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What have people heard about CCOM's 3rd year rotations?
I want to bump this thread and keep the conversation going.
Can someone give a strong comparison between preceptor based clerkships vs. teaching hospital based clerkships?
For those of you who found your rotations and succeeded in getting a high quality 3rd year, can you kindly list the hospital sites you chose?
http://journals.lww.com/academicmed...teopathic_Clinical_Training_in_Three.16.aspx/
I've had horrible preceptor based rotations and excellent teaching hospital based rotations. I've also had things the other way around.
The best way to figure out where you want to be is to ask people who've been there. If the rotations mostly shadowing, or will you have real clinical duties? Will there be assigned reading topics and a discussion of the reading with residents/attendings? These are the types of things to look for.
My best rotations have been preceptor based where I was given actual responsibility, i.e. See the patient, develop a full assessment and olan, present it to the preceptor and get feedback/learn about what I just saw/did. I had great experiences in OBGyn, HemeOnc, FM, IM, and ER where this was the pattern.
Then I've had rotations where I was given duties, but residents were really just redoing everything I did without actually talking/ consulting/teaching me. I'd spend the entire month going through the motions with zero feedback whatsoever.
TLDR; get feedback from previous students about the rotation and try to snag the ones that are high yield for both learning and doing.
I want to bump this thread and keep the conversation going.
Can someone give a strong comparison between preceptor based clerkships vs. teaching hospital based clerkships?
For those of you who found your rotations and succeeded in getting a high quality 3rd year, can you kindly list the hospital sites you chose?
http://journals.lww.com/academicmed...teopathic_Clinical_Training_in_Three.16.aspx/
Your question presupposes that there is some merit to a "preceptor-based clerkship" which in my opinion is erroneous. The reason these types of clerkships exist is simple - it allows DO schools to pocket lots of tuition $$ while satisfying accreditation requirements to a bare minimum. My opinion is that preceptor-based rotations have no place in the education of third-year students (except maybe for Psychiatry and Family Medicine).
When you do a preceptor-based rotation in something like Internal Medicine:
- you're getting taught by one person only
- you may or may not have actual clinical responsibilities
- you'll likely have less patients to see (one physician usually doesn't have that many patients on their census)
- you'll be in (most likely) a community-level hospital without high-level pathology to see and manage.
On the other hand, when you do a real Internal Medicine rotation in a teaching hospital (ideally a tertiary level center):
- you'll have one attending but many residents, all of whom you can learn from
- while it might be possible you could "tag along" without meaningful interaction with the team in some teaching hospitals; the good hospital-based rotations I had as a student emphasized the opposite - you were expected to work as a part of the team, presenting cases, formulating differential diagnoses, getting stuff done for the team.
- being on a ward team gives you exposure to exponentially more patients - even if you aren't directly involved with their care, the team usually rounds with the attending on all of the patients which means more learning
- usually higher-level pathology in teaching institutions.
Are there downsides? Yes, but they are overwhelmingly outweighed by the positives. I work in a community hospital and have seen DO students being "precepted" by the ICU attending and the teaching appears to be a complete joke. Most of the students wander around until the attending shows up, do cursory "rounds" and then cut out to "study". Third year isn't supposed to be a vacation - it's an essential part of medical education. Don't cheat yourselves out of a proper education.
Thanks for the advice. So at the end of the day, it is ALWAYS better to do clerkships at a teaching hospital vs preceptor based clerkships, correct?
At the end of the day you're more likely to get quality clinical education in a teaching hospital-based clerkship.
Your question presupposes that there is some merit to a "preceptor-based clerkship" which in my opinion is erroneous. The reason these types of clerkships exist is simple - it allows DO schools to pocket lots of tuition $$ while satisfying accreditation requirements to a bare minimum. My opinion is that preceptor-based rotations have no place in the education of third-year students (except maybe for Psychiatry and Family Medicine).
When you do a preceptor-based rotation in something like Internal Medicine:
- you're getting taught by one person only
- you may or may not have actual clinical responsibilities
- you'll likely have less patients to see (one physician usually doesn't have that many patients on their census)
- you'll be in (most likely) a community-level hospital without high-level pathology to see and manage.
On the other hand, when you do a real Internal Medicine rotation in a teaching hospital (ideally a tertiary level center):
- you'll have one attending but many residents, all of whom you can learn from
- while it might be possible you could "tag along" without meaningful interaction with the team in some teaching hospitals; the good hospital-based rotations I had as a student emphasized the opposite - you were expected to work as a part of the team, presenting cases, formulating differential diagnoses, getting stuff done for the team.
- being on a ward team gives you exposure to exponentially more patients - even if you aren't directly involved with their care, the team usually rounds with the attending on all of the patients which means more learning
- usually higher-level pathology in teaching institutions.
Are there downsides? Yes, but they are overwhelmingly outweighed by the positives. I work in a community hospital and have seen DO students being "precepted" by the ICU attending and the teaching appears to be a complete joke. Most of the students wander around until the attending shows up, do cursory "rounds" and then cut out to "study". Third year isn't supposed to be a vacation - it's an essential part of medical education. Don't cheat yourselves out of a proper education.
I would agree with this comment. I'm a current 2nd year at TCMC (MD school), and we have the 'preceptor-based clerkship'. Many of the upperclassmen have told me that there isn't really much responsibility, you see a very restricted amount of pathology, and it's a lot of shadowing. I know a girl in 3rd year that hasn't seen a single gyn, peds, or surgical consult by herself the entire year! They also have preceptors backing out of the program, so some students were without preceptors in certain specialties for a few months at the beginning!
It's very outpatient based, and presenting cases, formulating differential diagnoses, working as a team really isn't part of the 3rd year.
despite those issues, I doubt they will be affected by much "low tier MD" bias once they apply for residency. Their post-grad opportunities probably won't be too dissimilar from other USMD students, and in the end I think that matters most.Apparently TCMC is a newer MD program (established in 2008 per Wikipedia). It's sad that the school seems to be following the poor example set by osteopathic schools. You should complain to the higher-ups in the school or even to the AAMC.
What does someone do if the only medical school that accepted them has really bad preceptor-based rotations? Is there any way to get a good education regardless or are you pretty much screwed for PGY-1?
Third year isn't supposed to be a vacation - it's an essential part of medical education. Don't cheat yourselves out of a proper education.
despite those issues, I doubt they will be affected by much "low tier MD" bias once they apply for residency. Their post-grad opportunities probably won't be too dissimilar from other USMD students, and in the end I think that matters most.
People state that residency programs often avoid DO's due to uncertain quality of clinical rotations, but from what I have heard this has become an issue with some newer MD schools as well. If this is true though, how come there doesn't seem to be much "bias" against these schools as well?
Multiple inaugural grads of TCMC matched into programs at a top 20 institution (one that is pretty anti-DO) that I know people at... so I guess your statement is accurate.
At this point I think the truth is less about poor clinical training as much as its that having a DO in your program makes your program look "weaker". The top programs that don't care about that are the ones who think their reps can afford to take that hit, and even then they try to restrict it to 1-2 DOs.
Multiple inaugural grads of TCMC matched into programs at a top 20 institution (one that is pretty anti-DO) that I know people at... so I guess your statement is accurate.
At this point I think the truth is less about poor clinical training as much as its that having a DO in your program makes your program look "weaker". The top programs that don't care about that are the ones who think their reps can afford to take that hit, and even then they try to restrict it to 1-2 DOs.
Looking at match lists this year, there doesn't seem to have been much success breaking into the upper rung of IM programs. The best matches mostly seem to have been at upper mid-tier programs...I think that yeah, that's pretty much what's going on. But the good news is that there seems to be a creep upwards. Every year I hear of "the first DO accepted" at such and such prestigious residency. No doubt these people are rock stars, but it sets a precedent. And if they really are that good, it makes the PD that took that first DO more receptive to more DO's in the future.
At least in Diagnostic Radiology and Transitional Year/Medicine-Prelim (the things I applied for), I got what I considered a fair amount of interviews, some from prestigious programs, some that traditionally do not take DO's. I think the last big forefront for DO's is probably general surgery and most surgical subspecialties. There is a special kind of discrimination that seems more pervasive and stubborn, probably afforded to these PD's by the very competitive nature of these fields. Still, it does irk me when some surgical residencies prefer IMG's (some needing visas) to DO's.
Looking at match lists this year, there doesn't seem to have been much success breaking into the upper rung of IM programs. The best matches mostly seem to have been at upper mid-tier programs...
Looking at match lists this year, there doesn't seem to have been much success breaking into the upper rung of IM programs. The best matches mostly seem to have been at upper mid-tier programs...
I mean I'll agree that there are some similarities between TCMC's rotations and SOME D.O. rotations, but the main argument against D.O. rotations that really has any good backing is that they aren't regulated as well. TCMC apparently is under the holy regulation of whomever checks up on M.D. rotations to insure students get the amount of cases, etc. So to loop them together is probably a little much. If TCMC rotations suck it's because their own hospitals and the system of their preceptors (which they claim to be very innovative) is crap, not because it's similar to the D.O. schools.Apparently TCMC is a newer MD program (established in 2008 per Wikipedia). It's sad that the school seems to be following the poor example set by osteopathic schools. You should complain to the higher-ups in the school or even to the AAMC.
...the main argument against D.O. rotations that really has any good backing is that they aren't regulated as well.
This is an interesting thread to me. We definitely notice a difference between the average DO and average MD student who rotates through as an MS4. Much more common for the DO students to just seem a little confused about what they're supposed to be doing. And I don't mean in terms of our specific specialty, I mean just the general flow of writing notes before the residents arrive, finding out what cases are going the day before, having dressing supplies in their pockets, etc. Generally very nice and personable people, but odd to have to tell an MS4 these kinds of things. It definitely makes it hard for them to shine, even when they're very bright.
A question: these "preceptor" rotations you all discuss, do you have those for your core surgical rotations as well some places? That would explain a lot.
Oh boy. What a massive disadvantage if you want to go into the field.
That's good that you have that available. It never occurred to me before this thread that anyone could do a core rotation in surgery and not be on a ward team.
That definitely explains our observations. Wish I had known about that earlier. Right now my fellow residents' interpretation is either "that guy sucks" or "DO students suck."
I don't understand why us DO students have such ****ty rotations. Instead of worrying about popping up new schools, the higher ups should worry more about quality rotations/residencies.
I don't understand why us DO students have such ****ty rotations. Instead of worrying about popping up new schools, the higher ups should worry more about quality rotations/residencies.
What a jokePNWU is the medical school that uses nurses to teach their students medicine. Maybe that's the OP's school?
I'd be willing to bet a majority of DO students are satisfied with their clinical education. People don't often go online to post about how good things are going, only when there is something to complain about. You just have to be proactive. You want practice writing a note? Write one. It doesn't have to be official. Type it out on word and ask your preceptor to go through it. He/she refuses? Anonomyize it and take it to your clinical adviser or other mentors to go over (and also tell him or her that your preceptor is not teaching you). Use your electives to challenge yourself, not to pick a blow-off rotation because someone in the class above you said it was easy. Seek out ward based rotations. Talk to your clinical advisers. Read, not just the shelf study material but there are sources specifically on how to succeed on the wards. In psych I never did a full mental status exam but I know they're expected and roughly know how to do one because I read. For anesthesia I was never formally trained on doing a pre-op evaulation but I know how to do an airway exam because I read that was expected and asked the attendings to go through one with me. I could have easily just shown up in the OR without even knowing the patient's name or even what operation was going on and gotten a decent grade, but I challenged myself.This thread is such a massive bummer for incoming DO students.
I'd be willing to bet a majority of DO students are satisfied with their clinical education. People don't often go online to post about how good things are going, only when there is something to complain about. You just have to be proactive. You want practice writing a note? Write one. It doesn't have to be official. Type it out on word and ask your preceptor to go through it. He/she refuses? Anonomyize it and take it to your clinical adviser or other mentors to go over (and also tell him or her that your preceptor is not teaching you). Use your electives to challenge yourself, not to pick a blow-off rotation because someone in the class above you said it was easy. Seek out ward based rotations. Talk to your clinical advisers. Read, not just the shelf study material but there are sources specifically on how to succeed on the wards. In psych I never did a full mental status exam but I know they're expected and roughly know how to do one because I read. For anesthesia I was never formally trained on doing a pre-op evaulation but I know how to do an airway exam because I read that was expected and asked the attendings to go through one with me. I could have easily just shown up in the OR without even knowing the patient's name or even what operation was going on and gotten a decent grade, but I challenged myself.
Just work hard, be proactive and you'll be fine.
Agreed. This place is a dump. I like how you added the "professionalism" part because that's so classic about this place. I don't think I've heard anyone put more than 3 words together without adding the word "professionalism" or "humanism."1. As mentioned, why is it my job to do the school's job. What ever happened to professionalism? (Oh, that's right, it doesn't apply to medical schools... only students).
2. From my experience, the upper management at my well known school in the Southwest didn't give a damn about student complaints about rotation sites. They also actively did not post negative reviews about rotation sites on the student review site.
3. It's hard to network alumni when most of the alumni don't give a damn about their alma mater based off of poor decisions of said alma mater. Let me put it to you like this. If my med school ever called me for donations, I would demand to be put on their do not call list... and then enforce said request with the full weight of the laws governing said lists.
I gotta tell you, from a resident perspective, I think that some of your schools are doing you a horrible disservice with these "preceptor-based" rotations. Regardless of how much people like them, I think they're a terrible idea. Yes, much lower stress than a ward rotation, and probably far better hours with more time to study.
The problem, as I see it, is this: When it comes time for audition rotations or residency selection, you are going to do what you have learned. I'm a huge proponent of proactivity, and all the things you outlined above are good ways to try to make up the extreme lack of experience you're getting working only 1-on-1 with an attending. But there's no substitute for the muscle memory you get from doing these things over and over again in a time-constrained and stressful environment.
Writing a practice note and reviewing it with a preceptor is great. But how will you compare with a student who has been writing 5-10 notes every morning before 6am? You learned how to do a mental status exam by reading about it, but are you going to do it better than a student who did it every day for two months? Your attending helped you do a neuro exam, but how much better would it be if you had to do a focused neuro exam on the same patient every day for a week after surgery?
A previous poster mentioned how good their surgical skills were after their preceptorship, and that's really great (I mean that genuinely). But I'll tell you, I have never heard "OR skills" used as an important factor in selecting among applicants to my residency. When we select residents, we're really selecting interns. The things you do on a ward rotation as an MS3 and MS4 are intended to build you up to what you will do as an intern. On a preceptor based rotation, you're learning how to do attending work, and that's not the same. If you show up to an audition rotation not knowing how to function on a resident-led ward team, you're likely to be labeled either lazy or dumb.
With the coming merger, presumably more of you will be applying to ACGME programs. I would encourage everyone to do ward-based MS3 rotations whenever possible. If my people have noticed this issue with DO students, presumably many others will too.
Thought I'd chime in to back up the above post. Instead of being hostile and offended did it occur to you that the resident has a much better perspective than you? I completely agree that preceptor based rotations are a terrible disservice to DO students and are the main reason DOs are not even considered at some programs. It's great that you're a self-directed learner but unfortunately that's not the best way to learn in medicine. Those types of rotations may be popular with students because they're easy but that doesn't make them educational (it usually means the opposite).You seem to have a very twisted view of preceptor based rotations - good preceptor based rotations are NOT shadowing experiences. You will be taught how to do all of the things above. Also quite funny to see an ortho resident comment about documentation and exam skills...
In addition- I sincerely have absolutely no idea what you mean about attending work vs intern work. Please elaborate. If you're talking about standing in a corner and taking abuse silently, I would submit that this is not something you can train someone for, and is a feature unique to the ortho residency experience.
What is a ward based rotation? What is a preceptor rotation? How can I be a great student and not be "that crappy DO" student " during M3 ?
What is a ward based rotation? What is a preceptor rotation? How can I be a great student and not be "that crappy DO" student " during M3 ?
Your question presupposes that there is some merit to a "preceptor-based clerkship" which in my opinion is erroneous. The reason these types of clerkships exist is simple - it allows DO schools to pocket lots of tuition $$ while satisfying accreditation requirements to a bare minimum. My opinion is that preceptor-based rotations have no place in the education of third-year students (except maybe for Psychiatry and Family Medicine).
When you do a preceptor-based rotation in something like Internal Medicine:
- you're getting taught by one person only
- you may or may not have actual clinical responsibilities
- you'll likely have less patients to see (one physician usually doesn't have that many patients on their census)
- you'll be in (most likely) a community-level hospital without high-level pathology to see and manage.
On the other hand, when you do a real Internal Medicine rotation in a teaching hospital (ideally a tertiary level center):
- you'll have one attending but many residents, all of whom you can learn from
- while it might be possible you could "tag along" without meaningful interaction with the team in some teaching hospitals; the good hospital-based rotations I had as a student emphasized the opposite - you were expected to work as a part of the team, presenting cases, formulating differential diagnoses, getting stuff done for the team.
- being on a ward team gives you exposure to exponentially more patients - even if you aren't directly involved with their care, the team usually rounds with the attending on all of the patients which means more learning
- usually higher-level pathology in teaching institutions.
Are there downsides? Yes, but they are overwhelmingly outweighed by the positives. I work in a community hospital and have seen DO students being "precepted" by the ICU attending and the teaching appears to be a complete joke. Most of the students wander around until the attending shows up, do cursory "rounds" and then cut out to "study". Third year isn't supposed to be a vacation - it's an essential part of medical education. Don't cheat yourselves out of a proper education.
Hmm.It'll be rotation specific, not school specific.
This post by DrWBD is just godly....
Does Teaching Hospital imply that it is directly affiliated with a University?
Does Teaching Hospital imply that it is directly affiliated with a University?
Not necessarily. You can have teaching hospitals at community medical centers not affiliated with any University.
I'd be willing to bet a majority of DO students are satisfied with their clinical education. People don't often go online to post about how good things are going, only when there is something to complain about. You just have to be proactive. You want practice writing a note? Write one. It doesn't have to be official. Type it out on word and ask your preceptor to go through it. He/she refuses? Anonomyize it and take it to your clinical adviser or other mentors to go over (and also tell him or her that your preceptor is not teaching you). Use your electives to challenge yourself, not to pick a blow-off rotation because someone in the class above you said it was easy. Seek out ward based rotations. Talk to your clinical advisers. Read, not just the shelf study material but there are sources specifically on how to succeed on the wards. In psych I never did a full mental status exam but I know they're expected and roughly know how to do one because I read. For anesthesia I was never formally trained on doing a pre-op evaulation but I know how to do an airway exam because I read that was expected and asked the attendings to go through one with me. I could have easily just shown up in the OR without even knowing the patient's name or even what operation was going on and gotten a decent grade, but I challenged myself.
Just work hard, be proactive and you'll be fine.