Application process: Looking back as a 4th year

[Myuu]

It's an excellent post if you would like to have (and maintain) a completely distorted view of PBL, sure.

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[Narmerguy]

It's an excellent post if you would like to have (and maintain) a completely distorted view of PBL, sure.

That's all that you took away from that?

 

[Myuu]

That's all that you took away from that?

Hardly. That's all I chose to comment on.

 

[gravitywave]

 

[bucks2010]

Hardly. That's all I chose to comment on.

Since OP started med school around 2000 I think it's safe to say you two may be talking about 2 very different curricula.

 

[Depakote]

To add my own comments, looking back as a 4th year...

Pre-meds tend to focus on the pre-clinical curriculum a lot. Ask about the 3rd and 4th year.

It's a much bigger deal to know whether you'll be farmed out to rural and private practice offices and how similar your experiences will be to those of your classmates than how many students to a cadaver in first year anatomy? Which hospitals are rotated through? What is the quality of the rotations? How are 3rd-4th year grades determined? What percentage are subjective clinical evals compared to standardized tests?

To be honest, I'd rather know what percentage of students actually deliver a baby in 3rd year than the school's "USMLE Pass Rates".

When evaluating a school, you need to find factors you don't have control over. They'll present most of the material to you for first and second year in one way or another but your retention will be a function of the time/effort you put into it. You have less direct control over the experience you receive in your clerkships. If the preceptors or patient material are poor, you're already at a disadvantage.

 

[nfo2010]

I'd love to read more discussion on PBL vs. lecture. Every school I interviewed at mentioned that they were trying to get more PBL in their curriculum, or that they were doing more to "integrate" everything.

 

[Myuu]

Since OP started med school around 2000 I think it's safe to say you two may be talking about 2 very different curricula.

Oh, certainly.

I'd love to read more discussion on PBL vs. lecture. Every school I interviewed at mentioned that they were trying to get more PBL in their curriculum, or that they were doing more to "integrate" everything.

That can be very school-dependent. It doesn't seem to work well at schools that don't get behind it fully. We do a hybrid format with 6 hours lecture and 6 hours PBL for the week and the flexibility is actually quite nice. You can use your extra time to find out how you best learn material and then do that, or pursue areas you're particularly interested in in more depth, then discuss it in your PBL sessions if applicable.

The way we do it, we have PBL (which we call IQ) three times per week (MWF). On Monday, we get two clinical vignettes, which we read through and use to make learning objectives that are relevant to both the case and the block. A facilitator who may or may not be a content expert is present with the official learning objectives to make sure we don't go too far off course or drill into meaningless sublevels of detail, but otherwise does not interfere with the process. They make sure to give us plenty of online resources to start looking at, so it's not like they leave you entirely up to your own devices. We then go home (or to the library or whatever works best for you), research the objectives the group came up with, and come back to have a robust discussion of them on Wednesday and Friday. IQ works quite well in this way and should not be used as primary source of learning. Like all parts of our curriculum (lecture included), it is but one of many things that build on each other to create a richer whole. The group discussion can also be a great way of presenting alternative ways of thinking about problems that may facilitate greater understanding of the material.

In summary, IPBL the way we do it.

 

[CardiacIntensivist]

To add my own comments, looking back as a 4th year...

Pre-meds tend to focus on the pre-clinical curriculum a lot. Ask about the 3rd and 4th year.

It's a much bigger deal to know whether you'll be farmed out to rural and private practice offices and how similar your experiences will be to those of your classmates than how many students to a cadaver in first year anatomy? Which hospitals are rotated through? What is the quality of the rotations? How are 3rd-4th year grades determined? What percentage are subjective clinical evals compared to standardized tests?

To be honest, I'd rather know what percentage of students actually deliver a baby in 3rd year than the school's "USMLE Pass Rates".

When evaluating a school, you need to find factors you don't have control over. They'll present most of the material to you for first and second year in one way or another but your retention will be a function of the time/effort you put into it. You have less direct control over the experience you receive in your clerkships. If the preceptors or patient material are poor, you're already at a disadvantage.

+1

Definitely agree with this. It is understandable to focus mainly on the basic science years since the next major goal is Step I. However, the basic science years are pretty standardized and pretty malleable relative to the third and fourth years. If you don't like a class in the first two years, just don't go and study on your own. It won't work like that in the clinical years. Furthermore, the 3rd year clerkships matter so much more for residency. If most people in the school are not having a good time, it is likely you will not either. Ask about quality of teaching during 3rd year and overall satisfaction of 3rd and 4th years. Variety of exposure and hospitals are also important questions to try to gauge. You really want to make sure you're paying for a good education when it really counts.

 

[gravitywave]

OMG Myuu has a new avatar

/mind = blown, I think the earth just shifted a little

 

[Myuu]

I'd love to read more discussion on PBL vs. lecture. Every school I interviewed at mentioned that they were trying to get more PBL in their curriculum, or that they were doing more to "integrate" everything.

OMG Myuu has a new avatar

/mind = blown, I think the earth just shifted a little

It was required for participation in a lounge game.

 

[CardiacIntensivist]

I'd love to read more discussion on PBL vs. lecture. Every school I interviewed at mentioned that they were trying to get more PBL in their curriculum, or that they were doing more to "integrate" everything.

PBL is the worse idea ever. I don't want to spend my days arguing with a bunch of med students who are as clueless as I am.

 

[Myuu]

PBL is the worse idea ever. I don't want to spend my days arguing with a bunch of med students who are as clueless as I am.

That is not in any way how it works here.

 

[CodeBlu]

Bump!

 

[Doctor Cat]

OP, thanks for the long and informative post. It was very thoughtful of you to spell out so much from your experience for posterity. Gracias.

 

[Techmed07]

Bump.. Anybody have anything to add.

 

[FIREitUP]

PBL is the worse idea ever. I don't want to spend my days arguing with a bunch of med students who are as clueless as I am.

Just had intro to CBL today. Don't really feel like listening to med students who like the sound of their own voice. This will be an epic waste of time.

 

[Morsetlis]

Also like to add:

Consider how likely you are to get robbed walking between class and home.

 

[MikeS 78]

You're welcome

Someday when you guys are done with your training, you will realize that they could teach the first two years anyway they want, it all comes down to how much time you spent learning in a classroom

 

[CodeBlu]

You're welcome

Someday when you guys are done with your training, you will realize that they could teach the first two years anyway they want, it all comes down to how much time you spent learning in a classroom

Whoa, you made an appearance??

Sweet. How's that NSG treating you?

 

[fromnova]

wow... very good post at the start.

I personally HATE IT when people are like: I love the friendly atmosphere at this school, the faculty really cares about the students---


Uhhhhhhhhhhhh WTFFFFFFFFF I'D HOPE SO....

 

[asrikrishnan]

This was such a great post. I wish I had known about it before going to all my interviews.. seems like there were some important questions that I could have asked. I hope the OP is doing well also!

 

[jesse120]

bump!

 

[MikeS 78]

I am doing pretty well...done with training and out in practice taking out brain tumors....

 

[DoctorPardi]

Wow I book marked this thread when I was a pre-med and now I am about to graduate.

I have absolutely loved medical school and I am doing Orthopedic Surgery. The friendships I have had and the amazing times we shared going through this completely insane process I will never forget.

The application process is very difficult and frustrating, it seems like the most difficult thing you will ever do. Then something happens to people once they're here, we all step our game up and study and prepare and work harder than we ever thought we could. You will work never ending shifts, be exhausted, study for 16 hours a day and you'll be doing it with the people who will be your best friends and colleagues for the rest of your life. Some how I think that shared suffering builds a kind of camaraderie that you're able to overcome anything together that other people (maybe outside the military) can never appreciate.

Medical school for me was a great experience. I have trouble knowing whether I should suggest it to others though. You have to be dedicated and you have to know you want it. If you don't want to be a doctor medical school may be a terrible decision. It's such a long process you have to be able to forget about the long term and focus on the now and enjoy it.

If anyone has any questions I am happy to talk about anything specific. I really got a lot of good information from SDN and would be happy to give back if I can.

 

[VisionaryTics]

I am doing pretty well...done with training and out in practice taking out brain tumors....

Still spot on advice. As true now as it was eight years ago.

Makes me glad I go to a school with a culture of teaching and student experience.

 

[SaintJude]

I am currently in my 4th year of medical school. I am here to say that most of what people allow to weigh in on their decision to attend medical school is pretty irrelevant. I base this statement on 1) what I took into consideration 2) what other people I met on the trail into consideration 3) talking to prospective applicants 4) discussions with fellow classmates. This is in large part because most information about schools comes from is from first year students, who really have no idea of what the school is like, sales angles of schools attempting to reel in students etc, and random discussions from people who don't know much more than you do.

What is not important:

1) Impression of students: this is bogus, totally bogus. Every school has a fairly similar mix of a few types and if you think you can tell what students are like by meeting the tour guide and 3 other people you are fooling yourself.

A) Gunners- Every american medical school has gunners. Furthermore, your interview process will not allow you to prove or disprove my theory, as these people generally aren't doing interviews. Also don't let anyone tell you that theres no competition at their school because there is always someone who wants to do ortho at the hosp for special surgery, even at DO schools.

Moreover if you are really worried about dodging the "Gunners" then 90% chance that you are one....my observational experience

B) Slackers- These are the real people I'd be worried about: they tend not to show up to stuff and make everyone look bad.

C) Superstars- Every school has these, good schools have a few more.

D) Everyone else (prob 45-60% of a class)

2) Curriculum- Guys I hear this alot and read this on this board alot....looking back I thought this was a big deal, now I say "who really cares." Here's my breakdown of the issue

A) PBL- you have no background to base your case based learning on...and will not have it until year 2 and probably 1/2 through that (when you start organ system pathology/pathophys). Really how can you expect someone to understand CHF related fluid retention with no prior knowledge of renin-angiotensin and the kidneys...silly

B) lectures vs no lectures- For all practical purposes, you are going to teach your damn selves 90% of the first 2 years.
The reason for this is that most of the first two years really is vocab and getting your mind around a few key concepts so that third year you can actually understand what your residents and attendings are saying. So despite all the hype about new novel ways of learning it boils down to you hanging out with Robbins pathology, a microscope/online slides and a cadaver and figuring it out.

As far as clinical relevant knowledge year 1-2 is more or less the about the same, deal with it. I say this coming from an Ivy so trust me.

3) Quality of facilities- Theres three reasons why this is pretty irrelevant
A) they never show you all the facilities-

B) Does learning in an old building really impact your education

C) When you're trudging in the snow at 4 am to rounds on surgery are you really going to notice or care what the outside of the hospital looks like......highly doubtful

4) extracurricular/social stuff- This is +/-. If you have a passion for playing the violin...can't live without it and are willing to do it despite significant other time committments..this can be a plus

however, do not get the false impression that a medical school class remains this cohesive bunch of social butterflies for 4 years. Generally, everyone is very busy and alot of people are overwhelmed. The attendance at class events dropped preciptiously year 2.

5) early patient contact- I think this is a total sales pitch: To provide an anecdote: It was january of my second year. we were in our physical diagnosis class, having our first group interview with a patient with renal failure and volume overload causing CHF.

so the encounter goes like this.....

A classmate "so what brings you to the hospital today"
patient: "I am having a tough time breathing, it feels like im drowning when I lie flat"
Classmate "that sounds bad"

long silence.

This classmate was a smart guy and ended up being AOA and this was 1 1/2 years into medical school.....

so if thats 2nd year what are you really going to do interviewing patients 1st year.......basically acquire bad habits that you will need to fix later in life. Is it a total waste? no. However do not make this any more than a minor consideration.


Things that are important

1) What is the 3rd year like and how is it structured?:

I almost never hear any real questions or comment from applicants regarding this topic. In the end this is the only real difference between schools, and probably could be the only real question to ask? more specific questions?

a) How are the rotations structured? What is your role on the wards? Do you have a clear role Do you get your "hands dirty" alot, or is it alot of shadowing? This is very important. You really don't learn much by watching people do stuff and if they work you down to a minimal role you will not gain much experience and will suck for several months into internship.

Now I'm not saying you demand the right to cross clamp the aorta during a CABG, but medicine is not a spectator sport and if the school doesn't have a culture of teaching (i.e. alot of patients are private patients, medical students aren't allowed to do anything) it will be a long, boring 3rd year.


2) Where do 3rd year evaluations come from?

Alot of people go in with this attitude "I am here to learn not to get grades." I agree with this attitude 85%. However, using that attitude indiscriminantly is impractical and can lead to some evaulations that you are not too happy with, it happens

You probably can't please everyone equally. This is especially true on surgery and medicine where there is not enough hours in the day.

Thus, the recommendation I make to everyone is to figure out roughly who writes the evaluation and what they expect and make sure you do a really good job on that. I do not recommend kissing up....However, it is really easy at times to get caught up in "which 5 minute presentation do I spend preparing for tomorrow. " This is why if you know who is grading you you can prioritize which person you pull the NEJM articles out for, and who gets the 15 minute before cram session off up-to-date.

Understand however while this happens at all schools (its how the beast works) not all schools do a reasonable job at making this fair or letting you know who is grading you or what you are supposed to do. Thus you should really make an effort to ask questions such as for every rotation do you have an attending directly responsible for evaluating you, or a preceptor (someone not taking care of patients that you are caring for who evaluates your academic abilities and analytic abilities? ideally your grade should come roughly equally from both.

3) Where do the students end up? If you dont want to do primary care, and 75% of school X does. Guess what, you are signing up for 15 weeks of primary care rotations at that school. Conversely, if you want to do general internal medicine or family medicine....and you come to a school that puts out 25 orthopods and 10 neurosurgeons a year.....you will spend alot of time learning about surgeries that you will never perform in your life.


4) How are medical students protected from scut?

If they cannot give you a real answer to this question expect to learn alot about running bloods to the lab and wheeling patients to the CT scanner and very little about managing an MI.

Some schools do a good job of setting up systems to prevent this, however I have also met interns who told me that they failed the surgery shelf because their school was rampant with scut and they didn't learn anything. I think my school did a very good job at scut control, however I have wheeled my share of patients to CT at 2 am.

5) How receptive is the administation to fixing problems and/or disciplining out of line behavior, espcially from residents?

trust me when you have an ID class where the course director is terrible, you will really appreciate it when a new course director is hired the next year.

6) how is the research opportunities at this school?

If you want to end up at an academic program, there will come a time when you will seek papers and if they are not there to be written then you will understand the meaning of this question. If not then forget I mentioned this.

7) how good is this school at focusing on the bread and butter?

This is especially relevant if you are looking at an academic powerhouse type place. Typically alot of times you will find that big tertiary centers tend to be filled with people who A) study esoteric diseases, B) specialize in highly uncommon or speciallized surgeries or diagnostic tests, or C) only doing big commando surgeries on cases people in the community looked at and said no way im touching that.

This is something you may be interested in as an attending or at the end of your residency. However in medical school most of these areas will not be your field and learning the literature on steroid tapers for patients with the CREST syndrome, the signs and symptoms of spinocerebellar ataxia 8 or how to resect a pseudomyxoma peritonei is probably not the best use of time in your only exposure to the area. Its easy to get caught up in that stuff, however good schools recognize the nature of the academic beast and try to make sure that you leave knowing the stages of active labor, how to read an EKG and how to manage childhood asthma.

I hope this helps
mike

good to look at before 2nd look.

 

[Merely]

Great post man

 

[MonkeyDRuffy]

Great post, very insightful. What type of grading structure is used in 3rd and 4th year?

 

[ComfortCreature]

bump again.

Glad I've read this now, wish I read it the first time I applied. Impressed and elated by how long this thread has survived.

 

[am9451]

Wow, wish I had seen this thread back when I applied. As a current m4 now revisiting sdn as I start to prepare for residency apps, I think the OPs advice was and still is spot on. I wanted to add some thoughts of my own.

In terms of the preclinical years, I think the most relevant questions are 1) is the curriculum pass/fail and 2) how much time you are actually required to spend in class. As an independent learner who has always learned more from self study than snoozing through a lecture, I loved having a flexible curriculum. Trust me, you can spank boards without sitting in a lecture hall 8 hours a day.

In terms of the clinical years, this is DEFINITELY where your focus should lie. I agree with the OP that premeds (myself included) don't realize this enough. In addition to the excellent advice already discussed, I would add the following:

1) Elective time during m3 or early m4 year. I wound up choosing medicine, which every m3 will have. But I did have some angst over not having any elective time during m3 year to explore some of the non-core specialties, ie anesthesia, rads, surgical sub specialties etc. Granted, front loading m3 year has made for a sweet sweet m4 year. But if you're strongly considering a particular subspecialty, I'd recommend making sure you will have time to actually check it out within your schools curriculum!

2) ICU experience. I know several med schools do not require an ICU month prior to graduation. Ours requires that you complete a sub-I in the ICU as an m4, which may sound scary, but definitely less scary than starting intern year without learning how to manage the sickest patients in the hospital. I think having an ICU requirement speaks to our schools general approach to giving med students a lot of experience and responsibility to prepare us for residency. So I'm for it!

3) Already addressed, but m3 and m4 autonomy. You will look like a clown if you tell interviewers you want to independently manage 5 patients as a brand new m3. But getting some idea from the clinical students whether or not they feel like they are given opportunities to come up with plans for patients and play intern with appropriate supervision would be helpful.

Good luck to applicants! It's been a great ride so far.

 

[Mavii]

This thread was very insightful as I, and I'm sure many others, will be making some tough decisions in the coming months. Thank you to all who contributed.

 

[earf]

Wanted to bump this thread because I feel like it's useful advice!

 

[GomersGoToGround]

Bump, since I've gotten a few messages from students asking how to decide between schools.

Mentioned in an earlier thread, IIRC by Catalystik. I did not find this on my own.

 

[efle]

Good bump, glad I read it. People seem very concerned about things like P/F vs graded second year and match list for the specialty they somehow already decided is for them. Knowing what is actually worth caring about is huge.

Thanks mike

 

[Affiche]

Bump! Interview season has started

 

[Oh_Gee]

what's a Polite way to ask "how does your school Prevent scut work" in an interview , lol

 

[TheShowGoesOn]

Thanks for this.

Cheers

 

[Affiche]

what's a Polite way to ask "how does your school Prevent scut work" in an interview , lol

I think asking how rotations are structured doesn't necessarily answer this question.
Calling in the trusted @Goro and @gyngyn because I'm wondering too....

 

[gyngyn]

I think asking how rotations are structured doesn't necessarily answer this question.
Calling in the trusted @Goro and @gyngyn because I'm wondering too....

It depends on what one means by "scut."
The things considered scut by interns can be a good learning experience for a medical student (NG tubes, lines, catheters...).

 

[Affiche]

It depends on what one means by "scut."
The things considered scut by interns can be a good learning experience for a medical student (NG tubes, lines, catheters...).

Things like wheeling the patients around, chasing after labs, etc. (based on previous posters)

 

[Goro]

How about disimpacting stools?

Might help some the entitled Millennials learn some humility.

It depends on what one means by "scut."
The things considered scut by interns can be a good learning experience for a medical student (NG tubes, lines, catheters...).

 

[efle]

How about disimpacting stools?

Might help some the entitled Millennials learn some humility.

its pretty funny how my generation is simultaneously the most coddled until adulthood and the most ****ed once we get there. Baaaad combo

 

[Oh_Gee]

How about disimpacting stools?

Might help some the entitled Millennials learn some humility.

That'll go great for "what was a humbling moment for you" at residency interviews, right?

 

[md-2020]

its pretty funny how my generation is simultaneously the most coddled until adulthood and the most ****ed once we get there. Baaaad combo

How exactly are we the most ****ed generation? I'd argue society is far more developed and stable as compared to previous decades and centuries...

Just because we won't get stuff like social security doesn't mean our future is bleak or something.

 

[Affiche]

How about disimpacting stools?

Might help some the entitled Millennials learn some humility.

Before this spirals into another stupid debate....

I think previous posters referred to ''scut'' meaning that they were mostly shadowing during rotations and when they did participate in anything it was to wheel a patient somewhere. Thus, they didn't feel they were actually learning much. What is the best way to ask a school how they protect their med students from having those experiences?

 

[Goro]

To gyngyn and me, scut work means the unpleasant stuff, not the boring stuff. Maybe it's a Baby Boomer thing.

Before this spirals into another stupid debate....

I think previous posters referred to ''scut'' meaning that they were mostly shadowing during rotations and when they did participate in anything it was to wheel a patient somewhere. Thus, they didn't feel they were actually learning much. What is the best way to ask a school how they protect their med students from having those experiences?

 

[Affiche]

To gyngyn and me, scut work means the unpleasant stuff, not the boring stuff. Maybe it's a Baby Boomer thing.

Maybe. Let's pretend I didn't use the word scut, then. Is there an appropriate way to ask how a particular school ensures that their students actually learn things during rotations, as opposed to idly observing?

 

[gyngyn]

Things like wheeling the patients around, chasing after labs, etc. (based on previous posters)

Oddly enough, the coin of the realm in a teaching hospital is your ability to contribute to the success of the team. When all added value that a student can contribute has been removed, they actually become peripheral to the teaching they so long for.

 

[Affiche]

Oddly enough, the coin of the realm in a teaching hospital is your ability to contribute to the success of the team. When all added value that a student can contribute has been removed, they actually become more peripheral to the teaching they so long for.

So then what are the important questions to ask to ensure that we don't end up peripheral to the teaching of clinical skills?
There has to be a way that students can sort out of which schools prioritize rotations and which schools don't. I'm guessing that most pre-meds don't know enough (I certainly don't) to come up with the important questions about 3rd and 4th year at this stage, but it seems like those are important things to consider when choosing a school.