Rotations suck......not learn anything

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What have people heard about CCOM's 3rd year rotations?

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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.
 
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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.


Great advice, thank you very much!
 
Can some please comment on quality of rotation sites for NSU? I would think they would rank high compared to other DO schools because of the surrounding hospitals and MD programs.
 
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.
 
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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?
 
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.
 
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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.

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.

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.
 
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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.
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?
 
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?
 
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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?


No. Students who fail and blame the school or the rotation probably wouldnt be successful anywhere.

If you are motivated enough, you can learn just fine in ANY rotation. People just love to bitch. Especially medical students.
 
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.

nah, 3rd year is more about seeing sausage made and where you want to be in that system. Without responsibility (eg writing orders, admitting/dc'ing patients, etc etc) nothing you do has much impact. The biggest impact you bring to the team is being that guy who can get medical records.

The only thing essential about 3rd year is getting good grades. These will matter far more to residency applications than learning SO MUCH. Intern year is sink or swim. What you learned 2 years ago during a 4-8 week rotation will have very little bearing on how well you do.
 
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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.
 
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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.

It think you hit the nail on the head right here. I'm convinced this is the reason for 90% of the DO discrimination out there. This is the reason why you have upper-mid tier university programs like Utah and Washington and Colorado who openly discriminate against DOs, despite being less than über competitive.
 
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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.

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.
 
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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...
 
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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 suspect that's how it'll be until 2020. And then who knows
 
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...

Nothing changes overnight, you should only look at trends over time. Comparing the DO ACGME match list from 5-10 yrs ago to now, I think for the most part is clearly been positive. It may not strongly affect us, but 10-20 years from now, I could see the difference becoming really pronounced.
 
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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.
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.
 
I am worried about rotations as well. My goal is to match psychiatry at the moment. Do you think I will be okay if this is the case? I plan on writing my own notes and comparing to the attending notes even if I am not asked to. I will read extensively if my rotation ends early. It is very bad for people wanting to do IM or Surgery if those core rotations aren't adequate.
 
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.

Yes
 
Oh boy. What a massive disadvantage if you want to go into the field.

My school has ward based rotations available for those who want them in all the core rotations. The people who want surgery don't have any trouble getting a ward-based rotation in surgery. It does suck though if you don't know what you want to do. I got ward-based rotations in all the specialties I'm interested in. I guess I'm screwed though if I unexpectedly decidesurgery is the one thing that will make me happy. It's not ideal, and maybe my school is better than most.
 
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 think this is all a bit site dependent. I had a preceptor based general surgery rotation and definitely feel that I was prepared for my ward based surgery rotations. Specifically, in the operating room I've been asked "who trained you" several times and complimented on my "excellent surgical skills". Not sure how I would have learned any of this while fighting with a resident to be retractor monkey number three ...

Of course, on my first day I was a little lost on what to do outside of the OR (should I write a note or not), but simply speaking to a resident/attending usually clears up any issues. And most surgery folks tend to not care about the admin part anyway.
 
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.

The quality of clinical rotations is the main reason why we are up in arms about those schools. It's not that difficult to get quality teachers for the basic sciences at these schools. However, it is ridiculously difficult to get quality clinical education for these schools with a massive explosion of students in the first year. Just as there have been complaints about increasing class sizes. It is the same problem there.
 
Do you think these disparities matter more for people going into heavily clinical specialties like IM - ICU; Gen Surg etc vs. Psych or Rads because of the patient volume/diverse pathology one would miss out on?
 
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.
 
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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.

This attitude will get you far no matter what you are doing.
 
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.
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."
 
can anyone comment on the quality of rotations at Touro Nevada?
 
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.

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.
 
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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.
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).
 
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It is better if you have more people to bounce ideas off of so wards based rotations are optimal, but the moral of the story is we are not doomed if we work hard and are active learners
 
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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 ?

Ward usually implies the MS3 has a senior M4 student to get guidance from...the M3/M4 have an intern to get guidance from....the intern has senior residents...the senior resident has the fellow...then the attending. This allows students to get direction from a wide array of seasoned professionals. Preceptor based cuts all of that out and the student learns directly from an attending. You miss out on a lot. You can overcome this by reading every day, going in early and being the last to leave, writing your own notes, asking others if you can help. Be a sponge.
 
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can we get a list of where this is not happening?
 
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 ?

This post by DrWBD is just godly....

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.
 
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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.

As our kind moderator has pointed out, as long as their are residents being taught in a hospital then it is a teaching hospital. My state school doesn't have a university hospital, but there are community hospitals with primary care residencies (plus ortho and path and a few others). The university medical students rotate at these places where residents are being taught.
 
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My recommendation to future DO students is to seek out schools that have the largest proportion of teaching-hospital affiliates. When you choose a rotation site (rank, lottery, whatever) aim for those sites to get the exposure to wards based medicine that you need for 4th year and residency. If you end up getting stuck in a preceptor rotation or even a bad wards rotation, do what's recommended by Janet6 and others. Make it as good of a learning experience as it can possibly be for you.

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.

So, yeah, I don't get why people do this. I hear it all the time from 3rd/4th years, but why would you only want an elective so you can take a break? I mean, if you're going to use it as a research month, just do research. If you're going to use it as a buffer before Step 2, OK, I get it. Going to have a baby, OK, sure, that's a good reason. If you're going to schedule it for April of 4th year, OK, I can see why you don't care then, but maybe that's the best time to take something crazy, fun, you never thought of, etc.

Why would anyone without a good reason consciously decide, yeah, I want to do the least amount of work as possible in 3rd year, because that's me "winning" med school? I don't get it.
 
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