazing to see how
the pathophysiology you learn actually works in real time as pressures and gradient
change over the course of the procedure. Some of the devices used to close ASD's
and PDA's are pretty cool too. Most caths are done Thurs and Fri. *NOTE* The first
time you go to the cath lab, they'll ask you to lead up. There's a lot of lead hanging
around, so a) try NOT to pick the attendings lead, b) do pick the lighter one-piece skirt
and shirts - it'll really help with the fatigue of standing.
EP lab: We never went to this since we heard it's difficult to understand, and the
procedures go very fast if you don't know what's happening, but we've also heard the
attendings will explain some of the things to you if you're interested. Most EP
procedures happen on Wednesday.
Echo lab: Spend at most half a day here, just to get the basics on what to see on a TTE.
Some attendings are good at pointing out what to look for (Dr. Herlong, Dr. Camitta)
while others won't tell you unless you ask.
OR: The pediatric cardiac surgeons, Dr. Jaggers and Dr. Lodge are pretty nice and will
be glad to have you in the OR. Just let them know the day before – Dr. Jaggers has a
headset camera so you can see what he sees without having to scrub in. As with all
surgeries, you'll get a whole lot more out of it if you read a bit about the procedure
beforehand.
The Bad:
The student role is not well-defined in terms of what your responsibilities are, so you
sometimes feel like you're shadowing and not providing any benefit to the team,
especially while on service team and in the cath lab. It's not necessary to follow
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patients and write notes (that's what Davison interns are for), but try to be helpful in
terms of tracking down labs and radiology reports, etc.
The Ugly:
When Dr. Rhodes, our course director, drew up our schedule, it was a M-F schedule.
He did not mention weekends or call, so we didn't ask. Also, since patients were
covered by Davison teams or the PICU team, we did not preround or closely follow
patients. The only requirement other than showing up, being interested, and helping out
was a 20-minute presentation on any specific congenital cardiac illness (ASD, tetralogy
of Fallot, etc.) Dr. Rhodes never found a good time for us to present, so we ended up
just emailing him our presentations. Overall, it was a very relaxed elective, and the
fellows and attendings were friendly and more than willing to teach.
Neuroradiology
The Good:
The learning opportunities are everywhere, everyone is friendly, and there are no
expectations. Everything rests on your own motivation.
The Bad:
Med students are less than useless—we only get in the way of the residents, and slow
them down in reading scans whenever they stop to talk to us and explain things to us.
That said, they seemed to really enjoy having us around, and were very willing to teach,
given that we showed interest in the subject. Also, spending the entire 4 weeks
observing this one branch of radiology was probably a poor use of time, and I ended up
spending half of my days in other areas (peds, chest, msk).
The Ugly (call, tests, presentations, etc.):
We gave one case presentation apiece, never took call, and we administered a simple
take-home exam during the last week of the rotation. We split our time in observing
different modalities as we saw fit, and attended as many conferences as our attention
spans would allow.
What I would like to have known ahead of time:
This rotation probably shouldn’t be 4 weeks long. In reality, all of the radiology electives
would probably be better as 2-week selectives. Grading is difficult to do, since there is
really nothing on which to assess us as med students. Thus, this rotation is probably
best left to those who really have an interest in neuroradiology.
Private Diagnostic Clinic
The Good:
This elective was one of those set-it-up-yourself things. It had to be with a mentor in the
medicine program, and it had to be mostly outpatient clinic. Other than that, you were
12
free to contact whatever mentor you wanted. I specifically worked with Dr. Diehl in the
Heme-Onc division. Things I liked:
1) Chance to evaluate a field that the medicine course directors didn’t create as
specific defined elective course.
2) All (or mostly) outpatient. So a good schedule, and a different perspective than
inpatient care. Yay! Life exists outside Duke North! Who knew?
3) Direct mentorship from your attending mentor for a whole month. (So you
actually get to know your attending before you ask him/her to write you a
recommendation).
The Bad:
1) It’s kind of pain to set it up, especially if you didn’t know the attending first. Like
me. But I just asked some residents that I knew had interest in heme-onc, and it
worked out.
2) Because there is no set schedule, you have to be good about setting your own
goals and telling them to your mentor. But I suspect we (MS2007) all did this
year, what with the elective being a new addition to the curriculum.
The Ugly (call, tests, presentations, etc.):
- Show up in clinic, conferences, and any rounding time your mentor might have
(which was only for a week with mine).
- Dictate on the pts you see in clinic.
- No tests or presentations.
Thoracic Radiology
The Good:
You will really, REALLY get immersion in reading chest X-rays. Mornings are typically
spent going over the previous evenings/days CXR’s, then you have the chance to
present your read to an attending. You do film after film after film and it’s surprising how
quickly you can learn normal from abnormal. There are also learning files, conferences
and the thoracic CT reading room for some diversion. The residents are all very helpful
and very, very willing to teach if you show interest in learning. At the same time,
everyone from the residents to the fellows to the attendings will make it clear that you
should be doing other things with your afternoons than what you do with the mornings
(read: they don’t expect to see you around in the afternoons). Finally, radiologists know
a ton about general internal medicine, so you’re always learning useful stuff. There is a
lot to be said about knowing how to break down a CXR.
The Bad:
Four weeks is long time to look at chest films. You need to come up with something to
do in the afternoons to diversify. The CT reading room is typically rather busy, so while
they are happy to teach as they go, residents often have a bunch of CTs they have to
read out in a short amount of time, and can’t go into CT reading as deeply as they can
with CXRs. You often find yourself watching for long periods while they move too
13
quickly for you to follow. Spending time in other branches of radiology (neuro,
musculoskeletal, peds, etc.) is a good way to diversify. Also, you need to be very
personally assertive about learning and being taught, since radiologists are used to
students who don’t really want to be there. They will happily respond to your questions
and enthusiasm, but generally you have to start things off. Balancing this against trying
not to be a pain while they are getting their work done can be tricky.
The Ugly (call, tests, presentations, etc.):
No call. No tests. Daily, you present a bunch of CXRs to attendings, but this is a
learning experience, not really an evaluation. No weekends. You may be asked to make
a PowerPoint presentation on a relevant chest radiology topic, and given the afternoons
to work on it. Very laid back! Dr. McAdams has an aversion to bacon smells, so don't
eat it around him. Dr. Heyneman likes to free-associate with names, e.g., with a patient
whose first name is Teri, she will say "Teri 'Hatcher' [last name]". Dr. Patz has a cool
picture on http://dukehealth.org. Dr. Hurwitz is very friendly, teaches a lot, and will invite
you to “pull up a chair” when she reads out with residents. Dr. Goodman also teaches a
lot but has high expectations. Suggested readings: Felson’s Principles of Chest
Roentgenology; relevant chapters in Squire’s Fundamentals of Radiology or either of
Fraser and Pare’s chest radiology textbooks.
Urology
The Good:
Four weeks provided a great opportunity to really get to know the faculty and house
staff on the service. It gets to the point where students on the rotation actually become
a part of the team as opposed to 2 weeks during gen surgery clerkship where you visit
and just get a glimpse. The urology house staff is extremely cool. They are very
normal, especially in comparison to general surgery. The biggest perks of the elective
are that you are not expected to come in on weekends or take call. In essence, you get
the perks of surgery without the ridiculous call nights.
The Bad:
There were rarely problems. The only things I can think of is that some days you get
into cases where you will not get to do much and just stand there. This is particularly
true on radical retropubic prostatectomies (i.e. RRP) where the surgical field is difficult
to see when you are not the surgeon or first assistant. Given that this is one of the most
common procedures performed, it can be a drawback. Some attendings (i.e. Polascik
and Walther) are in the entire procedure and you are guaranteed to do nothing. On the
other hand, when Moul or Robertson are doing RRP with a senior or chief residents,
you may get to first assist on the entire opening, initial dissection, and closing. My
resident told me while holding the external iliac vein with a retractor that if I put a hole in
the vessel that I would die soon after the patient. Plus, be ready to do lots of rectals.
You’ll be much better at sizing a prostate to within 5-10cc by the end of the elective.
The Ugly (call, tests, presentations, etc.):
14
We were expected to pre round on all patients we saw in surgery for morning rounds
and present data. Morning rounds are at 6:30 AM on 6300. Afterwards, the team
usually goes down to breakfast and surgery starts at 7:30. Students usually do one
clinic day per week, sometimes two if the case load is low. You will usually be out after
PM rounds which usually happen between 4 and 5:30. There will be plenty of days
where you will be in surgery until 6 or 7 PM, but then again they don’t expect you to take
call and the weekends are yours to enjoy. Otherwise, occasionally you are asked to look
something up for the team and just mention what you found during or right after rounds.
No tests, papers, presentations or other stuff to deal with, just surgery and your
personal interest. During surgery, you may or may not get pimped on simple anatomy.
Unfortunately, many times you stumble on it because surgical approaches don’t exactly
look like Netter’s.
What I would like to have known ahead of time:
Ask lots of questions… some residents find it annoying and others feel like it shows
interest and it will in fact prompt them to teach. Also, MD Consult has an electronic
version of Cambell’s Urology which is considered the definitive text when it comes to
GU. Be sure to check out the procedures you’re going to see before hand and know the
approach…You will be able to follow what is going on much better. The text also
contains all of the useful anatomy that is considered important when it comes to
urology. For example, the likelihood of remembering that Denonvillier’s fascia lies
between the prostate and rectum from first year anatomy is slim to none but in fact you
will hear about this anatomical feature almost every day on service. Other anatomical
and random things to consider reviewing are:
1. The composition and layers of the abdominal wall
2. The pelvic contents (levators, blood supply to the genitals, prostate, bladder)
3. Gerota’s Fascia and renal anatomy (another one of those things you’ll hear in
every renal case)
4. Retroperitoneal anatomy
5. Pelvic lymph node dissection anatomy for RRP (external iliac vessels, obturator
nerve and vessels, vas deferens, gonadal vessels)
6. Prostate ca staging (clinical, Gleason scale)
7. Renal Cell Carcinoma (just know that its really bad and that you don’t want it)
8. Possibly review testicular ca (seminoma vs non-seminomatous germ cell tumors,
non germ cell tumors)`
9. If you’re doing case with Dr. Preminger, if he asks you the pKa of something, you
answer 5.5. I don’t even remember what it is the pKa of, but the answer is 5.5.
10. Consider reviewing the different types of renal calculi.
Adult ID
The Good:
The four-week Infectious Diseases rotation in the Department of Medicine is an
excellent elective because of its broad applicability to other disciplines. This consult
service involves you in the diagnosis and management of both common and unusual
15
pathogens. Students gain skill at antibiotic management and the management and
prevention of nosocomial infections. Through daily rounds in the microbiology
laboratory, you will learn about the basic biology of these infectious agents and lab
techniques used to identify them. The workup of a fever of unknown origin and care of
HIV patients are particular highlights. A great choice if you are interested in international
health.
The rotation allows for 7 students: 5 at Duke, 2 at the VA. A team is composed of
1-2 students, a senior resident, an ID fellow, and an attending. As a consult service, you
may be called at any time of the day (usually morning, 1 PM at the latest) with a consult,
which takes first priority. If you’re not working on a consult, your schedule will go roughly
as follows.
Starting 8-9 AM: Round on old patients. This may be alone or with either the resident or
fellow, depending on your team’s preference. You will write the progress notes for the
patients you are following.
Microbiology Plate Rounds: These occur at 11 AM at the VA and 1 PM at Duke in the
microbiology laboratory. You will review culture and test results on your team’s patients.
The clinical microbiologists will also bring positive test results to your attention from
patients you are not following (particularly if any unusual species or highly resistant
organisms are growing). You will have the unique opportunity to see the test results
firsthand and learn about the culture and growth properties of these organisms. The
clinical microbiologists will often use this time to give impromptu teaching sessions.
Attending Rounds: These start at 2-3 PM, depending on the attending’s preference. You
will present any new consults and see them with the attending.
After Attending Rounds: Finish any paperwork or orders that need to be done. Usually
you go home anywhere between 4-6 PM.
Mondays 4-5 PM—ID Grand Rounds: Lecture on a major research topic presented by
one of the Duke faculty or fellows.
Tuesdays 12-1 PM—Journal Club: A fellow leads the discussion or critique of a
research paper. Copies of the article are available the morning of the session, try to
read it if you can. Free food often provided, ask before you go.
Thursdays 4-5 PM—Case Conference: Fellows present 1-2 cases in the style of
morning report to illustrate diagnostic challenges or management dilemmas.
You may also have a half-day of clinic per week, where you see referrals (which
will require a full H&P) or follow-ups (mostly HIV patients). After you see these patients,
you will present directly to an attending or fellow. At the VA, you will be responsible for
writing the clinic notes on the patients you saw.
Fellows will often also give you the option (if you are not busy) of attending daily
Medicine Noon Conference (with free food, remember), Medicine Grand Rounds and
Chair’s Conference on Friday.
16
The Bad:
You can get called for a consult at any time so it can be a little time crunched if your
consult comes in later in the day. It can also be challenging trying to formulate a
streamlined A& P for your patients, especially when you just start off, but you’ll get the
hang of consult sheets very quickly.
The Ugly (call, tests, presentations):
- no call, and you have weekends off
- no formal exams; you just present your patients during rounds
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2007 Selectives Guide
Anesth220C: Anesthesiology
Course director: Stuart Grant, grant021@mc.duke.edu, 681-6150, 3438 Duke North
The Good:
You will get to hear Stuart Grant talk to you with his awesome accent and crack jokes all
week long, as well as enjoy the anesthesia philosophy of “never turn down a coffee
break” so it really doesn’t get too much better than that. You get a lot of physiology
learning and become more familiar with the drugs. You will also get to play with Stan –
the human simulator – and actually get a chance to “run the show” with him. Besides
that, what you do is up to you so you can go to the OR or just not show up – either way,
you’ll get out of it what you put into it.
The Bad:
The morning starts early, around 6:30am and you’re done around 3-5pm.
The Ugly (call, tests, presentations):
- No call, weekends off.
- There are 5 problem-based learning sessions and you are expected to look
something up for each of the PBL cases. The bad part is that you have to do
them, but they are pretty laid back so it’s not very time-consuming.
Anesth221C: Pain Management
Course director: Billy Huh, huh00002@mc.duke.edu, 684-6736, 932 Morreene Rd
Awaiting student input.
CommFam220C: Occupational Medicine
Course director: Sam Moon, moon0001@mc.duke.edu, 286-3232, 2200 W Main St
Suite 600
Awaiting student input.
CommFam221C: Nutrition
Course directors: Gwen Murphy, gwen.murphy@duke.edu, 681-3083, 372 Hanes
House (Duke South brown zone)
Franca Alphin, alphi001@mc.duke.edu, 613-7486, 108 Wilson
The Good:
Learned about numerous topics relevant to patient care/health (as well as my own
health) that were not covered in classes or on wards. Got to see the patients from a
nutritionist’s perspective. The setup of the class was great: class in the mornings,
afternoons at various sites around town with 1 or 2 free afternoons per week to do
“independent study.” Very knowledgeable, energetic group.
18
The Bad:
Most of the site visits required you to shadow and were less hands-on (but there was
not much to do anyway). I found that some of these afternoons got really long.
The Ugly (call, tests, presentations, etc.):
Attend class and site visits and give a very short presentation and paper at the end.
CommFam 222C: Integrative Medicine
Course directors: Tracy Gaudet, gaude001@mc.duke.edu, 660-6827, 271 Aesthetics
Bldg (on Center for Living campus)
Sam Moon, moon0001@mc.duke.edu, 286-3232, 2200 W Main St Suite 600
Awaiting student input. Hearsay is that this selective was pretty chill, with massages,
acupuncture, and the like.
Medicine221C: Palliative Care
Course directors: Katja Elbert-Avila, katja.elbertavila@duke.edu, 660-7582
Angela Kolls, angela.kolls@duke.edu, 668-7215, Hock Plaza (2424 Erwin Rd) Suite
1105 Room 11030
The Good:
This selective exposes you to patients with life-limiting illness, usually those
nearing death. Palliative care pursues a multidisciplinary approach to care as the end of
life approaches, integrating medicine, psychosocial, and spiritual support to relieve the
suffering of the patient and the patient’s family.
You will spend time on the Duke Palliative Care consult service and have the
opportunity to work up and formulate a multidisciplinary management plan for care of
severely ill or dying patients. With the Pain consult service, you will learn about the
appropriate use of narcotics at the end of life (an oft-misunderstood topic). You will learn
about communication with patients and families at the end of life and the management
of symptoms commonly experienced as death approaches. At Duke, you will rotate
through Bereavement Services, round with Pastoral Services to visit patients, and visit
Decedent Care which takes care of patients who die in the hospital.
The highlight of the rotation is the home visits with the Duke Hospice service.
You will have the privilege of visiting the homes of severely ill patients (some in their
final days) and their grieving families with the hospice case managers. You will also visit
the Meadowlands (the inpatient hospice facility), and possibly some local nursing
homes. Funeral home visits have recently been incorporated.
Ultimately, palliative care is something every student should learn about; you will
undoubtedly encounter patients for whom cure is not possible who will be in the process
of dying. Learning how to face the circumstance of caring for a dying patient and the
patient’s family rather than shrinking away from it will be invaluable, no matter what
medical discipline you enter into.
19
The Bad:
If the touchy-feely conversations are not your cup of tea, boredom potential is
high; but if you like a little down time and want to see something new, you can’t go
wrong.
The Ugly (call, tests, presentation):
- No exams or presentations.
- Slightly disorganized selective but definitely a relaxed schedule: no call,
weekends off, and a full 8-5 day is rare.
Medicine223C: Gastroenterology
Course director: Andrew Muir, andrew.muir@duke.edu, 684-2052, 0376 Duke South
Awaiting student input.
ObGyn220C: Prenatal Diagnosis
Course director: Brita Boyd, brita.boyd@duke.edu, 681-5220, 4010 Duke South purple
zone
Mostly genetic counseling and ultrasound. Great hours, presentation required (no big
deal). It's interesting if you like high-risk OB, chromosomal abnormalities, birth defects.
Time spent in the fetal diagnostic clinic in 1J Duke South.
ObGyn221C: Reproductive Endocrinology
Course director: Grace Couchman, couch004@mc.duke.edu, 684-5327, 207 Baker
House (Duke South brown zone)
The Good:
Extremely interesting and eye opening to the difficulties of REI. Relaxing rotation, no
call and no weekends, hours are typically 8-5 pm, OR on Monday and Friday mornings.
Fridays you are done by around noon. Clinic appointments are 30 min. Typically have
about 6 patients in the morning and 6 in the afternoon. Great rotation for anyone
interested in Ob/Gyn or endocrinology.
The Bad:
If there are two residents on service, there will not be much to do and a lot of down time.
Bring a recreational book or REI textbook to look interested.
The Ugly (call, tests, presentations, etc.):
Had to do a presentation during the REI conference (Thursday afternoons at 4pm).
Pretty chill 10 min. PowerPoint presentation. Otherwise just read and work on the
presentations of new patients.
20
Ophth220C: Ophthalmology
Course director: Sharon Fekrat, fekra001@mc.duke.edu, 681 0341, Albert Eye
Research Institute 3rd floor
Administrative assistant: Kina Steele, steel028@mc.duke.edu, 684 3316, Albert Eye
Research Institute 3rd floor
The Good:
They will love you for being there. Never have people been so happy to have students
as the ophthalmologists who run this selective. The residents are friendly and love to
teach. The OR is actually a fantastic place—you get to sit down, people talk to you,
teach you, and you get to share a teaching surgical microscope with the attending.
There are daily lectures at 7am. The morning will be either clinic or OR in one of
several different fields of ophtho (comprehensive, cornea, glaucoma, neuroophthalmology, oculoplastics, pediatrics, vitreoretinal) and the afternoon will also be
either clinic or OR in a different field. This way you rotate through a couple rounds of
clinic and OR in each field. In contrast to other selectives, they not only know you are
coming, they prepare binders for you (with names on them!) and provide textbooks.
Seriously, they are thrilled to have you and want to teach you lots. This is a model
selective, well organized and smoothly run.
The Bad:
Clinic can be busy. In many rooms, the slit-lamps do not have attached teaching scopes
and you have to stand idly by and observe the attending. Most are very good about
explaining as they go, some are not. Sometimes the clinic days devolve into shadowing,
which can make for a long day. Also, the eye is its own universe, so much of what
you’ve learned in other rotations won’t help you. This means to be knowledgeable you
have to do ophtho specific reading outside of class, bc you haven’t picked up the basics
anywhere else. This isn’t too bad, though, as the lectures they give help, and you don’t
have to do too much reading to get important basics down.
The Ugly (call, tests, presentations, etc.):
You will probably be assigned one weekend call night during the weekend in the middle
of the selective. How much and what you do is entirely negotiable with your resident,
who probably will take call over the phone from home. The residents don’t expect you to
take call, so it’s no problem if you don’t want to. If you want to do more than just watch,
ask Kina if you can spend some time at the VA. If you’re interested in oculoplastics, you
can also ask to go to the Aesthetics Center for part of your selective.
Pathology220C: Pathology
Course director: Patrick Buckley, patrick.buckley@duke.edu, 681-6578, M345 Davison
Bldg (Duke South green zone)
If you don't like histology, stay far, far away from this selective. They do a good job of
showing you the diversity in this field, but it all comes back to histology. Great hours,
though – probably the least hours of any selective.
21
Peds220C: Clinical Genetics and Metabolism
Course director: Marie McDonald, mcdon035@mc.duke.edu, 684 2036, 246B Bell Bldg
Awaiting student input.
Peds221C: Child Abuse and Family Violence
Course director: Aditee Narayan, aditee.pradhan@duke.edu, 419 3474
Awaiting student input.
Peds222C: Pediatric Hematology-Oncology
Course director: T McKinney
Awaiting student input.
Peds223C: Pediatric Intensive Care
Course director: Ira Cheifetz, cheif002@mc.duke.edu, 681 5872, 5415 Duke North
Awaiting student input.
Peds224C: Intensive Care Nursery
Course director: Ricki Goldstein, golds005@mc.duke.edu, 681 6024, 204E Bell Bldg
Awaiting student input.
Psychiatry220C: Addiction Psychiatry
Course director: Roy Stein, stein001@duke.edu, 286-0411x6321
The Good:
Super chill rotation, med students can basically control when and where they are during
the selective. Dr. Stein has a well organized outpatient rehab clinic at the VA, great
opportunities to interview patients, etc., if you are assertive about seeing patients, Dr.
Stein will let you see them and present to him afterwards.
The Bad:
Observing pt interviews is incredibly boring, especially if you are not interested in psych.
The Ugly (call, tests, presentations, etc.):
No call, no weekends, can go to various rehab programs in Greensboro, Chapel Hill,
Durham and Raleigh.
Psychiatry221C: Child Psychiatry
Course directors: Allan Chrisman, chris014@mc.duke.edu, 416-2402, 718 Rutherford St
Linwood Allsbrook, allsb001@mc.duke.edu, 286-4456
22
Awaiting student input.
Psychiatry222C: Geriatric Psychiatry
Course director: Mugdha Thakur, thaku001@mc.duke.edu, 681-8788, 54232 Duke
South red zone
Awaiting student input.
Radiol221C: Radiology
Radiology selective is only offered when MS4s are not around (July and sometimes
April, if the selective weeks do not overlap with the last MS4 rotation period).
Course director: Nancy Major, nancy.major@duke.edu, 684-7469, 1503 Duke North
Awaiting student input.
RadOnc220C: Radiation Oncology
Course director: Nicole Larrier, nicole.larrier@duke.edu, 660-2160, 05121A Morris
Building (Duke South white zone)
Administrative assistant: Lynn Wilson, sandra.l.wilson@duke.edu, 668-7342, Duke
South white zone basement
The Good:
Wonderful! Faculty and residents are enthusiastic and extremely eager to teach. The
faculty do their best to give a great overview of the field and to let you see a wide variety
of procedures if they occur during your two weeks – not just external beam radiation but
also radiosurgery, hyperthermia, prostate and gynecologic brachytherapy, high dose
rate brachytherapy, eye plaque placement, and intraoperative radiation therapy. You
also spend a day with the dosimetrists in order to learn about dosing radiation
treatments. Other days are spent seeing patients in clinic for new consultations,
treatment checks, and follow-up visits. Free lunch is sometimes available in the faculty
workroom or staff lounge.
The Bad:
If you’re looking for a non-time-intensive selective, this might not be to your liking. Duke
hours are 7-8am to whenever clinic finishes (4-6:30pm). VA and DRH hours are
shorter. The first day might not be too exciting, as it is comprised primarily of orientation
lectures and videos on radiation therapy.
The Ugly (call, tests, presentations, etc.):
No call. No weekends. One not-so-hard test that is designed to see if you learn what
Dr. Larrier intends to teach during the rotation – don’t stress out about it; remember that
selectives are pass/fail. One laid-back case presentation in front of Dr. Larrier and the
other two students on selective (no PowerPoint, please – just bring in the facts of the
case and the planned treatment with dose and fields).
23
On four out of the selective’s 10 days, you will meet at 7am with Dr. Larrier for
case presentations (she performs the first one). On the other days, morning conference
at 8am starts your day. On your first day, meet at 8am in the radiation oncology faculty
workroom (room 005113V) in the subbasement of Duke South white zone. After
conference, Dr. Larrier provides you with a short orientation, your clinic and procedure
schedule, and relevant reading material (textbooks on loan and a packet). Your two
weeks will be divided between Duke, the VA, and Durham Regional. Each student gets
a general overview during the first week and focuses on a specific group of cancers,
such as breast, genitourinary, or gastrointestinal cancers during the second week.
You might learn how to use Duke’s phone dictation system for clinic notes – to
get your esig dictation code, go to the Medical Records Service in room T401 of Duke
North (across from the ATMs on T level) or call Ellen Coles at 684-4014. While most
patients will have some type of cancer, the occasional patient will have a nonmalignant
disease such as a hemangioma or keloids.
Surgery220C: Neurosurgery
Course director: Michael Haglund, haglu001@mc.duke.edu, 684-6396, 4508 Duke
South blue zone
The Good:
Well-organized. All the residents and faculty either already knew about the course, or at
least expected us to be there. They did not, however, expect anything from us, and
allowed us to come and go as we pleased, to learn as we saw fit. Dr. Friedman
provided us with a rather large packet of reading for the course, which covered the
entire field broadly. This was a great experience.
The Bad:
We had no responsibilities, which made getting up for 6am rounds difficult. It would
have been nice to actually follow patients or something. But then again, that would
have meant more work….
The Ugly (call, tests, presentations, etc.):
A presentation on any topic was expected, and we were given the option of taking call
basically whenever we wanted. We were not expected to work on the weekends, and if
we saw a surgery, we were occasionally asked about the patient on rounds. VERY
occasionally….This selective was very easy to step into and learn from.
Surgery221C: Otolaryngology/Head and Neck Surgery/Ear, Nose, and Throat Surgery
(OHNS/ENT – pick your favorite name)
Course director: Joseph Farmer, farme002@mc.duke.edu, 681-6820, 1562 Duke South
blue zone
See description of ENT subrotation in the surgery course section.
24
Surgery222C: Orthopedic Surgery
Course director: Scott Levin, levin001@mc.duke.edu, 681-5079, 134 Baker House
(Duke South brown zone)
See description of orthopedic surgery subrotation in the surgery course section.
Surgery223C: Plastic Surgery
Course director: Scott Levin, levin001@mc.duke.edu, 681-5079, 134 Baker House
(Duke South brown zone)
See description of plastic surgery subrotation in the surgery course section.
Surgery224C: Surgical Critical Care (Surgical Intensive Care Unit)
Course director: Mark Sebastian, sebas002@mc.duke.edu, 681-6096, 433 MSRB
Dr. Sebastian’s administrative assistant (email her, not him): Michelle Harward,
harwa004@mc.duke.edu, 681-6096, 433 MSRB
The Good:
This selective was very laid back, and we had the chance to learn about critical care
medicine, which I hadn’t seen much of up to that point during 2 nd year. The hours were
easy, and the surgeons and anesthesiologists were friendly. If you were lucky, you got
to do procedures that ordinary med students never even get to see.
The Bad:
This rotation was boring. There were no expectations of us, nor should there have
been. The way the SICU works, the residents were there to check up on patients
constantly, and to be there in case of emergency. For the med students, it became a
matter of checking vitals and labs periodically, waiting for something to happen to
someone so that we could watch other people do something about it. Also, rounds are
pretty long.
The Ugly (call, tests, presentations, etc.):
There is no pre-rounding on this service, as the on-call team basically acts as a
separate shift of workers. They give report on each patient on morning rounds, and
then leave (which is great for the med student who was on call). The team then splits
up the patients, follows them during the day, and then reports on any occurrences at
afternoon rounds. Med students on the selective were given the option of taking call
whenever they chose, essentially in order to have the next day off.
What I would like to have known ahead of time:
Get your ID badge for the SICU, your account on CareVue, and your account on PACS
activated at the beginning of the rotation. That way, you can actually be of some help.
Also, these patients typically are very complicated in their disease processes, so spend
lots of time reading on them with the plentiful down time that you will have.
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Surgery225C: Thoracic Surgery
Course director: Thomas D’Amico, damic001@mc.duke.edu, 684-4891
See description of thoracic surgery subrotation in the surgery course section.
Surgery226C: Cardiac Surgery
Course director: Shu Lin, shu.lin@duke.edu, 668-0903, 3580 Duke South white zone
The Good: You learn a ton, you’re in the OR, and you don’t have to worry about kissing
ass b/c you’re not being graded. There is a lot to learn while on CT and esp when in the
OR with Jaggers (peds cards), you get a lot of teaching. If you read for the cases the
night before you get more out of it, but given that the rotation is P/F, you can do with it
as you please.
The Bad: The selective is like the surgery subrotation except you don’t get graded. The
average day spans 6:30am – 6pm, Saturdays for rounds, and Sundays off. You don’t
get to do much in the OR given that it’s heart surgery but watching chests get cracked
open can be pretty exciting the first couple times.
The Ugly (call, tests, presentations, etc.):
- Only take call if you enjoy pain. They don’t ask so you don’t need to.
- The day before you start, find out what fellow is on CT service and page them to
figure out where and when you meet the team.
- Expectations for the 2 weeks are highly fellow-dependent so ask them what they
want up front. Some will expect pre-rounding whereas others won’t care.
Surgery227C: Urology
Course director: Kelly Maloney, kelly.maloney@duke.edu, 684-9149, 3116 N Duke St
See description of urology subrotation in the surgery course section.
Surgery229C: Emergency Medicine
Course director: Joshua Broder, joshua.broder@duke.edu, 684-5537, 0682 Duke North
Awaiting student input.
Sports Medicine (last offered to ms2007)
The Good:
Great group to work with (Drs. Moorman and Garrett). Get a good mix of clinic and
surgery experience. Patient population was unique—all relatively healthy folks that
usually recovered well from their procedures.
The Bad:
Not really anything I didn’t like about it.
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The Ugly (call, tests, presentations, etc.):
All patients I saw were in an ambulatory setting so there were no patients to round on.
Just show up for clinic and the OR. No testing or presentations.
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