Quality and Adequacy of Clinical Rotations

[LUCPM]

Currently attending a DO school and rotating at a small, rural hospital as a 3rd year. I feel like I'm getting a mixed feeling about the quality and adequacy of my clinical rotations. In some rotations, like OB/GYN, I never got to do anything besides fundal height measurement or fetal heart tone monitoring. In others, I've been exposed to some minor procedures, such as suturing, splinting, joint injection, etc. and was encouraged to see any many patients as possible to develop good history taking skills. I haven't done too many notes either besides writing my own and showing them to my attending because the EMR system here wouldn't let me write notes and some of my attendings said I don't need to worry about them yet.

Just curious what kind experience you all have in your clinical rotations. I was talking to an EM attending the other day and his reply was "if you don't feel comfortable doing things like putting a central line or even deliver a few babies by the time you graduate, you will feel behind when you start your residency." On the other hand, another attending told me all I need to do well as a third year is to be able to do good H & P.

If I don't know how to put central lines or have never delivered a baby, am I really going to be behind?

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[GUH]

Currently attending a DO school and rotating at a small, rural hospital as a 3rd year. I feel like I'm getting a mixed feeling about the quality and adequacy of my clinical rotations. In some rotations, like OB/GYN, I never got to do anything besides fundal height measurement or fetal heart tone monitoring. In others, I've been exposed to some minor procedures, such as suturing, splinting, joint injection, etc. and was encouraged to see any many patients as possible to develop good history taking skills. I haven't done too many notes either besides writing my own and showing them to my attending because the EMR system here wouldn't let me write notes and some of my attendings said I don't need to worry about them yet.

Just curious what kind experience you all have in your clinical rotations. I was talking to an EM attending the other day and his reply was "if you don't feel comfortable doing things like putting a central line or even deliver a few babies by the time you graduate, you will feel behind when you start your residency." On the other hand, another attending told me all I need to do well as a third year is to be able to do good H & P.

If I don't know how to put central lines or have never delivered a baby, am I really going to be behind?

I haven't started rotations yet but do you think you could try to do some high-intensity away rotations next year if you're really worried about not having done enough procedures?

 

[Apoplexy__]

OP, I feel similarly and made a similar thread. Quite unanimously, the consensus was that you can get away with knowing next to no procedures and be okay in residency. That one attending that you're quoting may be right in that you can feel behind not doing the procedures you mentioned, but what about starting residency isn't overwhelming/humbling?

 

[zany_brainy]

Yea I feel the same way. I'm based out of a small community hospital and I've shadowed for over half my rotations. I haven't done any procedures. I'm trying to remedy that by scheduling as many away rotations at teaching hospitals as I possibly can in 4th year.

 

[Kaustikos]

Hey,
Welcome to third year medical school.
Honestly, my experiences haven't been much different or even worse. I never touched a baby during obgyn. Never delivered one. I was an observer.
Notes on EMR have become useless and not enforced because insurance companies don't care about them or even acknowledge them even if someone co-signs them. So no one cares if students write them anymore. If you want, you can actually call the it department and ask for authorization for notes and they'll usually do it.

Lastly, **** that attending who made that comment. That's the kind of malignant attitude that makes students feel like ****. You don't need to know how to do a central line or other procedures. That's where residency comes into play. Brush that off. Just focus on the fundamentals. I agree that part of our education does come from nailing an H&P. It makes you more reliable and earns you trust and responsibility

 

[witzelsucht]

I go to a school that's probably considered a major academic medical center, and I can say that the majority of my classmates have not delivered a baby in OBGYN, and definitely no one I know of has placed a central line. When I was on ICU the intern wanted to do a central line but the second year took it because she had only had like 3 so far in her career. The overwhelming majority of attendings I've worked with have said that H&P is the vital thing to learn in medical school, as well as knowing when you need to call for help as an intern (abnormal labs, abnormal EKG, abnormal CXR, call code team, etc.). It's not 1960 - you are not going to be covering a 300 bed hospital solo overnight when you graduate. I don't have too much perspective as a third year regarding notes, but from what I've seen, every hospital/service has their own style and templates that they want interns to use. I write "practice" notes in the EMR but no one reads them. If you are solid with the history, the patho, and the red flag symptoms, the note writing should come with not too much time when you get the long coat.

 

[LUCPM]

Thanks for all your replies. I have the luxury of rotating here all by myself and I've had no idea how things were outside of this hospital.

On the last day of my OB rotation, my attending who promised he would let me do a circ before I leave my rotation, disappeared after mumbling he had to attend some kind of meeting. He then showed up after two hours, snuck in through the back door of nursery, and performed a circ meticulously on the tiniest penis I've ever seen. When I finally heard his voice and showed up in the middle of the procedure, he told me back in old days, plastic surgeons used the foreskin for eyelid skin graft, which made the patient a little cockeyed. And I was laughing in my stupid short white coat. I hope I can still reflect fondly on these glorious days.

 

[redpanda]

Thanks for all your replies. I have the luxury of rotating here all by myself and I've had no idea how things were outside of this hospital.

On the last day of my OB rotation, my attending who promised he would let me do a circ before I leave my rotation, disappeared after mumbling he had to attend some kind of meeting. He then showed up after two hours, snuck in through the back door of nursery, and performed a circ meticulously on the tiniest penis I've ever seen. When I finally heard his voice and showed up in the middle of the procedure, he told me back in old days, plastic surgeons used the foreskin for eyelid skin graft, which made the patient a little cockeyed. And I was laughing in my stupid short white coat. I hope I can still reflect fondly on these glorious days.

I'm surprised he even attempted to promise you a circ. Ain't no medical student going near a circ here after an incident involving a resident and a circ.

 

[LUCPM]

Just curious what kind of incident it was.

 

[hallowmann]

I'm going to disagree with the crowd here.

The descriptions you are all giving are examples of crappy education and substandard rotations.

If you've rotated through OB and haven't done cervix checks and delivered a baby, your rotation has let you down. The only students in my class who didn't deliver a baby were the ones who actively sought to avoid doing so. Most of us had double digit deliveries.

I'm not saying I expect all students to be facile putting in central lines alone, because there just aren't enough of those to go around these days.

But pretty much anytime you can accurately use the term "shadowing" to describe your clerkship - that's an inadequate clerkship.

I think this speaks more to the inconsistency of undergraduate medical education. I thought this was a DO issue for a while, then I talked to some friends at mid-tier MD schools, and they had experiences similar to what's described in this thread (standing there, no central lines, no deliveries, etc.). I then talked to a couple at top-tier schools and a couple at new schools, and honestly it seemed random which ones had actually been allowed to do things and which weren't. Generally though, a lot of the guys on their OB rotation seem to be told to just stand there.

I don't know. I'm not there yet, but even talking to 3rd and 4th years at my school, it seems to vary significantly depending on which regional clinical site you go to. Some let you do a lot, some don't.

I tried to aim for sites that I've heard good things about, but who knows.

 

[LUCPM]

Thanks for sharing your experiences.

It can be quite depressing when I think about all this. I came here all the way to a remote town without friends and family. I got up early to get to hospital only to find out a case was canceled and no one bothered to tell me for hours or my attending always seemed to be running late an hour or two. I'm only given one chance to do a pelvic exam on an anesthetized patient during my OB rotation after wasting three hours in the OR. The only thing I can do is to put a fake smile on and pretend I'm always eager to learn although I'm damn sure I'm getting a real crappy education. 3/4 of my rotations have been nothing but shadowing but I still gotta look interested for 12 straight hours, right?

I then learned to stop thinking about things I have no control over. Instead, I begged my school to change my elective rotation to an attending who would let me try a lot of procedures. Whenever I have a down time, I go to the ER to see more patients. I really gotta go out of my way to set myself up for better education and stay proactive all the freakin' time.

Today is my daughter's birthday and I'm crossing my fingers to get home on time.

Happy rotation everyone!

 

[hallowmann]

It definitely speaks to inconsistency, I just don't think we should be so quick to accept inadequate clerkships as part and parcel of third year.

I think the best way, currently, to make the product more consistent is to keep everything under one roof (i.e.vast majority of rotations at a single hospital/institutions). That at least helps you control things a bit more and make sure that the minimum standards are being met.

I absolutely agree that we shouldn't just accept subpar clinical training, but at this point in medical school, I think most of us are just trying to make the best of our options.

So I'm already scheduled to go to a regional site for all of my core rotations, and the site has a fair number of residencies and a couple fellowships (mainly AOA ones though). I ranked it based on feedback I had heard of the teaching and med student involvement there (and because I didn't want to have to move all over for cores).

My main question is, in you're opinion, given the option of doing all your cores at say a medium sized community hospital vs. setting up your own rotations all over the place, where you know you'll get some rotations at nice big academic hospitals and some in the middle of nowhere, would you still recommend doing all of them at the smaller/medium community hospital? I guess I can aim to do electives/auditions/sub-I's at the bigger academic places.

 

[notbobtrustme]

I'm going to disagree with the crowd here.

The descriptions you are all giving are examples of crappy education and substandard rotations.

If you've rotated through OB and haven't done cervix checks and delivered a baby, your rotation has let you down. The only students in my class who didn't deliver a baby were the ones who actively sought to avoid doing so. Most of us had double digit deliveries.

I disagree. I basically got all my deliveries (3-4) in a single night because we got swamped. However, if it weren't for that day, I would have been essentially bystanding while the interns get all the deliveries. This was because it was in July when I started OB and intern education >>>>>>>> my education.

The biggest problem with medical education is that it's so ****ing variable. I'm on inpatient medicine and I got stuck with the **** team for Jan. As in, go do scutwork for 8 hours a day. Even during teaching rounds, we'd get stuck running scut when an issue came up. My bud on the other team raves about how much he's learned and how he carries patients by himself. I'm lucky if there's an extra patient sheet printed. The thing is that only this team has this problem. And in a couple years when all the residents have graduated, it'll probably all be fixed. However, for this year and the next, anyone stuck on this team essentially has a **** experience for medicine.

Raising a stink about this? **** that, I actually want to get an A. I'll probably mention something about it in the little feedback session we have at the end of the rotation, but during the rotation, standing up is the quickest way to get shutdown with 3s down the line (aka a C unless you crush the shelf, which might let you slide with a B). Kissing ass, saying "yes sir" and "thank you" is a way better use of my time than going to administration and complaining about my treatment.

If you have attendings/residents who give a **** about educating, you can have a great experience. If you get stuck with the resident going through a divorce, well then, your experience suffers for no good reason. One of my classmates had this exact situation happen to her. Her resident was going through a divorce and basically took it out on the med students and they all ended up with Bs and Cs because of their evals. How can you control something like this? The whole system is just subjective bull**** based on how much your superiors like you or how their life is going.

 

[redpanda]

I absolutely agree that we shouldn't just accept subpar clinical training, but at this point in medical school, I think most of us are just trying to make the best of our options.

So I'm already scheduled to go to a regional site for all of my core rotations, and the site has a fair number of residencies and a couple fellowships (mainly AOA ones though). I ranked it based on feedback I had heard of the teaching and med student involvement there (and because I didn't want to have to move all over for cores).

My main question is, in you're opinion, given the option of doing all your cores at say a medium sized community hospital vs. setting up your own rotations all over the place, where you know you'll get some rotations at nice big academic hospitals and some in the middle of nowhere, would you still recommend doing all of them at the smaller/medium community hospital? I guess I can aim to do electives/auditions/sub-I's at the bigger academic places.

My personal bias, having come from the deathstar of hospital systems, is to be able to do rotations are a single (or multiple VERY closely linked) hospital, hopefully next to your school. Nothing beats the quality control of the clerkship director being able to physically pull a teaching attending aside to chat about personnel issues or medical student education. My single experience at a medium sized rural community hospital was that there was some rather questionable practice regarding certain aspects of women's health. Other students' experience at an urban community hospital nearby involved calling consults for everything (including things that a general internist should be dealing with).

 

[mimelim]

I disagree. I basically got all my deliveries (3-4) in a single night because we got swamped. However, if it weren't for that day, I would have been essentially bystanding while the interns get all the deliveries. This was because it was in July when I started OB and intern education >>>>>>>> my education.

The biggest problem with medical education is that it's so ******* variable. I'm on inpatient medicine and I got stuck with the **** team for Jan. As in, go do scutwork for 8 hours a day. Even during teaching rounds, we'd get stuck running scut when an issue came up. My bud on the other team raves about how much he's learned and how he carries patients by himself. I'm lucky if there's an extra patient sheet printed. The thing is that only this team has this problem. And in a couple years when all the residents have graduated, it'll probably all be fixed. However, for this year and the next, anyone stuck on this team essentially has a **** experience for medicine.

Raising a stink about this? **** that, I actually want to get an A. I'll probably mention something about it in the little feedback session we have at the end of the rotation, but during the rotation, standing up is the quickest way to get shutdown with 3s down the line (aka a C unless you crush the shelf, which might let you slide with a B). Kissing ass, saying "yes sir" and "thank you" is a way better use of my time than going to administration and complaining about my treatment.

If you have attendings/residents who give a **** about educating, you can have a great experience. If you get stuck with the resident going through a divorce, well then, your experience suffers for no good reason. One of my classmates had this exact situation happen to her. Her resident was going through a divorce and basically took it out on the med students and they all ended up with Bs and Cs because of their evals. How can you control something like this? The whole system is just subjective bull**** based on how much your superiors like you or how their life is going.

I can't remember if it was you or someone else I told a couple of months ago, but regardless. Your clerkships and/or your school sounds like it sucks.

Education is variable, schooling is variable. Virtually everything in the work place is heavily influenced by subjective criteria and the most certainly is not exclusive to medicine. There is a good chance that you are going to have a crappy co-medical student, intern, resident, attending, clerkship director etc. at some point. But, if that is how EVERYTHING is, then either the school is the problem, or you are the problem. But, blaming, "subjectiveness" is a bit silly considering that that is pretty much how the entire world works.

 

[notbobtrustme]

Education is variable, schooling is variable. Virtually everything in the work place is heavily influenced by subjective criteria and the most certainly is not exclusive to medicine.

Medicine is a second/third career for me, I know enough of how workplaces work to know that medical education is 10x worse in terms of subjectivity than most workplaces.

 

[hallowmann]

My personal bias, having come from the deathstar of hospital systems, is to be able to do rotations are a single (or multiple VERY closely linked) hospital, hopefully next to your school. Nothing beats the quality control of the clerkship director being able to physically pull a teaching attending aside to chat about personnel issues or medical student education. My single experience at a medium sized rural community hospital was that there was some rather questionable practice regarding certain aspects of women's health. Other students' experience at an urban community hospital nearby involved calling consults for everything (including things that a general internist should be dealing with).

At my school there are clinical rotation directors for individual regions/regional campuses. I think there are 3 (maybe 4 now), but the rotations are for all the students at 2 pre-clinical campuses of the school and , and mainly focusing on 4 regional clinical sites. We have a ton of (like 20-30) regional clinical campuses now, but most students go to maybe 8 of those hospitals, 4 or 5 of which are run by the 3 or 4 regional clinical directors, who seem like they are closely involved in education (I have no idea what this means as a 2nd yr by the way - but this is the impression I have).

So what you're saying is, go to the place that has a regional director that is tied to your school, as opposed to another place that takes students from your school, but really has no one organizing the education in those rotations, is that right?

My school is actually trying to switch gears and make everyone do cores through a regional campus (and is trying to establish long-term regional campuses with directors - only a few have them now), but its also one of the biggest medical schools in the country with about 550 people/yr at 3 different campuses. What that ends up resulting in is at best everyone going to ~15 different hospitals (right now its closer to 20-30). That system may certainly be more stable than other DO schools, but still leaves room for a lot of variability in experiences.

 

[redpanda]

At my school there are clinical rotation directors for individual regions/regional campuses. I think there are 3 (maybe 4 now), but the rotations are for all the students at 2 pre-clinical campuses of the school and , and mainly focusing on 4 regional clinical sites. We have a ton of (like 20-30) regional clinical campuses now, but most students go to maybe 8 of those hospitals, 4 or 5 of which are run by the 3 or 4 regional clinical directors, who seem like they are closely involved in education (I have no idea what this means as a 2nd yr by the way - but this is the impression I have).

So what you're saying is, go to the place that has a regional director that is tied to your school, as opposed to another place that takes students from your school, but really has no one organizing the education in those rotations, is that right?

My school is actually trying to switch gears and make everyone do cores through a regional campus (and is trying to establish long-term regional campuses with directors - only a few have them now), but its also one of the biggest medical schools in the country with about 550 people/yr at 3 different campuses. What that ends up resulting in is at best everyone going to ~15 different hospitals (right now its closer to 20-30). That system may certainly be more stable than other DO schools, but still leaves room for a lot of variability in experiences.

Having no one organizing the education for the rotation sounds like the worst nightmare, but having a ton of clinical campuses all over the place sounds like a nightmare too, because I can't imagine a clinical director at any particular site being able to keep really good tabs on multiple clerkships at a site (or being that motivated to do so) much less finding 20 or more of them to do it. The type of control that I'm referring to here is that where you could walk into the clerkship director's office for your school (not any particular site) or your clerkship director could walk up to the teaching attendings any day of the week. This invariably requires serious geographic centralization.

 

[hallowmann]

Having no one organizing the education for the rotation sounds like the worst nightmare, but having a ton of clinical campuses all over the place sounds like a nightmare too, because I can't imagine a clinical director at any particular site being able to keep really good tabs on multiple clerkships at a site (or being that motivated to do so) much less finding 20 or more of them to do it. The type of control that I'm referring to here is that where you could walk into the clerkship director's office for your school (not any particular site) or your clerkship director could walk up to the teaching attendings any day of the week. This invariably requires serious geographic centralization.

I mean, I'm sure someone organizes the education for the rotations, and I'm sure the school send the sites some form of requirements for education, but there's noone at those other sites that is paid by the school to be responsible for directing clinical rotation education.

Maybe I wasn't clear by my description of a regional clinical clerkship director at my school. They are employed by the school to coordinate education for their site. They live and have offices at those sites (the hospitals), and most days of the week they are there, so you can walk into their offices and they could same day walk up to teaching attendings in the site and discuss things with them. 1 or 2 of them coordinate 2 sites in one area, so they are spread a bit more thin than the other 2 or 3. I don't know if that's closer to what you are describing or not. They are responsible for students rotating through all the core services.

For example, Drexel and Temple have a regional clinical campus in the same hospital system as my school recently started one. They each have their own clinical coordinators from their schools responsible for their students rotating through all the cores.

Does this make sense, or am I misunderstanding what you mean?

Obviously most hospitals have their own clerkship directors/coordinators for each service, but they coordinate all clerkships on that service, not only the ones affiliated with my school (so that includes all visiting students - technically all students are "visiting"). The thing is, only some of our clinical campuses have clinical campus directors that are specific to our school and that site. I mean technically all of them fall under the supervision of our ClinEd director, but beyond that, there's no one at 15-20 of those sites specifically representing my school.

 

[hallowmann]

Just so things are clear, I'd obviously prefer if my school had only 1, 2, or even 3 regional clinical campuses that were all in one region, but that's not really in my control. I'm talking more about choosing the lesser of two evils at this point.

 

[redpanda]

I mean, I'm sure someone organizes the education for the rotations, and I'm sure the school send the sites some form of requirements for education, but there's noone at those other sites that is paid by the school to be responsible for directing clinical rotation education.

Maybe I wasn't clear by my description of a regional clinical clerkship director at my school. They are employed by the school to coordinate education for their site. They live and have offices at those sites (the hospitals), and most days of the week they are there, so you can walk into their offices and they could same day walk up to teaching attendings in the site and discuss things with them. 1 or 2 of them coordinate 2 sites in one area, so they are spread a bit more thin than the other 2 or 3. I don't know if that's closer to what you are describing or not. They are responsible for students rotating through all the core services.

For example, Drexel and Temple have a regional clinical campus in the same hospital system as my school recently started one. They each have their own clinical coordinators from their schools responsible for their students rotating through all the cores.

Does this make sense, or am I misunderstanding what you mean?

Obviously most hospitals have their own clerkship directors/coordinators for each service, but they coordinate all clerkships on that service, not only the ones affiliated with my school (so that includes all visiting students - technically all students are "visiting"). The thing is, only some of our clinical campuses have clinical campus directors that are specific to our school and that site. I mean technically all of them fall under the supervision of our ClinEd director, but beyond that, there's no one at 15-20 of those sites specifically representing my school.

It does make sense. What it sounds like you're saying is that you have some director at site A who is in charge of the clerkships there and what I'm extrapolating is that said person could be in charge of directing clerkships in multiple specialties, which sounds rather less than ideal from a sheer logistics perspective and the personnel perspective. I am also extrapolating that this might involve an extra level of management (e.g. Medicine clerkship director for the medical school -> medicine clerkship director at site A -> teaching attendings), which, in my opinion, leads to a more difficult situation in terms of quality control. I have yet to find a situation in medicine or in the corporate world where having more levels of management has put the leadership in better touch with the people who are doing the dirty work. Having a clinical campus director whose fealty isn't only to your program isn't so hot as well. Where I'm going with this is that the quality control is most likely to be more stringent in a situation where you have the least number of diluting steps between whoever manages the clerkship for the entire medical school and you (geographic separation, differences in specialty).

 

[hallowmann]

It does make sense. What it sounds like you're saying is that you have some director at site A who is in charge of the clerkships there and what I'm extrapolating is that said person could be in charge of directing clerkships in multiple specialties, which sounds rather less than ideal from a sheer logistics perspective and the personnel perspective. I am also extrapolating that this might involve an extra level of management (e.g. Medicine clerkship director for the medical school -> medicine clerkship director at site A -> teaching attendings), which, in my opinion, leads to a more difficult situation in terms of quality control. I have yet to find a situation in medicine or in the corporate world where having more levels of management has put the leadership in better touch with the people who are doing the dirty work. Having a clinical campus director whose fealty isn't only to your program isn't so hot as well. Where I'm going with this is that the quality control is most likely to be more stringent in a situation where you have the least number of diluting steps between whoever manages the clerkship for the entire medical school and you (geographic separation, differences in specialty).

I completely agree with you, it's probably nowhere close to ideal. I guess the question becomes (and this is more for future students, as I'm already set to go somewhere), stuck between these two options, a site with a clinical coordinator from your school (who I think is usually an employee of both the school and the hospital) and a site or even collection of sites with no real on-site school rep, which would you choose? With one, you have someone from your school responsible for your education, but with the other, you have less levels of management.

 

[redpanda]

I completely agree with you, it's probably nowhere close to ideal. I guess the question becomes (and this is more for future students, as I'm already set to go somewhere), stuck between these two options, a site with a clinical coordinator from your school (who I think is usually an employee of both the school and the hospital) and a site or even collection of sites with no real on-site school rep, which would you choose?

How many times do I have to say it? The more control your school has over the clerkship, the more likely the quality control is going to be stringent. Let me start giving concrete examples:

Mothership with director of entire medicine clerkship and all students on site > off site with clinical coordinator from your school > off site with some "clinical coordinator" >>> place where school sends you and hopes they do the stuff on the competency matrix.

Seeing what went on in that rural community hospital for 4 weeks made me question WTF is going on in programs where students have to set up their own rotations. Would never choose a site like that again for education.

 

[hallowmann]

How many times do I have to say it? The more control your school has over the clerkship, the more likely the quality control is going to be stringent. Let me start giving concrete examples:

Mothership with director of entire medicine clerkship and all students on site > off site with clinical coordinator from your school > off site with some "clinical coordinator" >>> place where school sends you and hopes they do the stuff on the competency matrix.

Seeing what went on in that rural community hospital for 4 weeks made me question WTF is going on in programs where students have to set up their own rotations. Would never choose a site like that again for education.

Haha, sorry for being annoying, I'm just a stressed out 2nd year that doesn't know anything and has to be told stuff at least 4 times before I get it . Thanks for the advice, I appreciate it.

 

[Ismet]

My personal bias, having come from the deathstar of hospital systems, is to be able to do rotations are a single (or multiple VERY closely linked) hospital, hopefully next to your school. Nothing beats the quality control of the clerkship director being able to physically pull a teaching attending aside to chat about personnel issues or medical student education. My single experience at a medium sized rural community hospital was that there was some rather questionable practice regarding certain aspects of women's health. Other students' experience at an urban community hospital nearby involved calling consults for everything (including things that a general internist should be dealing with).

I think we had the same medium sized rural community hospital experience...

 

[KnuxNole]

I was a male, so I was not allowed to touch a vagina. So 0 cervical checks, delivering a baby or placenta. I actually didn't know other med students deliver babies until residency :/.

We did have good lectures and one or two good residents to teach which was nice. But I got kicked out of rooms 70% of the time.

 

[KnuxNole]

It definitely depends in hospital culture. Where I am at for residency, male students do a lot and see a lot. For where I went to school, it was basically implied that if you were male, you were going to do less. Probably depends on patient population too. In med school, the patients were all " oh hell naw, that boy better not go near my coochie. Sure this is my 9th pregnancy, but I have only let 9 men touch this fine thang!" vs in residency "aww you're so sweet, sure we'd love to have you in the room!".

 

[NickNaylor]

I'm going to disagree with the crowd here.

The descriptions you are all giving are examples of crappy education and substandard rotations.

If you've rotated through OB and haven't done cervix checks and delivered a baby, your rotation has let you down. The only students in my class who didn't deliver a baby were the ones who actively sought to avoid doing so. Most of us had double digit deliveries.

I'm not saying I expect all students to be facile putting in central lines alone, because there just aren't enough of those to go around these days.

But pretty much anytime you can accurately use the term "shadowing" to describe your clerkship - that's an inadequate clerkship.

Yeah, completely agree.

We were expected to write notes daily. The "supervision" involved with that process might be a resident reading them over and providing feedback to attendings cosigning the note and using that note as the daily note.

We had exposure to minor procedures, but we weren't putting in IABPs or anything like that. I'm not really sure what you expected. On surgery I would close pretty regularly unless we were in a hurry. We put in some IVs on our anesthesia rotation and, depending on the case, got to administer local anesthetic with US guidance. Med students were expected to do some very minor stuff for the ICU portion of our surgery rotation. Short of that, I didn't really get to do much either - though I'll admit that I wasn't actively seeking these opportunities out aggressively. I certainly haven't put in any central lines. However, we have an M4 elective where you rotate on the anesthesia procedure service, so I imagine that's a fantastic opportunity for those interested in that kind of thing.

I completely agree that if you describe your clerkship experience as little more than "shadowing," then something is wrong. Clueless though we may have been, we were expected to come up with management plans for our patients and defend them with some sort of intellectual rigor. You were expected to check on your patients throughout the day on inpatient rotations and report any changes to your residents or attendings. On rotations where you saw patients in the ED, you were expected to lead the discussion (or even see the patient by yourself) and then report back and present to your attending.

Don't get me wrong, I'm sure intern year will be a **** show and there's ever more that I have to learn. But when it comes to the basics - seeing someone, drawing up a basic plan for the short-/immediate-term, and knowing my way around the wards - I think I'm pretty well-prepared. I mean, that's what we did on rotations. If you weren't doing that, I can't imagine what it was that you WERE doing for 10-12 hours a day.

 

[mimelim]

Yeah, completely agree.

We were expected to write notes daily. The "supervision" involved with that process might be a resident reading them over and providing feedback to attendings cosigning the note and using that note as the daily note.

We had exposure to minor procedures, but we weren't putting in IABPs or anything like that. I'm not really sure what you expected. On surgery I would close pretty regularly unless we were in a hurry. We put in some IVs on our anesthesia rotation and, depending on the case, got to administer local anesthetic with US guidance. Med students were expected to do some very minor stuff for the ICU portion of our surgery rotation. Short of that, I didn't really get to do much either - though I'll admit that I wasn't actively seeking these opportunities out aggressively. I certainly haven't put in any central lines. However, we have an M4 elective where you rotate on the anesthesia procedure service, so I imagine that's a fantastic opportunity for those interested in that kind of thing.

I completely agree that if you describe your clerkship experience as little more than "shadowing," then something is wrong. Clueless though we may have been, we were expected to come up with management plans for our patients and defend them with some sort of intellectual rigor. You were expected to check on your patients throughout the day on inpatient rotations and report any changes to your residents or attendings. On rotations where you saw patients in the ED, you were expected to lead the discussion (or even see the patient by yourself) and then report back and present to your attending.

Don't get me wrong, I'm sure intern year will be a **** show and there's ever more that I have to learn. But when it comes to the basics - seeing someone, drawing up a basic plan for the short-/immediate-term, and knowing my way around the wards - I think I'm pretty well-prepared. I mean, that's what we did on rotations. If you weren't doing that, I can't imagine what it was that you WERE doing for 10-12 hours a day.

THIS is why where you go to medical school matters. Caribbean vs. DO vs. US MD and differences between US MD programs themselves. There are bad rotations at every school, but if on average, your clinical clerkships felt like a waste of time, there is something wrong with you or something wrong with the school.

 

[KnuxNole]

Yeah, completely agree.

We were expected to write notes daily. The "supervision" involved with that process might be a resident reading them over and providing feedback to attendings cosigning the note and using that note as the daily note.

We had exposure to minor procedures, but we weren't putting in IABPs or anything like that. I'm not really sure what you expected. On surgery I would close pretty regularly unless we were in a hurry. We put in some IVs on our anesthesia rotation and, depending on the case, got to administer local anesthetic with US guidance. Med students were expected to do some very minor stuff for the ICU portion of our surgery rotation. Short of that, I didn't really get to do much either - though I'll admit that I wasn't actively seeking these opportunities out aggressively. I certainly haven't put in any central lines. However, we have an M4 elective where you rotate on the anesthesia procedure service, so I imagine that's a fantastic opportunity for those interested in that kind of thing.

I completely agree that if you describe your clerkship experience as little more than "shadowing," then something is wrong. Clueless though we may have been, we were expected to come up with management plans for our patients and defend them with some sort of intellectual rigor. You were expected to check on your patients throughout the day on inpatient rotations and report any changes to your residents or attendings. On rotations where you saw patients in the ED, you were expected to lead the discussion (or even see the patient by yourself) and then report back and present to your attending.

Don't get me wrong, I'm sure intern year will be a **** show and there's ever more that I have to learn. But when it comes to the basics - seeing someone, drawing up a basic plan for the short-/immediate-term, and knowing my way around the wards - I think I'm pretty well-prepared. I mean, that's what we did on rotations. If you weren't doing that, I can't imagine what it was that you WERE doing for 10-12 hours a day.

That's the thing, the rotations that you weren't doing much, you weren't there for 10 hours, you went home after rounds or at like 2-3. That wasn't my experience(I had a rigorous medicine rotation which helped for residency), but for some peeps, it was the case.

For my med school OB rotation that I mentioned earlier, we thankfully had the privilege to walk into a patient's room and speak English to them and put our dirty male stethoscopes on their bodies and touch their abdomen, maybe their legs too, with our filthy male hands covered with a glove and with a nurse hovering me, and was honored by the resident princesses to speak about said patient in a presentation, and when HBIC aka attending comes in, there will be lots of teaching and I can make the princesses look good, even though there will be no mention of my peasant appearance. So, there was some hands on learning at the very least

 

[Light Yagami]

I've had family and peds and have been disappointed so far. See the same 4-5 type diseases every day. In peds that's because a scheduling quirk had me only in wards, nursery, and nicu with no outpatient. lots of scut work (mainly harass imaging, harass labs). The shelf has also ruined the clinical experience. I and most of my classmates just want to get the hell out of the hospital and be home studying for the shelf since the rotations are pretty much useless for shelf prep. I wish I didn't have the shelfs because I would be more proactive, less stressed, and enjoying the rotations a lot more. I feel like strangling whatever idiot instituted the shelves.

 

[Psai]

I've had family and peds and have been disappointed so far. See the same 4-5 type diseases every day. In peds that's because a scheduling quirk had me only in wards, nursery, and nicu with no outpatient. lots of scut work (mainly harass imaging, harass labs). The shelf has also ruined the clinical experience. I and most of my classmates just want to get the hell out of the hospital and be home studying for the shelf since the rotations are pretty much useless for shelf prep. I wish I didn't have the shelfs because I would be more proactive, less stressed, and enjoying the rotations a lot more. I feel like strangling whatever idiot instituted the shelves.

Yeah it's hard to think about patients when you're busy trying to study for the shelf. I tried not to worry too much about it and then scored just below the necessary score for one of my clerkships. I still feel cheated