ACGME Merger and USMLE/COMLEX

[235009]

Which ones primarily illuminate the reasoning behind MDs over DOs? To my best understanding, I want to say DO-screening PDs see DO students are seen as less able to perform clinically and more likely to struggle on standardized testing? Did I get that correctly?

A PD's worse nightmare I imagine would be having an intern show up who needs to catch up clinically from day 1 (similar to the previous example of not knowing how to do a routine obstetrics exam). That would be what would put patients most at risk and significantly slow productivity. The lack of perspective in some of these posts is pretty clear. Prioritizing what is in your view (GUH) fair and equitable is primarily selfish and has nothing to do with being patient centered.

It's probably pretty easy to predict how the resident would do on standardized tests with a step 1 and 2 score handy.


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[Dr Tony T. Chopper]

A PD's worse nightmare I imagine would be having an intern show up who needs to catch up clinically from day 1 (similar to the previous example of not knowing how to do a routine obstetrics exam). That would be what would put patients most at risk and significantly slow productivity. The lack of perspective in some of these posts is pretty clear. Prioritizing what is in your view (GUH) fair and equitable is primarily selfish and has nothing to do with being patient centered.

It's probably pretty easy to predict how the resident would do on standardized tests with a step 1 and 2 score handy.


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Interesting. Indeed it is incumbent on DO schools at large to control the quality of their rotation sites and show, beyond doubt, that clinical training at these sites are more than sufficient in producing useful residents. The burden of responsibility should not be on PDs. I agree.

 

[GUH]

A PD's worse nightmare I imagine would be having an intern show up who needs to catch up clinically from day 1 (similar to the previous example of not knowing how to do a routine obstetrics exam). That would be what would put patients most at risk and significantly slow productivity. The lack of perspective in some of these posts is pretty clear. Prioritizing what is in your view (GUH) fair and equitable is primarily selfish and has nothing to do with being patient centered.

It's probably pretty easy to predict how the resident would do on standardized tests with a step 1 and 2 score handy.


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Not just about fair and equitable. It's about making important decisions based on a rational set of criteria.

 

[TheOther]

Not just about fair and equitable. It's about making important decisions based on a rational set of criteria.

There's no universal standard/formula even across traditional ACGME residency programs for their MD applicants. It's up the each program's discretion.
As I'm sure you're well aware, most AOA programs make deliberations outside of board scores - weighing heavily on audition rotations. What makes a certain audition more stellar than another? That's subjective, involving characteristics that are often not quantifiable, which undeniably differs by programs also.
You can kick and demand all you want about a need for a "rational set of criteria" but it's neither pragmatic nor realistic.

 

[AlteredScale]

A PD's worse nightmare I imagine would be having an intern show up who needs to catch up clinically from day 1 (similar to the previous example of not knowing how to do a routine obstetrics exam). That would be what would put patients most at risk and significantly slow productivity. The lack of perspective in some of these posts is pretty clear. Prioritizing what is in your view (GUH) fair and equitable is primarily selfish and has nothing to do with being patient centered.

It's probably pretty easy to predict how the resident would do on standardized tests with a step 1 and 2 score handy.


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Agree 100%. I cannot see a PD being happy or comfortable at all when a DO student comes into a specific rotation with substandard training on just the basics of rounding and presenting a patient (but was first assist during their surgery preceptorship!), moreso if they cannot run pretty standard exams within that service. They are a liability and a risk.

The fact that a current resident who is an alum of my DO school would state they'd rather have MD students rotate through their service because they always seem to be better prepared than the DO students from their OWN alma mater speaks volume.

 

[GUH]

There's no universal standard/formula even across traditional ACGME residency programs for their MD applicants. It's up the each program's discretion.
As I'm sure you're well aware, most AOA programs make deliberations outside of board scores - weighing heavily on audition rotations. What makes a certain audition more stellar than another? That's subjective, involving characteristics that are often not quantifiable, which undeniably differs by programs also.
You can kick and demand all you want about a need for a "rational set of criteria" but it's neither pragmatic nor realistic.

rational =/= objective or quantifiable

 

[TheOther]

rational =/= objective or quantifiable

Then we're in the subjective realm. To throw out one's experiences and to make decisions in opposition to them would be irrational.
Rather than demanding residency programs to change their perspective on DO students, your energy would be better spent demanding DO schools to improve their clinical education.
Just focus on being a quality medical student/physician and contribute to the solution yourself.

 

[Drrrrrr. Celty]

A PD's worse nightmare I imagine would be having an intern show up who needs to catch up clinically from day 1 (similar to the previous example of not knowing how to do a routine obstetrics exam). That would be what would put patients most at risk and significantly slow productivity. The lack of perspective in some of these posts is pretty clear. Prioritizing what is in your view (GUH) fair and equitable is primarily selfish and has nothing to do with being patient centered.

It's probably pretty easy to predict how the resident would do on standardized tests with a step 1 and 2 score handy.


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Is there really a major fear of a intern not knowing how to do a basic gyno exam tho? I mean that seems a bit much.
I mean it's fair to question DO education. But you seem to be pushing it into the notion that our clinicals are shadowing experiences.

Agree 100%. I cannot see a PD being happy or comfortable at all when a DO student comes into a specific rotation with substandard training on just the basics of rounding and presenting a patient (but was first assist during their surgery preceptorship!), moreso if they cannot run pretty standard exams within that service. They are a liability and a risk.

The fact that a current resident who is an alum of my DO school would state they'd rather have MD students rotate through their service because they always seem to be better prepared than the DO students from their OWN alma mater speaks volume.

I think fundamentally at a DO school your preparedness for residency will depend more on you. If you seek out the work and try your best to do it, seek out good sub-is, etc you'll find yourself probably as ready as most MD students. But regarding the resident, not going to lie, theres probably some disinterest and lack of motivation there compared to MD students who probably can actually match in that area or more likely to have their mindsets primed for such fields ( We do honestly aim a bit low).

In either case and as much as I hate to bring up a mediocrity argument, it does seem like we're underselling the level of our education too. I mean, we might not be as high as some MD schools, but we're probably meeting benchmarks for adequate preparedness.

 

[Drrrrrr. Celty]

Then we're in the subjective realm. To throw out one's experiences and to make decisions in opposition to them would be irrational.
Rather than demanding residency programs to change their perspective on DO students, your energy would be better spent demanding DO schools to improve their clinical education.
Just focus on being a quality medical student/physician and contribute to the solution yourself.

I mean I'm not going to lie, what is exactly preparedness as a minimal, adequate, or high as a metric? I'm not trying to say that DO school clinical education in many cases is poor, because probably at least 5-10 schools that exist have unacceptable situations. But knowing where the lines fall and where poorer outcomes start is a valid interest.

I mean in the end as I mentioned before, improving clinicals is going to take some help from outside resources though. Which again, I think is fair.

 

[AlteredScale]

But regarding the resident, not going to lie, theres probably some disinterest and lack of motivation there compared to MD students who probably can actually match in that area or more likely to have their mindsets primed for such fields ( We do honestly aim a bit low).

In either case and as much as I hate to bring up a mediocrity argument, it does seem like we're underselling the level of our education too. I mean, we might not be as high as some MD schools, but we're probably meeting benchmarks for adequate preparedness.

The issue is that resident was from a very low tier FM program at a community hospital. So with the way I see it, that MD student was stronger despite not even wanting to match there while the DO student (who wanted to match there) showed an inability that was alarming to the resident.

 

[Drrrrrr. Celty]

The issue is that resident was from a very low tier FM program at a community hospital. So with the way I see it, that MD student was stronger despite not even wanting to match there while the DO student (who wanted to match there) showed an inability that was alarming to the resident.

That's a bit shocking. Not gonna lie.

But then again a few years ago our classes weren't exactly filled with the most brilliant types either.

 

[22031 Alum]

Is there really a major fear of a intern not knowing how to do a basic gyno exam tho? I mean that seems a bit much.

That was just referring to the N=1 example I gave. The expectation is that having a rotating MS4 is like having an extra intern on the team, not having an extra clerkship student. Being told "For postpartum rounds, see the patients in rooms 1, 2, and 3" should be followed by an "Okay," not "What exactly should I ask them about?" We can talk about how non-representative that may have been all we want, the fact is it affects the perception of program leadership. The thought is, "If someone comes here without rotating with us beforehand, is that something we'll have to teach them as an intern?" Most programs aren't going to want to deal with that uncertainty if they can help it.

rational =/= objective or quantifiable

I'm interested to know what you are calling "rational," then.

 

[Drrrrrr. Celty]

That was just referring to the N=1 example I gave. The expectation is that having a rotating MS4 is like having an extra intern on the team, not having an extra clerkship student. Being told "For postpartum rounds, see the patients in rooms 1, 2, and 3" should be followed by an "Okay," not "What exactly should I ask them about?" We can talk about how non-representative that may have been all we want, the fact is it affects the perception of program leadership. The thought is, "If someone comes here without rotating with us beforehand, is that something we'll have to teach them as an intern?" Most programs aren't going to want to deal with that uncertainty if they can help it.

I can see why that might be a problem I guess. It might not be an issue of skills or knowledge as much as possibly an issue about adjusting to a wards style of rotation from preceptor based. I know even some of the DOs on this forum talk about it occasionally requiring some time to adjust.

Meh, I would like to see improvements in the clinical education.

 

[IslandStyle808]

That was just referring to the N=1 example I gave. The expectation is that having a rotating MS4 is like having an extra intern on the team, not having an extra clerkship student. Being told "For postpartum rounds, see the patients in rooms 1, 2, and 3" should be followed by an "Okay," not "What exactly should I ask them about?" We can talk about how non-representative that may have been all we want, the fact is it affects the perception of program leadership. The thought is, "If someone comes here without rotating with us beforehand, is that something we'll have to teach them as an intern?" Most programs aren't going to want to deal with that uncertainty if they can help it.



I'm interested to know what you are calling "rational," then.

What can a DO student do so that they can make sure they are certainly meeting the criteria necessary to begin functioning near an intern level by 4th year?

 

[IslandStyle808]

I can see why that might be a problem I guess. It might not be an issue of skills or knowledge as much as possibly an issue about adjusting to a wards style of rotation from preceptor based. I know even some of the DOs on this forum talk about it occasionally requiring some time to adjust.

Meh, I would like to see improvements in the clinical education.

What is scary is that there have been DO med students on SDN who think they can use their sub-i's to make up that difference. However, residents have stated it is not a time to be making up a deficit, but showing your skills.

 

[Drrrrrr. Celty]

What is scary is that there have been DO med students on SDN who think they can use their sub-i's to make up that difference. However, residents have stated it is not a time to be making up a deficit, but showing your skills.

I mean better than never learning it at all? I'm certainly not advocating wasting a sub-I trying to become properly trained, but if it's the only good IM experience you got, then I can't blame you for trying it.

 

[IslandStyle808]

I mean better than never learning it at all? I'm certainly not advocating wasting a sub-I trying to become properly trained, but if it's the only good IM experience you got, then I can't blame you for trying it.

Of course, this help greatly when they do match into a residency program (future DO students will benefit as well). It will help the perception of that residency program where the DO student will intern, but at the price of the one where they auditioned during 4th year. Probably the next best thing is taking the 3rd elective and redoing certain rotations that one is weak in (or doing speciality of interest during that year and make sure to fix any deficit).

 

[kenjixshadow]

I mean better than never learning it at all? I'm certainly not advocating wasting a sub-I trying to become properly trained, but if it's the only good IM experience you got, then I can't blame you for trying it.

But when you show up to a sub-i, ppl are expecting you to show up to work independently and give you less teaching. If they have to hold your hands, they'll give you less autonomy and will match someone else. Moreover, guess what? They'll think all DO students are like this and how the stigma exists as we know. This will greatly hurt any DO student who is applying to surgical and EM field.

Of course, this help greatly when they do match into a residency program (future DO students will benefit as well). It will help the perception of that residency program where the DO student will intern, but at the price of the one where they auditioned during 4th year. Probably the next best thing is taking the 3rd elective and redoing certain rotations that one is weak in (or doing speciality of interest during that year and make sure to fix any deficit).

I'm about to tell you something crazy. Whenever his preceptors let him leave early or during his days off, this 3rd year student drive 40 mins - 1 hr away to a hospital with residents, so that he can shadow them. Don't feel bad for him. He is at least learning.

 

[IslandStyle808]

But when you show up to a sub-i, ppl are expecting you to show up to work independently and give you less teaching. If they have to hold your hands, they'll give you less autonomy and will match someone else. Moreover, guess what? They'll think all DO students are like this and how the stigma exists as we know. This will greatly hurt any DO student who is applying to surgical and EM field.

I'm about to tell you something crazy. Whenever his preceptors let him leave early or during his days off, this 3rd year student drive 40 mins - 1 hr away to a hospital with residents, so that he can shadow them. Don't feel bad for him. He is at least learning.

I swear man, you know stuff that I would never see on this site. I am amazed that person was able to get permission and have the stamina to pursue it. Good for him!

 

[Drrrrrr. Celty]

But when you show up to a sub-i, ppl are expecting you to show up to work independently and give you less teaching. If they have to hold your hands, they'll give you less autonomy and will match someone else. Moreover, guess what? They'll think all DO students are like this and how the stigma exists as we know. This will greatly hurt any DO student who is applying to surgical and EM field.


I'm about to tell you something crazy. Whenever his preceptors let him leave early or during his days off, this 3rd year student drive 40 mins - 1 hr away to a hospital with residents, so that he can shadow them. Don't feel bad for him. He is at least learning.

I mean, not gonna lie you have hella stamina. I mean all I can say is hopefully I get relatively good exposure to fields my 3rd year and don't appear too ignorant my 4th year.

 

[kenjixshadow]

I mean, not gonna lie you have hella stamina. I mean all I can say is hopefully I get relatively good exposure to fields my 3rd year and don't appear too ignorant my 4th year.

Woah, that's not me. I swear, but I do have that kind of stamina.

 

[SurgeDO]

I spent my 3rd year at an underserved, inner-city community hospital that two other MD schools send their 3rd year students to for their base rotations. I'm the first person to poop on the AOA when given a chance, but I think it is a bull-**** generalization to say DO students receive a substandard clinical education.

I've loved my clerkship experience. I've received excellent training. I've had good and bad rotations, but the good rotations have far outnumbered the bad rotations. If you think MD students don't have their fair share of bull **** rotations, you are absolutely mistaken. I've seen it first hand as I've had the same exact rotations as MD students. Simply a case of the "grass is always greener." The MD students put up with the same bull **** as we do.

Not knowing how to present a patient is not an MD vs. DO thing. It's a case of competence. If you don't know how to present a patient, you simply aren't making the effort. For ****'s sake just watch a YouTube video on it.

3rd year isn't about seeing rare diseases that you'll only see once in your career; it's about learning how to work up basic illnesses. It's about learning how the hospital works. It's about learning how to interact with patients and perform a solid h&p. It's about learning how to perform basic procedures. You can learn this at any hospital as long as you make the effort and put yourself out there.

When I was an MS1 and MS2, I thought kids at Harvard and Hopkins were working up kuru and knocking out whipples everyday. Not only is this not the case, but it is not what 3rd year should be about.

 

[22031 Alum]

What can a DO student do so that they can make sure they are certainly meeting the criteria necessary to begin functioning near an intern level by 4th year?

One thing that might help is just talking to your preceptors about it. Something like "In addition to seeing what it's like to be a practicing [specialty], I'd like to get a taste of what it's like to be a resident as well." If they use a midlevel to round/call consults/check labs/do post-op checks/do discharges, ask to be responsible for doing those things for some portion of the patients. If there's a patient list or census that needs to be kept updated, ask to help with that. For OB, following patients in labor, vs. only getting called from the office for deliveries or issues, is a major difference between residency and "real life." Now it's anybody's guess as to how individual preceptors may respond to that but they've all done a residency so they know what's up.

I've loved my clerkship experience. I've received excellent training. I've had good and bad rotations, but the good rotations have far outnumbered the bad rotations. If you think MD students don't have their fair share of bull **** rotations, you are absolutely mistaken. I've seen it first hand as I've had the same exact rotations as MD students. Simply a case of the "grass is always greener." The MD students put up with the same bull **** as we do.

Not knowing how to present a patient is not an MD vs. DO thing. It's a case of competence. If you don't know how to present a patient, you simply aren't making the effort. For ****'s sake just watch a YouTube video on it.

3rd year isn't about seeing rare diseases that you'll only see once in your career; it's about learning how to work up basic illnesses. It's about learning how the hospital works. It's about learning how to interact with patients and perform a solid h&p. It's about learning how to perform basic procedures. You can learn this at any hospital as long as you make the effort and put yourself out there.

When I was an MS1 and MS2, I thought kids at Harvard and Hopkins were working up kuru and knocking out whipples everyday. Not only is this not the case, but it is not what 3rd year should be about.

I think I mostly agree with you, but you're talking past the point a bit. Nobody has said that crappy MD rotations don't exist. Or that seeing rare diseases and doing Whipples is the most important thing. You're right, they do and it isn't. But your point about making the effort and putting yourself out there is important. The issue is, it seems that on the DO side, you're more likely to have to put in more effort to get the same experience that most MD students would honestly have to put in effort not to get. Even my least interested, most checked-out students don't have to "put themselves out there" to get that basic inpatient experience in the specialty. It is part of the package. Now this is an outsider's view, but I can't change how experiences color perceptions.

 

[IslandStyle808]

One thing that might help is just talking to your preceptors about it. Something like "In addition to seeing what it's like to be a practicing [specialty], I'd like to get a taste of what it's like to be a resident as well." If they use a midlevel to round/call consults/check labs/do post-op checks/do discharges, ask to be responsible for doing those things for some portion of the patients. If there's a patient list or census that needs to be kept updated, ask to help with that. For OB, following patients in labor, vs. only getting called from the office for deliveries or issues, is a major difference between residency and "real life." Now it's anybody's guess as to how individual preceptors may respond to that but they've all done a residency so they know what's up.



I think I mostly agree with you, but you're talking past the point a bit. Nobody has said that crappy MD rotations don't exist. Or that seeing rare diseases and doing Whipples is the most important thing. You're right, they do and it isn't. But your point about making the effort and putting yourself out there is important. The issue is, it seems that on the DO side, you're more likely to have to put in more effort to get the same experience that most MD students would honestly have to put in effort not to get. Even my least interested, most checked-out students don't have to "put themselves out there" to get that basic inpatient experience in the specialty. It is part of the package. Now this is an outsider's view, but I can't change how experiences color perceptions.

I really appreciate the detailed response, as well as all of us here on this forum.

The second paragraph right here is what should be emphasized on the forums more. The learning process is a two way street (have learned this both as student and as a teaching assistant/tutor). There have been many stories of students giving their all only to have a preceptor ignore their existence. The student can only do so much to educate themselves. They can't get the full 100% of the experience if the preceptor isn't completely on board.

 

[Ioannes Paulus]

This thread has actually made me appreciate the fact that that my school requires students to take both the COMLEX and USMLE more than I did before.

 

[SurgeDO]

One thing that might help is just talking to your preceptors about it. Something like "In addition to seeing what it's like to be a practicing [specialty], I'd like to get a taste of what it's like to be a resident as well." If they use a midlevel to round/call consults/check labs/do post-op checks/do discharges, ask to be responsible for doing those things for some portion of the patients. If there's a patient list or census that needs to be kept updated, ask to help with that. For OB, following patients in labor, vs. only getting called from the office for deliveries or issues, is a major difference between residency and "real life." Now it's anybody's guess as to how individual preceptors may respond to that but they've all done a residency so they know what's up.



I think I mostly agree with you, but you're talking past the point a bit. Nobody has said that crappy MD rotations don't exist. Or that seeing rare diseases and doing Whipples is the most important thing. You're right, they do and it isn't. But your point about making the effort and putting yourself out there is important. The issue is, it seems that on the DO side, you're more likely to have to put in more effort to get the same experience that most MD students would honestly have to put in effort not to get. Even my least interested, most checked-out students don't have to "put themselves out there" to get that basic inpatient experience in the specialty. It is part of the package. Now this is an outsider's view, but I can't change how experiences color perceptions.

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

 

[67552931811]

This thread has actually made me appreciate the fact that that my school requires students to take both the COMLEX and USMLE more than I did before.

The Rock?

 

[costales]

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

Seconded - speaking as a grad of a DO school that's setting up an MD school for TCU. Helluva of a broad brush people are using in this thread.

 

[Drrrrrr. Celty]

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

Seconded - speaking as a grad of a DO school that's setting up an MD school for TCU. Helluva of a broad brush people are using in this thread.

Well, you don't get this perspective often. Maybe SDN really needs to calm down with diminishing DO clinical education?

 

[Ioannes Paulus]

The Rock?

Yes

 

[Dharma]

Ya'll got a lot of time... Go throw a ball or something.

 

[sunealoneal]

And if you don't think that the thousands of practicing DOs in all specialties throughout the past several decades don't prove that "their product doesn't suck", then we are clearly not going to be able to have a rational discussion on the matter.

We're talking about interns though, not practicing physicians. The bulk of whom may have gone to an osteopathic residency and quickly caught up in a matter of weeks/days/minutes.

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

From what I understand, students at my school have excellent rotations as well. However, that does not affect the issues inherent in the preceptor model. Issues that may dwarf the many challenges that the ward model has. I'm sure our schools overcame those issues; that was the biggest deciding factor of school choice for me. Unfortunately, it sounds like some residency programs (rightfully or not) see these as exceptions rather than the rule.

 

[Wordead]

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

How on earth do you think that you have the perspective to say you have a better clinical education than any other student? I have no idea how my education compared to the vast majority of other students because I was at most privy to a couple rotations with them and have no idea what they did outside of the rotation.

Statements like this are obviously baseless bravado and don't work in your favor....or comments about "feeling" your education is great.

 

[hallowmann]

...Someone with a 260 who doesn't know how to check a fundal height isn't automatically "more qualified" than someone with a 210 who does.

If you come out of at least 4 weeks of an OB/Gyn rotation unable to check fundal height, something is wrong, even if you just followed a preceptor around. I mean, you should have at least seen them check it or read it somewhere, which obviously is very different than doing it yourself, but still. And you'd think someone actually interested in OB would be busting their butt for opportunities to learn anything and everything OB. Sounds like you had a dud.

I will say that I've seen more DO auditioners/4th years that don't seem to understand the point of auditions/sub-Is compared to the MD sub-I's. The point is to look good doing what an intern does. That means studying daily, staying interested, volunteering for tasks/patients, taking opportunities to teach, and, I can't believe I have to say this, not falling asleep on your audition. To everyone on here, don't be that DO.

I mean it almost makes me wonder if the issue is naivete. I mean, maybe a lot of DOs don't see auditioners and sub-I's as much, so they think their job on auditions is the same as it was on their 3rd year cores. Kind of like how people at my school don't really understand the residency app process, but friends at MD schools have already been taught the ins and outs of it.

...Being told "For postpartum rounds, see the patients in rooms 1, 2, and 3" should be followed by an "Okay," not "What exactly should I ask them about?"...

Yeah, now I'm more confident in my assessment that you got a dud. Who wouldn't know that? Not interested in OB and did a preceptor-based rotation (by choice because I actually saw more on it than most at my clinical site), but unless someone flat out didn't have an OB/Gyn rotation, how could they not know the standard post-partum eval/concerns? I'm even more concerned that they did this on an audition and were actually interested in OB/Gyn. You'd think they would've known that cold.

What can a DO student do so that they can make sure they are certainly meeting the criteria necessary to begin functioning near an intern level by 4th year?

A lot of it has to do with being observant. Look at the interns, see what they do. For the most part, you can figure out what you're supposed to do, and feel free to ask the interns you're rotating with during 3rd year what they do in "x" situation.

When you're dealing with the more procedural fields, things are a bit different. I've never done certain things. I've never even seen certain things done. People at my school that went to sites without residents or with only FM residents have done a lot more than me. Maybe I'll do more on EM in 4th year (I'm told I will). Maybe if I was interested in surgery, I would have done more than just staple-close incisions. A lot are skills you develop, so if you know you're interested, jump in. If you're willing to see one, do one, you should be alright, but I imagine that's residency program specific how much they actually expect you to know going in.

I spent my 3rd year at an underserved, inner-city community hospital that two other MD schools send their 3rd year students to for their base rotations. I'm the first person to poop on the AOA when given a chance, but I think it is a bull-**** generalization to say DO students receive a substandard clinical education.

I've loved my clerkship experience. I've received excellent training. I've had good and bad rotations, but the good rotations have far outnumbered the bad rotations. If you think MD students don't have their fair share of bull **** rotations, you are absolutely mistaken. I've seen it first hand as I've had the same exact rotations as MD students. Simply a case of the "grass is always greener." The MD students put up with the same bull **** as we do.

Not knowing how to present a patient is not an MD vs. DO thing. It's a case of competence. If you don't know how to present a patient, you simply aren't making the effort. For ****'s sake just watch a YouTube video on it....

Yeah, this is definitely the case. It's really not as easy as saying all DOs have terrible clinicals. There is variability though. My experience at my clinical campus is different from my classmate's at another clinical campus. That said, I know some MDs who have similarly varying clinical campuses, so it can't just be an MD vs. DO thing. Maybe it's just easier for PDs and MDs to think that though.

 

[IsWhat]

It sounds like the argument against DO clinical education is it doesn't always prepare students for academic medicine. Which is interesting, because academic medicine is an inherently poor place for a medical student to learn due to its top-->down structure.

I would argue the preceptor based education is actually a better place for medical students, because it gives students a chance to hone the skills they should be learning as students. Many large academic medical centers like the Mayo Clinic are moving towards a preceptor based education in their surgical residencies to cut down on rounding time and increase hands on experience... Seems pretty logical to me.

 

[DrBowtie]

It sounds like the argument against DO clinical education is it doesn't always prepare students for academic medicine. Which is interesting, because academic medicine is an inherently poor place for a medical student to learn due to its top-->down structure.

I would argue the preceptor based education is actually a better place for medical students, because it gives students a chance to hone the skills they should be learning as students. Many large academic medical centers like the Mayo Clinic are moving towards a preceptor based education in their surgical residencies to cut down on rounding time and increase hands on experience... Seems pretty logical to me.

The preceptor model places immense pressure on a single person to teach the breadth of an entire specialty for a short 4 week clerkship. Often this could represent a persons entire exposure to a specialty.

For a surgical residency, it would be a small subsection of training smoothed over 5-7 years of various preceptors.

 

[AlteredScale]

It sounds like the argument against DO clinical education is it doesn't always prepare students for academic medicine. Which is interesting, because academic medicine is an inherently poor place for a medical student to learn due to its top-->down structure.

I would argue the preceptor based education is actually a better place for medical students, because it gives students a chance to hone the skills they should be learning as students. Many large academic medical centers like the Mayo Clinic are moving towards a preceptor based education in their surgical residencies to cut down on rounding time and increase hands on experience... Seems pretty logical to me.

Where did you get such a statement that I placed in bold above? Academic medicine sits on a foundation of teaching. Preceptor based teaching at a community hospital with loose ties to a DO school have no incentive and really no need to go crazy in terms of having solid teaching experiences. I'm not stating community hospitals with GME are of "lesser degree" because on the contrary there has been some evidence to show that non centralized teaching on third year improved clinical exam scores (http://www.ncbi.nlm.nih.gov/pubmed/27064717)

I disagree. A 3rd year or 4th year student should be learning to become a INTERN...not a full fledge physician whom which they will learn from in an preceptor based setting. In many cases, these attending docs are light years out from their intern and really have no idea what "the basics" nor how to teach them as well as a PGY-2 or PGY-3 who truly understands the system of teaching in an academic environment.

In regards to the surgical service utilizing preceptors: obv I may be riding the slippery slope here with your statement but just because Mayo Clinic has focused their srugery service to be preceptor based does not illustrate it as an effective way of teaching medical students. What you also need to bring into question is the risk that occurs in a preceptor based model in becoming a "make or break" type of career decision factor since you're only with one person that whole time. (http://www.sciencedirect.com/science/article/pii/S1072751506015870?np=y)

 

[Event_Horizon]

How on earth do you think that you have the perspective to say you have a better clinical education than any other student? I have no idea how my education compared to the vast majority of other students because I was at most privy to a couple rotations with them and have no idea what they did outside of the rotation.

Statements like this are obviously baseless bravado and don't work in your favor....or comments about "feeling" your education is great.

Many would argue that there are those who like to comment on DO education without the appropriate perspective you speak of. Though, this applies to all sub-forums. It seems almost a fun game to overstep one's qualifications to make comments on something that has never been experienced personally.

As a side note: I sure hope the COMLEX gets done away with in the near future. What a wonderful world that would be.

 

[Wordead]

Many would argue that there are those who like to comment on DO education without the appropriate perspective you speak of. Though, this applies to all sub-forums. It seems almost a fun game to overstep one's qualifications to make comments on something that has never been experienced personally.

As a side note: I sure hope the COMLEX gets done away with in the near future. What a wonderful world that would be.

I would agree that med students also suffer from the same problem. The people who are on the other side of the match process, though, are better qualified at least having the end product to compare.

And lol at preceptor model being better. One man didactics from non academics? Sounds great

 

[SurgeDO]

How on earth do you think that you have the perspective to say you have a better clinical education than any other student? I have no idea how my education compared to the vast majority of other students because I was at most privy to a couple rotations with them and have no idea what they did outside of the rotation.

Statements like this are obviously baseless bravado and don't work in your favor....or comments about "feeling" your education is great.

agreed. merely speculating based on talking to other medical students and hearing about others' experiences. i was trying to offer a perspective to balance out the opinion that DO clinical education is subpar. i believe that my clerkship experience has been above average.

 

[GUH]

...However, that does not affect the issues inherent in the preceptor model. Issues that may dwarf the many challenges that the ward model has...

...
And lol at preceptor model being better. One man didactics from non academics? Sounds great

Not sure why we have to knock on preceptor-based rotations under all circumstances. I think for certain specialties it's probably better to be with a preceptor than on wards at an academic hospital. My pediatrics rotation was on a teaching service and entirely inpatient and I missed out on some basic stuff because of it. My FM rotation was with a preceptor at her office and I think that was better than if it had been at a teaching hospital. My classmates who did inpatient FM at a teaching hospital said it was pretty much just another IM rotation and they didn't actually learn any family medicine.

So while it's probably not ideal to do all rotations with preceptors, I don't agree that preceptor-based rotations are necessarily inferior, especially for certain specialties.

 

[GUH]

I'm interested to know what you are calling "rational," then.

An example of a rational but possibly subjective point of evaluation: "In my assessment, this student's personality was not highly compatible with our team because she was X, Y, and Z so we don't feel like she would be a good fit for this program".

 

[DrBowtie]

Not sure why we have to knock on preceptor-based rotations under all circumstances. I think for certain specialties it's probably better to be with a preceptor than on wards at an academic hospital. My pediatrics rotation was on a teaching service and entirely inpatient and I missed out on some basic stuff because of it. My FM rotation was with a preceptor at her office and I think that was better than if it had been at a teaching hospital. My classmates who did inpatient FM at a teaching hospital said it was pretty much just another IM rotation and they didn't actually learn any family medicine.

So while it's probably not ideal to do all rotations with preceptors, I don't agree that preceptor-based rotations are necessarily inferior, especially for certain specialties.

Your argument isn't for the preceptor model, it's for balanced inpatient and outpatient experience in specialties that have both.

 

[hallowmann]

Where did you get such a statement that I placed in bold above? Academic medicine sits on a foundation of teaching. Preceptor based teaching at a community hospital with loose ties to a DO school have no incentive and really no need to go crazy in terms of having solid teaching experiences. I'm not stating community hospitals with GME are of "lesser degree" because on the contrary there has been some evidence to show that non centralized teaching on third year improved clinical exam scores (http://www.ncbi.nlm.nih.gov/pubmed/27064717)

I disagree. A 3rd year or 4th year student should be learning to become a INTERN...not a full fledge physician whom which they will learn from in an preceptor based setting. In many cases, these attending docs are light years out from their intern and really have no idea what "the basics" nor how to teach them as well as a PGY-2 or PGY-3 who truly understands the system of teaching in an academic environment.

In regards to the surgical service utilizing preceptors: obv I may be riding the slippery slope here with your statement but just because Mayo Clinic has focused their srugery service to be preceptor based does not illustrate it as an effective way of teaching medical students. What you also need to bring into question is the risk that occurs in a preceptor based model in becoming a "make or break" type of career decision factor since you're only with one person that whole time. (http://www.sciencedirect.com/science/article/pii/S1072751506015870?np=y)

I think it's a mistake to make blanket statements like this especially from someone who for one hasn't gone on any clinicals yet and two is a bit biased since they're interested in academic medicine, quite frankly the interest of a minority of all medical students.

In something like IM, I would strongly agree with you that an academic site would be far superior to a non-academic site, because it would require a very involved and up-to-date preceptor to get the type of education that one would get from an intern, senior, and attending team.

In something like surgery, I would argue that you'll get more out of being first-assist with a surgeon than you would with surgical interns where you might not even be scrubbing into many cases. You really wouldn't be learning how to be a surgical intern, because you wouldn't be in there at the field with them. Sure, you'll learn how to round, but you should be able to get this from other rotations and from the surgeon when they round on their consults and pre and post-op patients. Its hard to argue for that system to educate medical students when you see nursing students get as much "training" in cases as you do.

As others have said there's also something to be said about outpatient experiences vs. inpatient in some fields. A lot of the MDs I know get some of the worst exposure to real FM. Its a shame, because the concerns of an FM doc are very different than those of an internist or hospitalist (e.g. long-term health maintenance and social stability vs. acute health and where can they be discharged to).

In any case, my point is, be careful with blanket statements like wards-based academia > preceptor-based always.

 

[AlteredScale]

I think it's a mistake to make blanket statements like this especially from someone who for one hasn't gone on any clinicals yet and two is a bit biased since they're interested in academic medicine, quite frankly the interest of a minority of all medical students.

In something like IM, I would strongly agree with you that an academic site would be far superior to a non-academic site, because it would require a very involved and up-to-date preceptor to get the type of education that one would get from an intern, senior, and attending team.

In something like surgery, I would argue that you'll get more out of being first-assist with a surgeon than you would with surgical interns where you might not even be scrubbing into many cases. You really wouldn't be learning how to be a surgical intern, because you wouldn't be in there at the field with them. Sure, you'll learn how to round, but you should be able to get this from other rotations and from the surgeon when they round on their consults and pre and post-op patients. Its hard to argue for that system to educate medical students when you see nursing students get as much "training" in cases as you do.

As others have said there's also something to be said about outpatient experiences vs. inpatient in some fields. A lot of the MDs I know get some of the worst exposure to real FM. Its a shame, because the concerns of an FM doc are very different than those of an internist or hospitalist (e.g. long-term health maintenance and social stability vs. acute health and where can they be discharged to).

In any case, my point is, be careful with blanket statements like wards-based academia > preceptor-based always.

True. I would say for a few of the rotations such as FM, psych that a preceptor based model is just fine. I still find myself sitting on the edge about utilizing a preceptor based model on the surgical service since I feel there's much to learn on the differences of managing pts in the SICU and post-anes unit vs pts on the general floors, things that you'd probably follow a resident team to learn about. I really do think it comes down to what the expectations are of the medical student at the end of the rotation.



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[hallowmann]

True. I would say for a few of the rotations such as FM, psych that a preceptor based model is just fine. I still find myself sitting on the edge about utilizing a preceptor based model on the surgical service since I feel there's much to learn on the differences of managing pts in the SICU and post-anes unit vs pts on the general floors, things that you'd probably follow a resident team to learn about. I really do think it comes down to what the expectations are of the medical student at the end of the rotation.

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It really depends though. If you're talking about a preceptor-based surgical rotation, its almost guaranteed you're not just at an outpatient surgical center, you're rounding on consults, SICU, and pre and post op on the floors. Obviously if you do a preceptor-based surgery (or any) rotation at a site that has a surgical (or the same) residency, you'd miss out on that though.

I suppose it puts more responsibility on you to go after opportunities that will give you the best learning experience. That's probably the main difference between clinicals at a DO school vs. clinicals at an MD school.

 

[235009]

I really do think it comes down to what the expectations are of the medical student at the end of the rotation.

The expectations for surgery are pretty clearly laid out by the NBME in their exam. Almost all of what is tested is learned outside the OR. When and why to go to surgery, when not to go to surgery, post surgical management, etc.

With regards to the rest of the discussion... Saying that FM should be an outpatient rotation has nothing to do with a preceptor based vs academic model. That's just common sense. My peds rotation had a month of inpatient (at the University med center) and a month of outpatient. At US MD school you typically rotate at more than one site during a single rotation. In fact during the outpatient portion of my peds rotation I spent several days with private practice preceptors! There is typically much less useful learning involved. I remember one of the peds preceptors "taught" me how to do weight based medication dosing for children. While clinically relevant this kind of information is completely useless to learn as a med student.

I think part of the disconnect observed in this thread comes from the fact that you guys don't realize that we have experienced both!

My IM rotation also had an outpatient component with a private practice preceptor. Like the peds experience this was also a joke. So much of what he did is not guideline recommend or evidence based (he would shotgun labs and do EKGs on everyone). As long as the insurance was going to reimburse it he didn't think twice about it. I also went with this guy to "round" with him on nursing home patients where he was "medical director". This consisted of me following him around while he signed nurses' and mid-levels' orders, making medical decisions without discussing his reasoning with me and putting me in a room with a patient with MS to chat for half an hour. Back in his office he would let me see patients but would come in and interrupt me halfway through. No presenting, didn't have time to hear what I found, etc. And this guy is what constitutes a superstar preceptor too! He graduated from my med school and was chief resident at an upper mid tier University program....20+ years ago.

Bottom line is once you venture outside the ivory tower learning takes a back seat to well...the bottom line.

So @GUH and others, I hope you guys realize we aren't (or at least I am not) speaking theoretically when we say if your whole rotation is preceptor based then this is an inferior rotation. In fact from my past experiences I am very confident in that assessment and until DO schools stop relying so heavily on them I think it is completely rational and warranted for PDs to prefer US MD students over DO students.


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[Dr Tony T. Chopper]

I wish the ward vs preceptor comparison would show up more in do vs md threads. It's much more illuminating than just the stale "they are identical other than 200 hrs of OMM".

 

[Drrrrrr. Celty]

I wish the ward vs preceptor comparison would show up more in do vs md threads. It's much more illuminating than just the stale "they are identical other than 200 hrs of OMM".

It's brought up ad nauseum.

 

[AlteredScale]

The expectations for surgery are pretty clearly laid out by the NBME in their exam. Almost all of what is tested is learned outside the OR. When and why to go to surgery, when not to go to surgery, post surgical management, etc.

With regards to the rest of the discussion... Saying that FM should be an outpatient rotation has nothing to do with a preceptor based vs academic model. That's just common sense. My peds rotation had a month of inpatient (at the University med center) and a month of outpatient. At US MD school you typically rotate at more than one site during a single rotation. In fact during the outpatient portion of my peds rotation I spent several days with private practice preceptors! There is typically much less useful learning involved. I remember one of the peds preceptors "taught" me how to do weight based medication dosing for children. While clinically relevant this kind of information is completely useless to learn as a med student.

I think part of the disconnect observed in this thread comes from the fact that you guys don't realize that we have experienced both!

My IM rotation also had an outpatient component with a private practice preceptor. Like the peds experience this was also a joke. So much of what he did is not guideline recommend or evidence based (he would shotgun labs and do EKGs on everyone). As long as the insurance was going to reimburse it he didn't think twice about it. I also went with this guy to "round" with him on nursing home patients where he was "medical director". This consisted of me following him around while he signed nurses' and mid-levels' orders, making medical decisions without discussing his reasoning with me and putting me in a room with a patient with MS to chat for half an hour. Back in his office he would let me see patients but would come in and interrupt me halfway through. No presenting, didn't have time to hear what I found, etc. And this guy is what constitutes a superstar preceptor too! He graduated from my med school and was chief resident at an upper mid tier University program....20+ years ago.

Bottom line is once you venture outside the ivory tower learning takes a back seat to well...the bottom line.

So @GUH and others, I hope you guys realize we aren't (or at least I am not) speaking theoretically when we say if your whole rotation is preceptor based then this is an inferior rotation. In fact from my past experiences I am very confident in that assessment and until DO schools stop relying so heavily on them I think it is completely rational and warranted for PDs to prefer US MD students over DO students.


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Very good explanation. I myself have only seen preceptor-based rotations work in a solid way and that was at UCSD at an outpatient endocrinology clinic with one fellow and two medical students. Said attending spent time b/t consults to teach, allowed the student to perform the interview, present the pt to us and asked them how they would manage with solid clinical pearls tied in. Without a doubt, these students also had a very strong inpatient experience with a resident team.

That's why I feel so strongly that the casual affiliations that the majority of DO schools make with small community hospitals needs to become a lot more stringent....but sadly there's still a huge variability on the aspect of those expectations and as you said, it comes with the justification for PD's to hone in on US MD students because the clinical training is structured and the checks and balances in place to ensure such training goes beyond a SINGLE core site director who throws you to the wolves with really no guidance at all.