Northwestern clinical experience

[blue flowers]

Hi.
Does anyone have insight into the clinical experiences students get at Northwestern? The clinical years were not covered at all during my interview day, and since it was my first interview, I didn't realize how big of an omission this was.

I am curious how accessable the attendings and residents are, how much responsibility is given to med students, whether med students are given their own patients, etc. I am also curious whether there is any possibility of gaining clinical experience at Cook County Hospital during the third and fourth year rotations.

Are there any Northwestern med students out there who can address this? Did anyone else get a better feel during their interview day?

Thanks.

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[modelslashactor]

UCLAMAN is an ms4 and wrote me a pretty good PM on this very subject. however, I am pretty sure it is against the forum rules to post anything from PMs, so I'll sum it up: they have a bunch of different hospitals they can rotate through so there's good opportunities for other experiences.

(my opinions start again here) I don't know about a Cook County affiliation, but I also don't understand why people love this place so much. You could probably do an away there, but I don't think it's one of their affiliates.

One thing you have to think about with Northwestern is that there'll be A LOT of private patients there. That doesn't mean there won't be anything for you to do, but it would also be naive to think you'd see as many privates at any other hospital in Chicago.

 

[Frankie.A]

I am friends with an M4 - she says that first year you have virtually no patient contact with a lot more contact second year.

 

[ESzczesniak]

I'm a first year at NU and feel the oppurtunities for patient contact are pretty good. By strict standards, the required portions of the curriculum require no real patient contact until second year. However, this is only the minimum of the curriculum. First of all, the official classes have you doing significant work with patient instructors (actors) to learn general communications as well as physical exam. In addition to this, NU has several free clinics that you can volunteer at as a medical student and be responsible for a large amount of the patient interaction. I have been at clinics where I have done the entire physical and history as an M1 and then conferred with the attending. There are also several organized programs to go into the hospital and work with patients, plus all the attendings I have met so far have been happy to work out a way I could shadow them, whether it be on rounds with a cardiologist or in the OR with a surgeon. Like I said, all of these are optional and no patient contact is required first year, but it is easy to get it if you want.

In the second year, you work with preceptors once to twice a week to do physical exams for patients in a internal medicine practice which means required patient contact for at least 3-4 hours a week.

I can't really speak much for third and fourth year right now, but the attendings I have worked with were very eager to get medical students involved in their specialties. Obviously this is a kind of self selecting group though since they have chosen to let me shadow them and I don't know if there may be attendings who aren't so pleasant to work with.

 

[whynot]

bump

 

[neom3x11]

-

 

[Senor Fish]

That there was a quality post, ESzczesniak. Thank you.

I'm a first year at NU and feel the oppurtunities for patient contact are pretty good. By strict standards, the required portions of the curriculum require no real patient contact until second year. However, this is only the minimum of the curriculum. First of all, the official classes have you doing significant work with patient instructors (actors) to learn general communications as well as physical exam. In addition to this, NU has several free clinics that you can volunteer at as a medical student and be responsible for a large amount of the patient interaction. I have been at clinics where I have done the entire physical and history as an M1 and then conferred with the attending. There are also several organized programs to go into the hospital and work with patients, plus all the attendings I have met so far have been happy to work out a way I could shadow them, whether it be on rounds with a cardiologist or in the OR with a surgeon. Like I said, all of these are optional and no patient contact is required first year, but it is easy to get it if you want.

In the second year, you work with preceptors once to twice a week to do physical exams for patients in a internal medicine practice which means required patient contact for at least 3-4 hours a week.

I can't really speak much for third and fourth year right now, but the attendings I have worked with were very eager to get medical students involved in their specialties. Obviously this is a kind of self selecting group though since they have chosen to let me shadow them and I don't know if there may be attendings who aren't so pleasant to work with.

 

[blue flowers]

Thanks for your feedback, slashie.

I don't know about a Cook County affiliation, but I also don't understand why people love this place so much.

I can't speak for other people, but I am interested in working in a public hospital, so gaining experience there would be a plus for me. However, I also want to go to the best school I can, so I would like it if my top pick schools had public hospital affiliations. While I am impressed with the quality of care offered at NMH, I know that it is not the norm in public hospitals and probably won't be any time soon. An understanding of how medical care should be given in my mind needs to be balanced with knowledge of what is the status quo in the public sphere. I don't want to be caught off guard in a residency or practice in a public hospital having only experienced the more ideal conditions made possible by the Feinbergs. I want to be comfortable practicing in both ideal and less-than-ideal conditions, and confident that I could deliver high quality care in both.

So, while I would very much like to attend Northwestern because I liked their program, I want to make sure that I would be able to gain experience outside of their private hospital system. It seems that while this isn't part of their standard offerings, it would be possible.

 

[ESzczesniak]

While I am impressed with the quality of care offered at NMH, I know that it is not the norm in public hospitals and probably won't be any time soon. An understanding of how medical care should be given in my mind needs to be balanced with knowledge of what is the status quo in the public sphere.

Don't be completely fooled by NU's private hospital affiiations. NMH is the trauma center for all of downtown Chicago, plus a number of the near north and some western areas. Also, approximately 15% of all NMH patients are uninsured--a pretty healthy number. A public hospital it certainly is not, but don't think that it means you won't get a lot of exposure to these kinds of issues.

 

[katester25]

Northwestern is also affiliated with the Jesse Brown Veterans Administration Medical Center. Rotations there provide an opportunity to work with more low-income and minority patients.

I think that rotations in family medicine and primary care internal medicine also provide opportunities to work in a variety of community-practice settings, not all of which are as posh as NMH.

 

[UCLAMAN]

Wow...its been awhile since I have put some smack down in this forum.

I thought I should make a return and chime in on this topic.

I can't remember what I actually wrote to modelslashactor back in the day. nevertheless...as an MS4 who has rotated through every single hospital that northwestern rotates through and having about 2.5months of medical education left to fulfill I can give you all what i think now(having hindsight into my brief medical school career.)

We have 5 main hospitals where we do our rotations. Our residents also rotate through all 5 of these hospitals. So as a medical student you will always be supervised by a Northwestern resident or intern.

1. The main hospital is Northwestern Memorial Hospital(NMH). It is a 700+ bed facility that always fills its beds. It is not uncommon for the hospital to go on "bypass" once or twice a month and divert new patients for about half a day because the hospital is so busy and all the beds are taken. NMH gets all the crazy/weird/fascinomas for the area. Often, people get transferred to NMH because its an academic center and consequently is better equipped to figure out what is wrong with someone when the local community hospitals cant figure things out. Remember, many of the faculty are world-renowned in their respected fields, from neurosurgery to ophthalmology, to cardiology, to obstetrics and gynecology.

During the interview day all you get to see is the main NMH hospital. People tend to walk in and think when they see the mahogany furniture, the oil paintings, the flat panel tv's that NMH only serves Oprah and her friends. This could not be further than the truth, there is a significant number of indigent patients(i have had to care for many a homeless person on my rotations at NMH). Yes, there are affluent patients there. However, in my opinion there is an excellent mix in the patient population at NMH. Furthermore, the patients(rich or poor) rarely if ever object to being cared for by a medical student.

The surgical side of NMH is ridiculous! There are 30+ operating rooms in the hospital. At 7am when the ORs start moving, the pre-op area looks like O'Hare airport the friday before the Superbowl. Beds are wheeled in one after the other into the OR area as if it were planes being cleared for take-off.

I also want to add another note...On this message board(and perhaps it is a misconception by pre-meds across the nation) people always talk about "MY patient." you have to realize that there is no such thing as "MY patient." At least not in a solitary sense. Medicine is a TEAM SPORT. Get that through your heads now. In ANY teaching institution in the US the way it works is that as a 3rd year medical student you are given several patients to follow(At NMH the most I was "carrying" was 4-5 and the average was 2-3). Remember, as a 3rd year you are NOT A PHYSICIAN yet...in reality you don't know jack. As a 3rd year student you always have an intern who holds your hand during your rotation. Yes, it is "your patient." You see that patient by yourself when they get admitted, you must round on them by yourself every morning(before the whole TEAM rounds), you can put orders in for them, and when the TEAM rounds(ie yourself, the interns, the senior resident, and the attending physician) YOU as a 3rd year medical student are presenting the patient to the TEAM. Hopefully you have some insightful things to say during said presentation. With that said, your intern is really the person who makes things run and actually signs orders, and knows which tests to order and fills in gaps in your presentation to the team. I dont care if you are at Harvard or Cook County, this is how medical hierarchy is structured(or some minor variation upon this theme). Now, at a place like cook county the reason some people like(or actually dislike it) is because the nurses don't do jack and the ancillary services suck. So the medical student frequently gets to do blood draws, arterial blood gases, blood cultures etc. But the point is this...as a 3rd year medical student do not expect that you will be the only person running the show and that all you have to answer to is the attending. Nope...you have to answer to your intern who answers to the resident senior who answers to the attending. again, subtle variations depending on institution.

...i digress...

 

[UCLAMAN]

2. Another hospital where the majority of your clinical work may occur is Evanston Northwestern Hospital(ENH). The hospital is a private hospital a subway ride(or shuttle) ride away north of the downtown campus. It is near the main Northwestern Undergrad campus. I am actually a week away from finishing my Medicine Sub-Internship there. The feel is much less formal than NMH. Thats not to say that teaching does not occur. I actually think that the teaching is excellent at ENH. But it is less formal in that the attendings and residents won't police you as much for sloppy presentations whereas at NMH the attendings tend to hold you to a slightly higher standard. Again, more style than a difference in substance. ENH also gets its share of indigent patients but the majority of the patients you will see are geriatrics who have multiple medical problems. You will get excellent training here because every patient you get has at least 3 organ systems failing if not more. furthermore, despite the fact that it is a private hospital, it is still very much a teaching hospital in that they allow medical students to do things. I have done several lumbar punctures and arterial blood gases as a student at ENH.

3. Another hospital which I highly recommend spending some time at is the VA hospital. Our VA experience is at the VA WESTSIDE/Jesse Brown right in the heart of the medical district and across the street from Cook County. I spent 6 weeks of my internal medicine rotation there. If you want a patient population that is 100% indigent and 100% super sick and 100% non-compliant this is the hospital for you. Get ready for blind diabetics with maggots eating their necrosed diabetic peripheral neuropathy ulcers and actually need their legs amputated. get ready for tuberculosis patients coughing up blood who insist on trying to escape from isolation rooms. Get ready for learning how to manage alcohol withdrawal on top of all their other healthcare issues. Get ready for MRIs that do not get done unless you physically wheel your patient down yourself. get ready for blood draws that do no get drawn unless you draw them yourself. I have to say...everyone should have a VA/county experience in their medical schooling. However, for those of you who clamor for having this experience for ALL of your clincal rotations, realize that a lot of the BS you have to put up with actually can detract from your learning. For medical education you want a good mix of poor/county/indigent and an equal amount of normal private-type care. Nevertheless, I think Northwestern does an excellent job of covering all aspects of clinical health education thru these three main hospitals.

 

[Oschemi]

Wow...its been awhile since I have put some smack down in this forum.

I thought I should make a return and chime in on this topic.

I can't remember what I actually wrote to modelslashactor back in the day. nevertheless...as an MS4 who has rotated through every single hospital that northwestern rotates through and having about 2.5months of medical education left to fulfill I can give you all what i think now(having hindsight into my brief medical school career.)

We have 5 main hospitals where we do our rotations. Our residents also rotate through all 5 of these hospitals. So as a medical student you will always be supervised by a Northwestern resident or intern.

1. The main hospital is Northwestern Memorial Hospital(NMH). It is a 700+ bed facility that always fills its beds. It is not uncommon for the hospital to go on "bypass" once or twice a month and divert new patients for about half a day because the hospital is so busy and all the beds are taken. NMH gets all the crazy/weird/fascinomas for the area. Often, people get transferred to NMH because its an academic center and consequently is better equipped to figure out what is wrong with someone when the local community hospitals cant figure things out. Remember, many of the faculty are world-renowned in their respected fields, from neurosurgery to ophthalmology, to cardiology, to obstetrics and gynecology.

During the interview day all you get to see is the main NMH hospital. People tend to walk in and think when they see the mahogany furniture, the oil paintings, the flat panel tv's that NMH only serves Oprah and her friends. This could not be further than the truth, there is a significant number of indigent patients(i have had to care for many a homeless person on my rotations at NMH). Yes, there are affluent patients there. However, in my opinion there is an excellent mix in the patient population at NMH. Furthermore, the patients(rich or poor) rarely if ever object to being cared for by a medical student.

The surgical side of NMH is ridiculous! There are 30+ operating rooms in the hospital. At 7am when the ORs start moving, the pre-op area looks like O'Hare airport the friday before the Superbowl. Beds are wheeled in one after the other into the OR area as if it were planes being cleared for take-off.

I also want to add another note...On this message board(and perhaps it is a misconception by pre-meds across the nation) people always talk about "MY patient." you have to realize that there is no such thing as "MY patient." At least not in a solitary sense. Medicine is a TEAM SPORT. Get that through your heads now. In ANY teaching institution in the US the way it works is that as a 3rd year medical student you are given several patients to follow(At NMH the most I was "carrying" was 4-5 and the average was 2-3). Remember, as a 3rd year you are NOT A PHYSICIAN yet...in reality you don't know jack. As a 3rd year student you always have an intern who holds your hand during your rotation. Yes, it is "your patient." You see that patient by yourself when they get admitted, you must round on them by yourself every morning(before the whole TEAM rounds), you can put orders in for them, and when the TEAM rounds(ie yourself, the interns, the senior resident, and the attending physician) YOU as a 3rd year medical student are presenting the patient to the TEAM. Hopefully you have some insightful things to say during said presentation. With that said, your intern is really the person who makes things run and actually signs orders, and knows which tests to order and fills in gaps in your presentation to the team. I dont care if you are at Harvard or Cook County, this is how medical hierarchy is structured(or some minor variation upon this theme). Now, at a place like cook county the reason some people like(or actually dislike it) is because the nurses don't do jack and the ancillary services suck. So the medical student frequently gets to do blood draws, arterial blood gases, blood cultures etc. But the point is this...as a 3rd year medical student do not expect that you will be the only person running the show and that all you have to answer to is the attending. Nope...you have to answer to your intern who answers to the resident senior who answers to the attending. again, subtle variations depending on institution.

...i digress...

Thanks a lot UCLAman. I am interviewing there on Wed and this info is very important.

 

[UCLAMAN]

yeah...theres more that we have to offer...

4. For you aspiring pediatricians out there...NMH does not provide any pediatric care. ZERO. So you may ask..."where the hell do you guys get your pediatric training?" Excellent question! We get our peds experience at Children's Memorial Hospital of Chicago(CMH). It is only one of the best Children's hospitals in the nation and undoubtedly takes ALL of the weird/odd/fascinoma cases in the city(ok not all...UofC gets a few too. but i would argue that the majority go to children's). The faculty at CMH are also world class. The residents are some of the bes tin the nation.

5.Prentice Women's Hospital - How in the hell could I forget about one of the BEST OB/GYN hospitals in the nation? Also keep in mind, the new Prentice hospital is opening this October. Many of the advances in birthing and laparoscopic surgeries and gynecologic oncology were made at Prentice. There are an insane amount of 11 thousand births at Prentice per year. The new prentice will be accommodating 15 thousand deliveries per year and will also have a dozen or so operating rooms strictly dedicated to gynecologic surgery. You want to become a rockstar laparoscopist? Spend some time at Prentice. (remember, laparoscopy was invented by the OB/gynies. And don't give me this BS about how surgeons perfected it. When you watch Dr. Milad-arguably the best laparoscopist in the world-work his magic there is no way a surgeon can come close to his laparoscopic skillz. Are you interested in gyne-oncology? Lurain and Schink are world famous gyne-oncs...by the way...Gyne-oncs are badass surgeons...they operate on multiple organ systems on a daily basis. Talk about cowboys! Sheesh. No lie though...Prentice is in the top 5 of OB/gyn programs in the nation. On par with Brigham and Women's and Beth Israel Deaconness(Harvard for those not in the know...and arguably better than those hospitals at this point in time).

6. ok yeah theres s sixth...I totally forgot about the Rehabilitation Institute of Chicago(RIC). This is hands down one of the best rehab centers in the nation if not THE best. Are you interested in robotics? Are you interested in stroke rehab? Do you like dealing with quadriplegics? This is the place for you.

lets review...theres NMH, ENH, VA Westside, CMH, RIC and Prentice.

Hmm...so to sum it up...I think We cover every single base of medicine...from the poor to the rich, to the young , to the old, to the males to the females, to the rehabbing, to the cutting edge of research; hence the deserved world-class reputation in my opinion.

Any questions?

 

[Oschemi]

yeah...theres more that we have to offer...

4. For you aspiring pediatricians out there...NMH does not provide any pediatric care. ZERO. So you may ask..."where the hell do you guys get your pediatric training?" Excellent question! We get our peds experience at Children's Memorial Hospital of Chicago(CMH). It is only one of the best Children's hospitals in the nation and undoubtedly takes ALL of the weird/odd/fascinoma cases in the city(ok not all...UofC gets a few too. but i would argue that the majority go to children's). The faculty at CMH are also world class. The residents are some of the bes tin the nation.

5.Prentice Women's Hospital - How in the hell could I forget about one of the BEST OB/GYN hospitals in the nation? Also keep in mind, the new Prentice hospital is opening this October. Many of the advances in birthing and laparoscopic surgeries and gynecologic oncology were made at Prentice. There are an insane amount of 11 thousand births at Prentice per year. The new prentice will be accommodating 15 thousand deliveries per year and will also have a dozen or so operating rooms strictly dedicated to gynecologic surgery. You want to become a rockstar laparoscopist? Spend some time at Prentice. (remember, laparoscopy was invented by the OB/gynies. And don't give me this BS about how surgeons perfected it. When you watch Dr. Milad-arguably the best laparoscopist in the world-work his magic there is no way a surgeon can come close to his laparoscopic skillz. Are you interested in gyne-oncology? Lurain and Schink are world famous gyne-oncs...by the way...Gyne-oncs are badass surgeons...they operate on multiple organ systems on a daily basis. Talk about cowboys! Sheesh. No lie though...Prentice is in the top 5 of OB/gyn programs in the nation. On par with Brigham and Women's and Beth Israel Deaconness(Harvard for those not in the know...and arguably better than those hospitals at this point in time).

6. ok yeah theres s sixth...I totally forgot about the Rehabilitation Institute of Chicago(RIC). This is hands down one of the best rehab centers in the nation if not THE best. Are you interested in robotics? Are you interested in stroke rehab? Do you like dealing with quadriplegics? This is the place for you.

lets review...theres NMH, ENH, VA Westside, CMH, RIC and Prentice.

Hmm...so to sum it up...I think We cover every single base of medicine...from the poor to the rich to the cutting edge to the deserved reputation.

Any questions?

Wow, UCLA man, thanks a lot!!

 

[UCLAMAN]

By the way...the attendings are usually very accesible. Often times many of them will take the students who are on their teams for the month out for dinner etc.

and....in terms of responsibility...i outlined the hierarchy but of course...if you can prove yourself...you may be relied and trusted upon to do more within your team or in the operating room. its all about how much trust you can gain from your seniors. I mean, if you are on your 3rd year rotation and you see your patient is in respiratory distress from heart failure and their lungs sound like a sponge and you do not tell your intern or senior resident and the patient gets tubed and sent to the unit because you failed to notify anybody ina timely manner, don't expect them to give you much responsibility....and it doesnt matter whether you are at a VA hospital, a county hospital, at mayo clinic, or at NMH. prove your competence and you get to do more stuff. act like a dud and you get treated like one.