Rotations at community hospitals

[NontradICUdoc]

Future doctors,

I keep reading about people wanting to do rotations at large academic centers but what you are failing to see are the diamonds in the rough. These are community programs.

If you are in a large academic center, especially if you are doing IM, you will not be managing the rare/interesting cases. These are the ones that the sub specialists will. Smaller community hospitals with less sub specialists provide a training ground for those critical thinking skills that are so important and cannot be taught but rather gained through experience.

I am at a community hospital and our residents (IM) do everything because there are no fellows. What do I mean? I am not talking about scut work rather I am talking about running codes, handling all the rapid responses, putting in central and arterial lines, running the ICU team of residents, family meetings, talking with specialists, etc. They have been to these large academic centers and they note that those residents do not have the confidence to handle what they can.

Patients at community hospitals tend to be more sicker because they put off going to the doctor for longer and come in only when their bodies can no longer compensate. And these places tend to really need good, competent doctors. Also, these programs tend to be very DO friendly.

So, don’t poopoo community programs, you will probably learn more than you think compared to a large academic center. Not to mention, because you can stand out you can potentially get a more useful letter of recommendation.

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[diesel2202]

Without a doubt there are stellar community IM programs. People ideally should rotate at both to get an idea of which fits them better. The pitch of "we don't have fellows so you do so much more," I heard a lot. The autonomy and responsibility is more program-specific than academic vs community. I am at a large academic program with fellows in all sub-specialties, and we as residents get to do it all or at least as much as we would like, including everything you listed. Our local community programs typically send their residents to do rotations with us just because we have everything available, in addition to tons of available research. As far as the confidence goes, it's a spectrum regardless of where you trained.

 

[AlbinoHawk DO]

Community programs with residents are where everyone should aim. These are the best opportunities to learn for medical students. Academic centers are fine for other training, but they are not the best when you're at the bottom trying to learn

 

[Angus Avagadro]

As a medical student you should rotate at BOTH community and academic centers as each have distinct advantages. I agree with much of the above with regards to community programs. Believe it or not, some DO students graduate without ever doing an inpatient IM rotation. I have heard PD's on SDN saying they will not hire students from these programs. They have no idea how an inpatient service is run, how to write orders, acces the EMR, or how to critically review a scientific journal. Also, some busy community programs don't have the didactic components, e.g., noon conferences, journal clubs, or if they do, you are too busy to attend them. I would highly recommend rotating at both types of centers.

 

[DO2015CA]

As a medical student you should rotate at BOTH community and academic centers as each have distinct advantages. I agree with much of the above with regards to community programs. Believe it or not, some DO students graduate without ever doing an inpatient IM rotation. I have heard PD's on SDN saying they will not hire students from these programs. They have no idea how an inpatient service is run, how to write orders, acces the EMR, or how to critically review a scientific journal. Also, some busy community programs don't have the didactic components, e.g., noon conferences, journal clubs, or if they do, you are too busy to attend them. I would highly recommend rotating at both types of centers.

I don’t hold the students at fault if they don’t have an inpatient experience through their school but I do absolutely hold them at fault if they haven’t done one by the end of med school. Imo it shows a lack of initiative which is more telling to me. I want a resident that will go above and beyond what is required to become the best doctor they can be. Do an away rotation or two 4th year. Even if I was interviewing residents early in 4th year, If they haven’t had that experience yet but had a couple lined up then I wouldn’t hold it against them.

 

[Angus Avagadro]

I completely agree. Many students leaving pre clinical don't realize how important it is to have these inpatient skills, otherwise they will be behind and have a lot of ground to make up when starting Pgy1. They need to be proactive and make sure they get some inpatient experience.

 

[Ho0v-man]

I don’t hold the students at fault if they don’t have an inpatient experience through their school but I do absolutely hold them at fault if they haven’t done one by the end of med school. Imo it shows a lack of initiative which is more telling to me. I want a resident that will go above and beyond what is required to become the best doctor they can be. Do an away rotation or two 4th year. Even if I was interviewing residents early in 4th year, If they haven’t had that experience yet but had a couple lined up then I wouldn’t hold it against them.

Sadly, my well-established DO school has a couple of sites like this. And there’s always some students happy to go to these sites because they’re notoriously easy Honors.

 

[Prehealth1011]

The concern brought up here is students not working with residents +/- having any real inpatient experience. This is a common DO thing. It's just weird because everyone (except Pathology) has to do some form of IM as a resident

 

[DO2015CA]

Sadly, my well-established DO school has a couple of sites like this. And there’s always some students happy to go to these sites because they’re notoriously easy Honors.

Yep and those are the med student that will plummet on the rank list

 

[FootballAndSkiing]

Yep and those are the med student that will plummet on the rank list

How do they know? Do programs ask during the interview?

 

[DO2015CA]

When I was interviewing, I was asked. I was asked to describe my inpatient experience. They didn’t overtly asked if I worked with residents but that’s what they were looking for.

 

[FootballAndSkiing]

I didnt realize this was such a big problem. Ive had three inpatient rotations with residency programs, and three more with preceptors.

 

[Prehealth1011]

How do they know? Do programs ask during the interview?

I got asked a few times how many patients I carried as a student and how I liked the residents