Rotations suck......not learn anything

[nRomaleos]

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.

Do MD schools also have preceptor rotations, but a smaller proportion?

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[postbacpremed87]

Do MD schools also have preceptor rotations, but a smaller proportion?

Maybe at a few (less than 5) and in select specialties (Primary Care). The LCME has very stringent policies on the quality of rotation sites for students. If shadiness is going on, then they are more likely to shut it down flexner report - esque style.

 

[nRomaleos]

Maybe at a few (less than 5) and in select specialties (Primary Care). The LCME has very stringent policies on the quality of rotation sites for students. If shadiness is going on, then they are more likely to shut it down flexner report - esque style.

Hmm. This is a bit scary to think about as a DO hopeful...

Although I excel in independent book-studying, I have always preferred to learn hands-on skills through mentorship and high-volume/repetition training. I am sure preceptors can be fantastic teachers, but I would prefer that my school/institution would ensure that almost all of them are reasonably demanding and meaningful.

 

[postbacpremed87]

Hmm. This is a bit scary to think about as a DO hopeful...

Although I excel in independent book-studying, I have always preferred to learn hands-on skills through mentorship and high-volume/repetition training. I am sure preceptors can be fantastic teachers, but I would prefer that my school/institution would ensure that almost all of them are reasonably demanding and meaningful.

I am a DO student and I am not worried. You can overcome all of this by being an active learner and taking responsibility for your education (read, seek mentors, put in the hours, go above and beyond what is required of you).

 

[zany_brainy]

I am a DO student and I am not worried. You can overcome all of this by being an active learner and taking responsibility for your education (read, seek mentors, put in the hours, go above and beyond what is required of you).

You can also do what I'm currently doing this year and set up a bunch of aways in 4th year at bigger institutions. Yeah you might get your butt handed to you initially because you will probably be behind allopathic students on your sub-internships, but as long as you work hard you can learn a ton.

 

[acapnial]

Maybe at a few (less than 5) and in select specialties (Primary Care). The LCME has very stringent policies on the quality of rotation sites for students. If shadiness is going on, then they are more likely to shut it down flexner report - esque style.

If by preceptor based, you mean no residents or interns, it's more common than that. And it would take more than a lack of residents at one or two rotation sites to get shut down by the LCME.

 

[nRomaleos]

If by preceptor based, you mean no residents or interns, it's more common than that. And it would take more than a lack of residents at one or two rotation sites to get shut down by the LCME.

What percentage of your rotations were preceptor-based?

 

[wjs010]

So basically, DO students will be behind Md students in 3/4th yr because DO students get ****ty preceptor rotations, and MD students get hardcore ward-based rotations. So, how can I get these hardcore, ward- based rotations ?

 

[Postictal Raiden]

So basically, DO students will be behind Md students in 3/4th yr because DO students get ****ty preceptor rotations, and MD students get hardcore ward-based rotations. So, how can I get these hardcore, ward- based rotations ?

Take advantage of the elective rotations. How many months does your school give?

 

[IslandStyle808]

Take advantage of the elective rotations. How many months does your school give?

This right here is one of the largest factors that tons of applicants over look. I think every medical student that has commented wish they took this into consideration when choosing a school.

 

[wjs010]

This right here is one of the largest factors that tons of applicants over look. I think every medical student that has commented wish they took this into consideration when choosing a school.

But how can just am away rotation in 4th yr make up for ****ty 3rd year rotations? I'm not talking from a letter of rec. perspective, but from an experience-gaining perspective

 

[Harker Heights]

So basically, DO students will be behind Md students in 3/4th yr because DO students get ****ty preceptor rotations

This is probably school dependent, for example state DO schools vs. new private schools. I know that TCOM 3rd year rotations are residency-based and students are assigned to teams and taught by house staff in their teaching hospital. They are required to round, present and attend morning reports and lunch conferences etc. with the residents. During the two months of surgery they also have to write up case reports for an attending. The exception is the FM rotation which is in the school clinic but students often round with their attendings in hospitals as well.

 

[notbobtrustme]

So basically, DO students will be behind Md students in 3/4th yr because DO students get ****ty preceptor rotations, and MD students get hardcore ward-based rotations. So, how can I get these hardcore, ward- based rotations ?

don't sweat it too much. all 3rd is is getting a good H&P and maybe some semblance of a plan. learn how to develop a decent differential, learn how to present.

if you do that, you're in a position to hang with most students.

 

[acapnial]

What percentage of your rotations were preceptor-based?

I'm a DO student who's about to begin 3rd year... it's hard to guess at what percent of students at my school do rotations with residents. We have them, but you're more likely to get them if you tell the clinical department "I'm interested in [specialty]! Could you try to fit me into the best rotations for that?" Some rotation sites don't have any residents at all though. My comment was from communicating with people at MD schools (more than 5) that have a similar deal in the sense that some rotation sites have residents and some don't. They all have a greater percent of students that do rotations with residents than any DO school I know about though.

 

[IslandStyle808]

But how can just am away rotation in 4th yr make up for ****ty 3rd year rotations? I'm not talking from a letter of rec. perspective, but from an experience-gaining perspective

Some schools have elective rotations even in 3rd year and you could use that time to get a ward based experience. You could even have your first few 4th year rotations set up in primary care rotations to help you understand how they function this setting. However, you don't need all your rotations to be ward based, but a least a good chunk of them to get a feel of what it is like to be a resident. The main thing is to get strong at the H&P and making notes from what a lot of residents and attending have stated.

 

[Postictal Raiden]

Some schools have elective rotations even in 3rd year and you could use that time to get a ward based experience. You could even have your first few 4th year rotations set up in primary care rotations to help you understand how they function this setting. However, you don't need all your rotations to be ward based, but a least a good chunk of them to get a feel of what it is like to be a resident. The main thing is to get strong at the H&P and making notes from what a lot of residents and attending have stated.

Yup. My school offers two months of electives during 3rd year and about 10 months in 4th year. We literally have more electives than core rotations. Plus, our core rotations are mostly at very busy community hospitals (ward-based).

 

[notbobtrustme]

Yup. My school offers two months of electives during 3rd year and about 10 months in 4th year. We literally have more electives than core rotations. Plus, our core rotations are mostly at very busy community hospitals (ward-based).

vast majority of that elective time is garbage time though. The only electives that matter are the ones you take before you submit ERAS. Why do you think 4th year is so chill?

 

[hallowmann]

Maybe at a few (less than 5) and in select specialties (Primary Care). The LCME has very stringent policies on the quality of rotation sites for students. If shadiness is going on, then they are more likely to shut it down flexner report - esque style.

Every MD I have talked to about rotations has some preceptor (i.e. non-resident/wards based) rotations. The LCME requirement is that some of the core rotations be wards-based with a resident hierarchy.

DO schools just have more variability in this regard. For example, its possible that a DO student does 0 or 1 core rotation that is wards based. You'd have to go out of your way to do something like that at my school, but there are students who have that experience. I on the other hand will have wards-based rotations for all but 1 or 2 core rotations. It really depends on your clinical site. That said, I know people going to places for cores where the only residency is FM or FM/IM and GenSurg.

But how can just am away rotation in 4th yr make up for ****ty 3rd year rotations? I'm not talking from a letter of rec. perspective, but from an experience-gaining perspective

You'll be fine. Clinical rotations are so variable across all medical schools (MD and DO) that the amount of real experience or skills you're expected to have is minimal. If you work hard and try to learn and get the best experience you can, that'll be fine. Even if you're behind in the first couple months of PGY-1, from what I hear, the learning curve is steep and you'll catch up fast.

 

[IslandStyle808]

vast majority of that elective time is garbage time though. The only electives that matter are the ones you take before you submit ERAS. Why do you think 4th year is so chill?

From the stand point of impressing PDs, this is true. However, I cannot agree with the overall message you are stating. Having more electives means having more time to cater your education toward your field of interest. If I wanted to do PM&R, I would front load my rotations with them before ERAS. However, I would still want to do rotations that are similar to or involved with PM&R including Neuro, Ortho, Rheumatology etc. afterward. I don't want to be stuck doing primary care rotations (or sub-I's) that don't have much to do with my field of interest, when I could be learning something new and more relevant. More electives are a huge plus.

 

[group_theory]

At PCOM when I was a student, I was able to do my entire 3rd year rotations on wards with resident-attending teams (with the exception of family medicine) ... Pediatrics was half inpatient half outpatient and I had to make sure I picked a spot that provided inpatient opportunity. And I was able to do them all in the same state within the clinical sites set up by PCOM. Hopefully students these days can still have the same opportunities that I had.

I agree that an entire preceptor based rotations would be a bit disservice to medical education. There's something to be said about the logistics and dynamics of a resident team that you need to quickly learn ... What job is the intern vs resident vs fellow vs attending? When should you go up the chain and ask vs when should you find out how to do stuff yourself? Trying to get disposition on your patients while getting paged on other patients while going admissions are always fun. And to Be honest, the atmosphere is different in academic medical centers compare to non teaching hospitals (not necessarily a good thing or bad thing ... Just different)

When I was interviewing for residency ( a long time ago), I've had several interviewers in different programs (acgme) ask if I've had inpatient experiences. I've met on the interview trail some DO students (not from PCOM) who were in mid 4th year and did not have any inpatient experiences. Reading on SDN, apparently this school is notorious for lack of inpatient exposure.

As a resident, and as a fellow, and now as an attending, I've had visiting medical students on my team, both MD and DOs. Most were ok, some were functioning at a level of a beginning 3rd year, and a few impressed me. It takes more than just book knowledge to impress me (although lack of book knowledge will hurt) ... It's how you interact with the team and patients. Is the team a well oil machine or do the seniors and attending school have to constantly work harder to keep the team from breaking down? When all hell breaks loose, does the team rise up to the challenge?

As an attending now, I expect my subI to function like an intern. If I, my interns, and residents have to take time to show you how to function like an intern, ... Trust me, you're not going to "wow" us on the rotation.

 

[AlteredScale]

At PCOM when I was a student, I was able to do my entire 3rd year rotations on wards with resident-attending teams (with the exception of family medicine) ... Pediatrics was half inpatient half outpatient and I had to make sure I picked a spot that provided inpatient opportunity. And I was able to do them all in the same state within the clinical sites set up by PCOM. Hopefully students these days can still have the same opportunities that I had.

I agree that an entire preceptor based rotations would be a bit disservice to medical education. There's something to be said about the logistics and dynamics of a resident team that you need to quickly learn ... What job is the intern vs resident vs fellow vs attending? When should you go up the chain and ask vs when should you find out how to do stuff yourself? Trying to get disposition on your patients while getting paged on other patients while going admissions are always fun. And to Be honest, the atmosphere is different in academic medical centers compare to non teaching hospitals (not necessarily a good thing or bad thing ... Just different)

When I was interviewing for residency ( a long time ago), I've had several interviewers in different programs (acgme) ask if I've had inpatient experiences. I've met on the interview trail some DO students (not from PCOM) who were in mid 4th year and did not have any inpatient experiences. Reading on SDN, apparently this school is notorious for lack of inpatient exposure.

As a resident, and as a fellow, and now as an attending, I've had visiting medical students on my team, both MD and DOs. Most were ok, some were functioning at a level of a beginning 3rd year, and a few impressed me. It takes more than just book knowledge to impress me (although lack of book knowledge will hurt) ... It's how you interact with the team and patients. Is the team a well oil machine or do the seniors and attending school have to constantly work harder to keep the team from breaking down? When all hell breaks loose, does the team rise up to the challenge?

As an attending now, I expect my subI to function like an intern. If I, my interns, and residents have to take time to show you how to function like an intern, ... Trust me, you're not going to "wow" us on the rotation.

Good explanation! This just fortifies the fact that I'll be headed out to a site where most if not all rotations for third year are ward based. It's a bit frustrating that there are no ward-based rotations set up in the city where my school is at, so will need to relocate one of their other core sites.

 

[NurWollen]

At my school, everyone does a ward-based IM rotation. Ward-based rotations in FM, peds, general surgery, and OB Gyn are there for the taking. Basically all you have to do is ask. One student isn't likely to get all ward-based rotations, but I was able to get them in specialties I'm interested in. I'm happy and looking forward to it.

 

[nouedis]

Why complain to begin with? There are other countries out there who don't even have an educational system as well balanced off as ours and you're complaining because you get to leave early or aren't learning **** or because they don't care? News flash for you, pal, nobody ****ing cares.

 

[YankeeCandle1141]

Why complain to begin with? There are other countries out there who don't even have an educational system as well balanced off as ours and you're complaining because you get to leave early or aren't learning **** or because they don't care? News flash for you, pal, nobody ****ing cares.

What a useless, irrelevant post.

 

[nouedis]

It's not as extraneous as your existence, though, is it?

 

[Winged Scapula]

Keep it civil and professional guys.

 

[notbobtrustme]

From the stand point of impressing PDs, this is true. However, I cannot agree with the overall message you are stating. Having more electives means having more time to cater your education toward your field of interest. If I wanted to do PM&R, I would front load my rotations with them before ERAS. However, I would still want to do rotations that are similar to or involved with PM&R including Neuro, Ortho, Rheumatology etc. afterward. I don't want to be stuck doing primary care rotations (or sub-I's) that don't have much to do with my field of interest, when I could be learning something new and more relevant. More electives are a huge plus.

spoken like a true pre-med

wait until you get to M4 year and watch the ****s fly out the window.

 

[IslandStyle808]

spoken like a true pre-med

wait until you get to M4 year and watch the ****s fly out the window.

Or would you prefer having to do primary care rotations for the last 6 months of your 4th year, when you have already done 4-8 weeks of them or even rotations that don't have much to do with your speciality choice and are a total b****? Point is that elective rotations puts the choice in YOUR hands and not the school's. Ideally you want to rotations that would help with the residency of your choice. It may not turn out that way in the end due to pulling out all the stops in MS3 and MS4 (first months), but it is better to have the choice than not have it.

 

[notbobtrustme]

Or would you prefer having to do primary care rotations for the last 6 months of your 4th year, when you have already done 4-8 weeks of them or even rotations that don't have much to do with your speciality choice and are a total b****? Point is that elective rotations puts the choice in YOUR hands and not the school's. Ideally you want to rotations that would help with the residency of your choice. It may not turn out that way in the end due to pulling out all the stops in MS3 and MS4 (first months), but it is better to have the choice than not have it.

as a new M4, i plan on doing jack-all after December.

 

[IslandStyle808]

as a new M4, i plan on doing jack-all after December.

Some people don't have that choice, I don't want to be one of them. Good luck to you and I hope you get the specialty you want.

 

[wjs010]

Why complain to begin with? There are other countries out there who don't even have an educational system as well balanced off as ours and you're complaining because you get to leave early or aren't learning **** or because they don't care? News flash for you, pal, nobody ****ing cares.

I hear they don't even have education on Jupiter. Damn I feel lucky!

 

[YankeeCandle1141]

Or would you prefer having to do primary care rotations for the last 6 months of your 4th year, when you have already done 4-8 weeks of them or even rotations that don't have much to do with your speciality choice and are a total b****? Point is that elective rotations puts the choice in YOUR hands and not the school's. Ideally you want to rotations that would help with the residency of your choice. It may not turn out that way in the end due to pulling out all the stops in MS3 and MS4 (first months), but it is better to have the choice than not have it.

Yea you clearly don't understand the point of rotations. All doctors are expected to know certain things...you dont get to pick and choose what is "important" or not.

You need to know the basics of core specialties for so many reasons that I am not even gonna start. Just go back to the pre med forums.

 

[IslandStyle808]

Yea you clearly don't understand the point of rotations. All doctors are expected to know certain things...you dont get to pick and choose what is "important" or not.

You need to know the basics of core specialties for so many reasons that I am not even gonna start. Just go back to the pre med forums.

Did you read this thread and my post properly? Look at all my posts on this page, where have I stated you don't need core rotations? The majority of schools have 4 weeks of certain core rotations, while a few others have 8 or more weeks. My state MD schools has 11 weeks of internal medicine, which is overkill in my book (8 weeks is understandable). There is a point where you would gain more from a completely different rotation, but you do need certain cores.

Having electives even in 3rd year will serve you well because if you get a preceptor based primary care rotation that wasn't good, you could used the elective to get a ward based education (not to say there are no good preceptor based rotations). However, not all schools have this option. Pre-medcial students don't even consider electives as a potential reason to pick a school. Medical students have stated themselves they wish they have considered the amount of electives they had when picking their schools.

There are schools that only offer 3 electives and others that offer 5 or more. Let's say you had a school that only offered 3 electives and you want to do a radiology rotation to get better reading films (the school's sub-I's don't allow for radiology as a rotation and it is not a required rotation). Are you going sacrifice one of your 3 electives that could be used as audition rotations to do that radiology rotation? I don't think any medical student would. If there is the potential for elective rotation system to be abused, the school can put a rule that prevents a student from rotating in a specialty more than once.

You don't need 10+ elective rotations, but having 5-7 is much better than 2-3.

 

[serimeri]

I was wondering if you guys had any suggestions for someone who did not have a very good 3rd year experience and did not do a lot of presenting in 4th year ( I switched my mind about audition rotations--had some issues come up and switched which specialty I matched into--->Pscyhiatry).

I'm a bit shy/nervous when it comes to these things, but now that I start residency next week. I'm just presenting fake patients to my BF over Skype, and he's critiquing me.

I am just trying to look confident, be audible etc.

I'm good with SOAP notes, forming differential, the Plan is still a struggle with me some times (I get it wrong half the time). But my presenting skills need some work for sure.

What's done is done, but I'm at least glad that most of my co-interns are from India and other countries where they did not have this experience either. But I need to be concise when I present.

 

[serimeri]

At PCOM when I was a student, I was able to do my entire 3rd year rotations on wards with resident-attending teams (with the exception of family medicine) ... Pediatrics was half inpatient half outpatient and I had to make sure I picked a spot that provided inpatient opportunity. And I was able to do them all in the same state within the clinical sites set up by PCOM. Hopefully students these days can still have the same opportunities that I had.

I agree that an entire preceptor based rotations would be a bit disservice to medical education. There's something to be said about the logistics and dynamics of a resident team that you need to quickly learn ... What job is the intern vs resident vs fellow vs attending? When should you go up the chain and ask vs when should you find out how to do stuff yourself? Trying to get disposition on your patients while getting paged on other patients while going admissions are always fun. And to Be honest, the atmosphere is different in academic medical centers compare to non teaching hospitals (not necessarily a good thing or bad thing ... Just different)

When I was interviewing for residency ( a long time ago), I've had several interviewers in different programs (acgme) ask if I've had inpatient experiences. I've met on the interview trail some DO students (not from PCOM) who were in mid 4th year and did not have any inpatient experiences. Reading on SDN, apparently this school is notorious for lack of inpatient exposure.

As a resident, and as a fellow, and now as an attending, I've had visiting medical students on my team, both MD and DOs. Most were ok, some were functioning at a level of a beginning 3rd year, and a few impressed me. It takes more than just book knowledge to impress me (although lack of book knowledge will hurt) ... It's how you interact with the team and patients. Is the team a well oil machine or do the seniors and attending school have to constantly work harder to keep the team from breaking down? When all hell breaks loose, does the team rise up to the challenge?

As an attending now, I expect my subI to function like an intern. If I, my interns, and residents have to take time to show you how to function like an intern, ... Trust me, you're not going to "wow" us on the rotation.[/QUOTE]

While I agree some students are just lazy and love the preceptor laid back rotations...I feel that you should take into account the fact that if someone has had close to zero exposure in the inpatient setting, they would need extra coaching. I'm not saying hold their hand for the whole month, but expect them to need some guidance for the first week or so. Then they should "wow" you by their work ethic and personality.

This is precisely the reason, why everyone should do at least 3 audition rotations, regardless of how uncompetitive your specialty is

 

[j4pac]

I read all 7 pages of this thread tonight while watching a few episodes of Vikings on Bluray. Something incredible stood out to me. Not a single person mentioned how dangerous having interns NOT READY for internship truly is. People die when doctors make mistakes.

You learn something that gives you an edge in DO schools...you learn to adapt well and you learn how to be proactive. I don't think that there is any questions that the majority of DOs are behind the curve when it comes to starting internship. Most just didn't have enough STRONG inpatient exposure to be on the same level as a MD resident. The majority of DOs that I have witnessed catch up to their piers fairly quickly because they usually have good work ethic and adaptability...but shouldn't we expect more from our medical schools? It's not only important to be a good physician so that you can look good and make your school look good. Good physicians take better care of their patients than ones trying to learn on the fly.

If we are going to be the future of our profession then I wish that more was available in regard to the funds of our colleges. Why are resources being allocated the way that they are and is there a way to improve clinical education? I doubt that DO programs want their students to have poor clinical education experiences. Maybe they simply either don't have the money or don't have the available sites to make it happen. I personally will NOT give to my college until there is more transparency. It is sad that graduates are not proud of their alma mater.

 

[Goro]

Any news from OP @Siggy????

 

[Siggy]

Any news from OP @Siggy????

I think you mean @SpringDO

 

[Goro]

Ooops! My bad. OP stopped posting in 2013, so hopefully things worked out for him/her.

 

[apr27]

Bump.

So, I'm glad I cam across this thread. I'm a soon to be 3rd year DO student. My school pretty much has a lottery. I was hoping for the best ward based site we have, but, unfortunately, I was placed at a preceptor based site. Fortunately, it's in Denver though. I didn't have the opportunity to read most of the thread, but what is the general consensus on making the most out of these experiences? What have current 3rd years realized?

 

[JustaDO]

I didn't have the opportunity to read most of the thread

One thing suggested was being proactive in your endeavors.

 

[Danglebells]

if schools just called preceptor rotations "PBL" ...half of you would start raving about how much better they are than traditional style rotations.