Do residencies even care about clinical skills?

[Nookular]

After visiting several campuses I have started to notice that many of the "prestigious" schools that talk about how they are the top research school and rank the highest in terms of residency matches seem to totally neglect clinical skills in their curriculum and instead focus on research. I realize that the USNews rankings are pretty bogus, but many of the schools in the top 10 for research and what everyone would consider great schools aren't even ranked in the top 50 for clinical skills.

Obviously I want to be the best doctor I can be, and thus go to a school where clinical skills are a large part of the curriculum, but do residencies care about this at all? I feel like "research + big name = residency" and "great clinical training + smaller name = who cares."

(Specific example: Stanford and Yale not in top 50 on primary care, and an osteopathic school being #5 in primary care. I really feel like a Yale grad will get residencies over a grad from Mich. State. College of Osteopathic Medicine)

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[smq123]

After visiting several campuses I have started to notice that many of the "prestigious" schools that talk about how they are the top research school and rank the highest in terms of residency matches seem to totally neglect clinical skills in their curriculum and instead focus on research. I realize that the USNews rankings are pretty bogus, but many of the schools in the top 10 for research and what everyone would consider great schools aren't even ranked in the top 50 for clinical skills.

Obviously I want to be the best doctor I can be, and thus go to a school where clinical skills are a large part of the curriculum, but do residencies care about this at all? I feel like "research + big name = residency" and "great clinical training + smaller name = who cares."

(Specific example: Stanford and Yale not in top 50 on primary care, and an osteopathic school being #5 in primary care. I really feel like a Yale grad will get residencies over a grad from Mich. State. College of Osteopathic Medicine)

You're confusing "primary care" and "clinical training."

USNews doesn't rank schools based on their clinical training. Just because your school focuses on "primary care" doesn't mean that it has good clinical training. Similarly, just because your school focuses on the clinical aspect of medicine (over research) doesn't mean that they'll produce a lot of primary care doctors.

The ONLY way you can tell if a school has a good clinical training program is talking to the students. Does the school teach them physical exam skills during the first two years? How often do they learn basic physical exam skills and physical exam findings? Does the school use standardized patients or not? How many students pass USMLE 2 CS the first time? How much patient contact do they get?

My school focuses on "producing good clinicians" - which includes orthopedic surgeons, ophthalmologists, and surgeons. But we do not focus on producing primary care physicians. Good clinical training does NOT always = a focus on primary care.

 

[Law2Doc]

After visiting several campuses I have started to notice that many of the "prestigious" schools that talk about how they are the top research school and rank the highest in terms of residency matches seem to totally neglect clinical skills in their curriculum and instead focus on research. I realize that the USNews rankings are pretty bogus, but many of the schools in the top 10 for research and what everyone would consider great schools aren't even ranked in the top 50 for clinical skills.

Obviously I want to be the best doctor I can be, and thus go to a school where clinical skills are a large part of the curriculum, but do residencies care about this at all? I feel like "research + big name = residency" and "great clinical training + smaller name = who cares."

(Specific example: Stanford and Yale not in top 50 on primary care, and an osteopathic school being #5 in primary care. I really feel like a Yale grad will get residencies over a grad from Mich. State. College of Osteopathic Medicine)

You have to take the primary care rankings with a grain of salt -- they put great weight on things like the % of students who go into primary care, which doesn't actually tell you much about what is taught or how well it was taught. So you are drawing your conclusion based on faulty methodology. The primary care ranking mostly tells you which schools don't funnel as many folks into the specialties, not how good the students are in terms of skills. So on the allo board, you pretty much want to focus on the research rankings if you must use rankings, because that ranking (also problematic) at least focuses on the basic prestige the schools have (i.e. if a ranking doesn't put schools like Harvard, Hopkins toward the top, it is not using parameters residency directors are going to be using).

You are not going to find an allo school that doesn't teach clinical skills. Most of the top ones encourage research AS WELL, not instead of clinical skills. Every single allo school has a mandatory clinical skills/physical diagnosis class or two (most have them both in first and second year), and in every one you will spend your latter two years on the wards. I hardly think you can call that neglect. There certainly are some schools that do better than others, but you aren't going to get to the meat of this from USNews. You need to talk to attendings in the field you hope to go into, about residents they have been impressed with in the past. Every attending will have their own view, but I kind of doubt many are going to suggest that the research heavy schools do a worse job.

 

[BigRedPremed]

After visiting several campuses I have started to notice that many of the "prestigious" schools that talk about how they are the top research school and rank the highest in terms of residency matches seem to totally neglect clinical skills in their curriculum and instead focus on research. I realize that the USNews rankings are pretty bogus, but many of the schools in the top 10 for research and what everyone would consider great schools aren't even ranked in the top 50 for clinical skills.

Obviously I want to be the best doctor I can be, and thus go to a school where clinical skills are a large part of the curriculum, but do residencies care about this at all? I feel like "research + big name = residency" and "great clinical training + smaller name = who cares."

(Specific example: Stanford and Yale not in top 50 on primary care, and an osteopathic school being #5 in primary care. I really feel like a Yale grad will get residencies over a grad from Mich. State. College of Osteopathic Medicine)

?

How a school ranks in the primary care ranking has nothing to do with their emphasis on clinical skills. Many of the top schools I've interviewed at have student clinics, standardized patients, simulation centers, preceptorships, shadowing, etc. to help their students develop clinical skills early on.

 

[lord_jeebus]

I would add that at any school there is a huge range in clinical skills from the graduates.

Much like boards and residency placement, your clinical skills are primarily derived from your hard work and motivation to develop them. Any accredited school should offer you the clinical material to become a great doctor if you so choose.

 

[Law2Doc]

Many of the top schools I've interviewed at have student clinics, standardized patients, simulation centers, preceptorships, shadowing, etc. to help their students develop clinical skills early on.

They pretty much all have these things.
The OP is demonstrating why it's problematic for US News to have a primary care ranking at all. While a research ranking does a good job of quantifying which schools are the best for research, based largely on the objective data of the amount of research grant money coming in, which in turn is a nice metric for what places do the most research, the primary care ranking doesn't really do the same job. ALL schools prepare their students for the wards and residency. ALL med students will have history and physical diagnosis courses before you hit the wards. So really, all the primary care ranking tells you is that some schools students end up in primary care more frequently. But it's not like the students who have the best clinical skills go into primary care. That determination is based on the career interests and stats of the individual students. So you don't know if a school that sends 100% of its students did a really good job of teaching clinical skills and a love for primary care medicine, or a really bad job of making its students competitive for other things. Which to me negates all value in such a ranking. So you have to read this kind of data really critically. Just my two cents.

 

[Nookular]

Thanks guys. My lack of knowledge on exactly what a few medical buzz-words mean came through on this but thank you for clearing up my confusion.

Does anyone have any sources on some of the top clinical skills training schools? I was just at Pitt and their WISER center is incredible. They said stanford was one of the 4 schools to have a bigger simulation center, but when I was at stanford they didnt say anything about it... I figured if they truly had the 3rd biggest simcenter in the country they would want to show it off.

 

[lord_jeebus]

A simulator isn't going to be what makes the difference for clinical skills.

The key is your own hard work. Sick patients with clinical findings are everywhere.

 

[QuantumMechanic]

Thanks guys. My lack of knowledge on exactly what a few medical buzz-words mean came through on this but thank you for clearing up my confusion.

Does anyone have any sources on some of the top clinical skills training schools? I was just at Pitt and their WISER center is incredible. They said stanford was one of the 4 schools to have a bigger simulation center, but when I was at stanford they didnt say anything about it... I figured if they truly had the 3rd biggest simcenter in the country they would want to show it off.

Simcenters are nice (my school has a beautiful new one), but what you can't find out so easily when looking at schools is the quality of the teaching (which a simulation mannequin won't help with necessarily). The size of the simuation center isn't a very good metric for comparison, especially since class sizes differ.

 

[MrBurns10]

Does anyone have any sources on some of the top clinical skills training schools? I was just at Pitt and their WISER center is incredible. They said stanford was one of the 4 schools to have a bigger simulation center, but when I was at stanford they didnt say anything about it... I figured if they truly had the 3rd biggest simcenter in the country they would want to show it off.

One thing I'll throw in there is don't underestimate how cool it is to get to actually see the rare stuff you read about when you're at either a really large city hospital (like Jackson Memorial) or one of the "big name" hospitals. That's one thing I didn't think about so much when choosing a med school, but it's been interesting to see people from all over the country come specifically to your school's hospital for their care because they have some rare disease or are just really sick. Not that this is the biggest reason to choose a med school, but it's definitely been a plus.

 

[mikedc813]

Residencies most certainly care about clinical skills. Third year grades are the most important out of the first 3 years. What else do I need to say?

 

[Pinkertinkle]

Residencies most certainly care about clinical skills. Third year grades are the most important out of the first 3 years. What else do I need to say?

Unfortunately third year grades can be affected a lot by luck and subjective evaluations.

 

[Terpskins99]

Residencies most certainly care about clinical skills. Third year grades are the most important out of the first 3 years. What else do I need to say?

In my limited experience, I'm finding that residencies care about board scores, class rank and maybe publications. They don't especially care what your grades were during core clerkships so long as you pass, but they do take notice of students that rotate at their hospital.

Clinical skills? Well, thats a really vague term. I think most 3rd year students look like baffoons during rotations and I doubt any attending is ever impressed by anything we do. Frankly, most attendings have enough trouble keeping track of their own residents/interns. I think they classify medical students as either A) stupid or B) REALLY stupid. In the end, your clerkship evaluation is really reflective of how much they like (or dislike) you, how hard you look like you're working and how enthusiastic you appear to be.

Just my 2 cents.

 

[nevercold]

In my limited experience, I'm finding that residencies care about board scores, class rank and maybe publications. They don't especially care what your grades were during core clerkships so long as you pass, but they do take notice of students that rotate at their hospital.

Clinical skills? Well, thats a really vague term. I think most 3rd year students look like baffoons during rotations and I doubt any attending is ever impressed by anything we do. Frankly, most attendings have enough trouble keeping track of their own residents/interns. I think they classify medical students as either A) stupid or B) REALLY stupid. In the end, your clerkship evaluation is really reflective of how much they like (or dislike) you, how hard you look like you're working and how enthusiastic you appear to be.

Just my 2 cents.

*Hands the two pennies back.*
- Most of my attendings really really cared about what I was doing.
- By the end of my third year, I was not slowing down the team but helping it run more efficiently.
- Some schools don't have class rank.
- Residencies DO like to see strong evaluations and optimally Honors in the applicable core rotations.
- Board scores are pretty important for stratifying, while a publication can be a plus that distinguishes your resume some.

 

[Terpskins99]

*Hands the two pennies back.*
- Most of my attendings really really cared about what I was doing.
- By the end of my third year, I was not slowing down the team but helping it run more efficiently.
- Some schools don't have class rank.
- Residencies DO like to see strong evaluations and optimally Honors in the applicable core rotations.
- Board scores are pretty important for stratifying, while a publication can be a plus that distinguishes your resume some.

I think you may be misinterpreting what I stated.
- Attendings may care, but I don't think they have very high expectations of us.
- I also will admit that the selection criteria each residency uses probably varies based upon the specialty. But much of my opinion is based upon this survey of orthopedic surgery residency directors in 2002-2003 (orthopedic surgery being one of the most competitive residencies for quite a few years now).

In a nutshell, the study found that ortho directors rank in order of importance:
#1 Elective rotation at the site
#2 USMLE score
#3 Class rank.
Various aspects of the interview were ranked 4-6, which was followed by the recommendation letter from an ortho surgeon at #7.
Having published research came #14

 

[nevercold]

- I also will admit that the selection criteria each residency uses probably varies based upon the specialty. But much of my opinion is based upon this survey of orthopedic surgery residency directors in 2002-2003 (orthopedic surgery being one of the most competitive residencies for quite a few years now).

In a nutshell, the study found that ortho directors rank in order of importance:
#1 Elective rotation at the site
#2 USMLE score
#3 Class rank.
Various aspects of the interview were ranked 4-6, which was followed by the recommendation letter from an ortho surgeon at #7.
Having published research came #14

Touché. For ortho I would definitely agree with your assessment. I think my points are more applicable for the larger specialties like medicine, pediatrics, and general surgery.