About the ads

Which setting would you choose for 3rd year rotations?

Discussion in 'Clinical Rotations' started by DeadCactus, Feb 19, 2011.

  1. SDN is a nonprofit organization. Services are made possible through the generous support of SDN members and sponsors. Thank you.
  1. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor

    Joined:
    Oct 28, 2006
    Messages:
    1,976
    Status:
    Resident [Any Field]
    SDN 7+ Year Member

    SDN Members don't see this ad. (About Ads)
    Academic center complete with residency programs, fellowship trained specialists, and the local big names in their respective fields.

    Smaller community hospital with few or no residents and lots of one-on-one time with relatively obscure attendings and no fellowship level specialization.

    Why?
  2. DrBowtie

    DrBowtie Responsible?!?! PGY3 Moderator Emeritus

    Joined:
    Feb 24, 2005
    Messages:
    14,658
    Location:
    Classyville
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Academic center. They'll train you to function in the Attending - Resident - Student axis that you will be in until the end of residency. More diverse pathology. Getting to know the people who make residency decisions, etc.
  3. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor

    Joined:
    Oct 28, 2006
    Messages:
    1,976
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    To play devil's advocate:

    1) It seems far easier to learn to fall back into a hierarchy than learn to operate at a higher level of expectations and responsibility. It would seem the lack of hierarchy sets you up to act at a level above what's expected of a medical student.

    2) Does one really care about zebras when they're trying to master fundamental concepts? There is all of fourth year, residency, and maybe even fellowship to hunt zebras. Besides, aren't most zebras getting referred to the academic centers by the community centers?

    3) Is fourth year really going to be too late to meet the folks who make residency decisions?
  4. vicinihil

    vicinihil Member Moderator Emeritus

    Joined:
    Aug 12, 2004
    Messages:
    1,582
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Community hospitals are staffed with poorer teachers than major academic centers. I speak from experience as my school sends us out 4 months of the our 3rd year to community hospitals in different parts of the state. These community hospitals are staffed with physicians that are not there to teach but to get their work done. They are not use to having students until recently and most are not the most current on their medical knowledge. I have a hard time believing them when they tell me something and always find myself 2nd guessing them. If you have a choice, don't do it at a community hospital.

    That being said, you probably have more down time and more time to book study for a shelf at a community vs a major academic center. However, you have to balance this with higher power recommendation letters and surrounding yourself with people that may influence your career.
  5. DrBowtie

    DrBowtie Responsible?!?! PGY3 Moderator Emeritus

    Joined:
    Feb 24, 2005
    Messages:
    14,658
    Location:
    Classyville
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    One on One attending time can either be really good (lots of autonomy) or really bad (lots of shadowing). As the poster above me said, teaching is highly variable at these sites too.

    As for point #3. I'd say yes. ERAS opens Sept 1. You would know someone better after two rotations rather than one correct?
  6. shwin

    shwin New Member

    Joined:
    Feb 12, 2005
    Messages:
    67
    SDN 7+ Year Member
    i echo this sentiment. every physician at an academic center will impart more knowledge more efficiently than any community physician. moreover, you will likely learn how to perform MRIs using only your steth and present your differential as a haiku or limerick. community hospitals are academic suicide and will render you as a medical pariah.






    :rolleyes:
  7. cabinbuilder

    cabinbuilder

    Joined:
    Nov 21, 2005
    Messages:
    3,076
    Location:
    Travelling Rent-A-Doctor
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    I did all of my rotations in a small setting when I could. Why? I wanted to do rural medicine and in the smaller places. YOU GET TO DO EVERYTHING. There is no fighting residents and other med students for cases and procedures. The more rural the place, the more opportunity to get to do things yourself.

    Just my 2 cents
  8. Lokhtar

    Lokhtar Dreaming about the lions

    Joined:
    Aug 6, 2007
    Messages:
    3,104
    Location:
    Philadelphia
    Status:
    Medical Student
    SDN 5+ Year Member
    It may also depend on the specialty of your interest right?

    For more competitive residencies, would the LORs not matter a lot more if they come from 'well known' people rather than attendings from community hospitals who may not be known?

    On the other hand, community attendings may get to spend more time with you so may be able to write better LORs overall.
  9. Lokhtar

    Lokhtar Dreaming about the lions

    Joined:
    Aug 6, 2007
    Messages:
    3,104
    Location:
    Philadelphia
    Status:
    Medical Student
    SDN 5+ Year Member
    Err, just want to mention I am speaking theoretically, I've no personal experience with rotations yet. It seems (from what people say) that you get to do and learn more since you have more hands of experience, but maybe it's not as good in terms of career planning (not saying one is prohibitive one way or another)?
  10. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    I'm going to further stir the pot with my personal conundrum. The caveat here is that unles something surprising happens, I'm going with the academic center over the community hospital. But I will present my case for the community hospital, since I felt strongly about it for a while too.

    In my schools specific case the community hospital was actually a system of three community hospitals you bounced between (all very close, so geography wasnt an issue). This community hospital system was run by a DME who was extremely well known (head of trauma for columbia, published multiple books, one of Obama's two personal doctors when he is in NYC) who decided to primarily practice out of the hospital closest to his home in North Jersey. He *is* the selling point of this place.

    So anyway the deal at this community hospital is that he takes you under his wing for surgery and has equally dedicated people for IM who teach you everything. You get to be first assist on every procedure he does surgically and get to be hands on with everything that comes in to the IM dept. He admits that his ER/OBGYN/Psych/etc are not as teaching oriented as a teaching hospital would be, but you'll still learn tons by finding a doc you like and making sure you're around when he's in. And the community hospitals aren't out in the middle of nowhere. They are feeders to all the NYC mega-hospitals, so the obscure pathology that shows up there starts at these hospitals before being transferred up.

    Is it worth it now to ditch the resident driven system to be able to get massive hand-on experience during the 4 months of surgery and IM when you'll be doing stuff that 2nd and 3rd year residents only begin to do (I've heard some impressive specifics, including cutting). And add in that you can probably rely on him to write you a LOR with his name weight behind it. Is it worth the loss of residents to get that hands on experience you can turn aroudn in later rotations at other sites to show the skills you have and impress?

    note: I am choosing to still have residents. But I still believe fully in what i said above. I just realized one of our sites was a level I trauma center, so being a student there, even if I can't touch, would give me the trauma experience I want guaranteed. And thats something I want to get into... so... yea. An "x" factor sold me elsewhere, despite the community hospital having that amazing surgery experience.
  11. Perrotfish

    Perrotfish Has an MD in Horribleness

    Joined:
    May 26, 2007
    Messages:
    6,169
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Depends on the rotaton:

    If it's a specialty where you round a lot (I'M, Peds, Neuro) then go with the academic medical center. They're much better at teaching you.

    If it's a more procedural rotation (surgery, OB) I'd go with the community hospital every time. At academic medical centers these rotations basically consist of waiting to leave. The presence of resident means you'll never do anything but retract, and there's no teaching because academic OBs and surgeons are even more malignant than the other membes of their profession. Go somewhere where far away where they won't completely waste your time.

    FOR eM and Family it's a toss up.
  12. vicinihil

    vicinihil Member Moderator Emeritus

    Joined:
    Aug 12, 2004
    Messages:
    1,582
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    I semi agree with the above poster. As a medical student, your procedural skills and savvy in the OR is unimportant. What is important is you know why certain things happen and how to be an efficient resident and get the kick-***** residency that will propel you to the next level.

    The skills you mentioned above may matter more when it comes to residency where you will actually be cutting into people and running the show. As a medical student, shadowing is a large and boring part of medical training and while the old adage of see one, do one, teach one, no longer applies, being around the "best" in a field still matters more than getting your hands dirty. So retract away dear friends and hope you're not supporting the next large pannus that rolls into the OR.
  13. Lokhtar

    Lokhtar Dreaming about the lions

    Joined:
    Aug 6, 2007
    Messages:
    3,104
    Location:
    Philadelphia
    Status:
    Medical Student
    SDN 5+ Year Member
    What about the LOR situation? Say you do surgery at a community hospital and want to do surgery, will an LOR from there be looked upon the same way as a big academic hospital, even though you might have done and learned more at a community hospital?
  14. Lunasly

    Lunasly

    Joined:
    May 17, 2010
    Messages:
    779
    Location:
    Canada
    SDN 2+ Year Member
    I'd also be interested in the above answer. Would it be easier to get an honours evaluation at a community hospital as opposed to an inner city/academic hospital? Do the LOR's from an attending at a community hospital hold the same weight?

    Is the above specialty dependent?
  15. unsung

    unsung

    Joined:
    Mar 12, 2007
    Messages:
    1,356
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Wow, I disagree with most of y'all.

    I am the biggest zebra lover there is, and if I could do it all over again, I'd pick the community hospital with no residents every single time.

    Residents get in the way of learning. Except for possibly the Chief residents who are well-trained enough to be bored with the bread & butter, where they are willing to let you take on some real responsibility. And plus they're so far above you, they don't feel threatened by your knowledge or prowess.

    Sure, some juniors are willing to teach & it's nice... but more often I wound up doing scut for them or getting sh!t on 'cuz they really enjoyed the power trip... which involved micromanaging me, down to every sentence in a frickin' SOAP note.

    I once sat there done with my day, with the resident "going over" my one progress note over the course of 2 hrs-- getting distracted by something every 10 sec, and picking everything apart... it was ridiculous. Never had an attending do that.

    And ANYWAY, even if they're not power-hungry micromanagers, even if they teach, and even if they're nice & non-jealous... there's still that matter of any time there's an opportunity for a procedure or interesting case, they're all over it.

    In a community hospital, there's much more opportunity to gain 1st hand experience.
    ---------------------------------------------------

    Aside from the issue of residents, doing a rotation at an academic center means your day will be packed with *required* meetings & grand rounds, etc.

    I always hated how these meetings took away from the day. A day that would otherwise be quite manageable turned into a stress ball, 'cuz I was always rushing from place to place. Right when morning lab results come back (i.e. the Perfect time to finish my A/P), I'm forced to leave the patients behind to attend some meeting. So it's actually kind of funny-- 'cuz by making everyone do that, patient care is delayed 'cuz you can't formulate a plan without 1st going over the lab results.

    Plus, while I'm trying to learn the basics of managing COPD or pancreatitis, is it really helpful to attend these things ?

    I'm sure once I'm proficient at the basics, they will be quite helpful & interesting. But 3rd yr rotations should be focused on mastering the bread & butter, imo.
    ------------------------------------------------------

    I think rotation-wise, the above probably applies to surgery the most. It's mostly about hands-on experience with surgery, so the more 1st hand practice you get, the better. The more you participate, the better you function in the OR. Standing around will not gain you that experience nor prepare you for residency.

    The only exception I can think of is Emergency Medicine. There, it's helpful to be at a more major hub, as opposed to some quiet community ER.
  16. drizzt3117

    drizzt3117 chick magnet

    Joined:
    Oct 29, 2006
    Messages:
    14,696
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Looking back on m3 I would have chosen:

    FM, OB, Peds, 1/2 of Surgery, Psych: community hosp
    Other 1/2 surg, medicine, neuro, IR, diag rads: academic center
  17. pianoman511

    pianoman511 Member

    Joined:
    Jun 8, 2005
    Messages:
    487
    Location:
    Buffalo, NY
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    There is a huge variety among both academia and community hospitals in regard to quality of rotations (as you can tell from the other posters). I have experienced some of the best and some of the worst rotations at community hospitals just as I have experienced some not so great rotations at larger academic centers.

    One of the best rotations I had was doing ortho at a community hospital because the surgeon did EVERYTHING. Most of the time if you go to a big hospital or large city everyone subspecializes, but I assisted on everything from shoulder replacements and ACL repairs to traumatic fracture repair. I also got to hone my knee, shoulder, and hip assessments really well. To be honest, from the onset (since it was a "mandatory" rotation area) I thought it would be one of the worst rotations but I definitely got my mind blown. The same thing happened on pediatrics where I ended up in the middle of nowhere with a guy who was brilliant. I not only got really experienced at newborn assessments and fluid replacement in kids, but got to see some of the oddest genetic disorders that you only read about (kids with Prader-Willi, Angelman, etc).

    Just like having experiences like that I did multiple ER rotations and found the large academic centers great because of the diverse pathology but there wasn't too much teaching involved (i.e. read up on it yourself and have some idea before you present). Contrast this with the small community ER where I got tons of teaching from docs who had been doing the job forever and got great experience with minor procedures and quick acute complaints; things you don't really get to see much in a large ER because it gets shuffled to the midlevels in fast track.

    I would say that there is some value in doing a rotation at an academic center in the specialty you choose, regardless of what it is. You will need to see how the hierarchy works, what your role will be, and get an idea from the residents how they like the programs. Plus you get to have face time (even if its not an audition you might get an LOR out of it). Even though you may get a diamond in the rough community rotation with a well-known preceptor who can give you a rocking letter, the odds are an academic letter will have more weight.

    At my school we had to choose rotations amongst ourselves so I "took the hit" and did a lot of community rotations in things that were not ER and there were plenty of not so great rotations to go with the spectacular ones but it just meant that I had to read a lot more for my shelves instead of learning from my attending.
  18. FSU2013

    FSU2013

    Joined:
    Aug 11, 2011
    Messages:
    1,217
    Status:
    Medical Student
    SDN 2+ Year Member
    I take exception to the comment that physicians at academic centers are better teachers. I go to a community oriented school without residents and we have some AMAZING faculty. As far as hands-on learning, you can't beat it. I was first assist on every surgery for my GS rotation. Did I scrub on any whipple's? No. (Some of my classmates did) But, I was able to do just about every part of a lap chole.

    The idea that you won't see zebras at a community hospital seems fundamentally off. Do the zebras just walk into the tertiary care center without being worked up in the local hospital first? Also, the point of the third and fourth year of medical isn't to focus on the zebras, it's the horses (although the zebras are fun)

    I wouldn't trade my experience for anything. I have killed all of my shelf exams to-date because I have had tremendous clinical experiences. Our school has a below average MCAT and average-ish Step 1 scores. We have a 20-something point jump between step1 and step2 scores from average or a few points below average step1 to well above average for step2. Most attribute this directly to our preceptor model.
  19. mdpdgirl

    mdpdgirl Senior Member

    Joined:
    Mar 3, 2005
    Messages:
    484
    Status:
    Resident [Any Field]
    Physician PhD SDN 7+ Year Member
    There are good and bad academic rotations and good and bad community rotations. Can you talk to students that have done each rotation at a particular site with a particular preceptor/team and make choices on each one individually?
  20. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    Let me put it this way: No residency will ever care in the least how many gall bladders you've pulled out yourself compared to how many you've seen pulled out. No residency will ever care how many rare and obscure diagnosis you can make when you can't write an amazing H&P or can't manage >5 patients while still going to all those require meetings.

    Complaining about required meetings ruining the rotation is like a pre-clinical student complaining about pharmacology ruining the first two years of med school. It's going to be a crux of your future whether you like it or not. Feel free to complain about it and ignore it and thus be grossly unprepared for a future that will be full of it no matter what you do.

    There are great opportunities to be had at community hospitals. Of that there is *NO DOUBT*. But those opportunities will be much less frequent than the same great opportunities at academic centers, and its hard as hell to get enough word of mouth beforehand to know if the rotation youre walking into is crappy or excellent. If you have no information ahead of time to educate your decision, you have to pick the academic center 9 times out of 10 just because the odds of a great educational experience are higher there. Plus every month at a community center is time away from "learning how to be an intern" which is... really... what we're doing in our clinical years you don't need every month to be dedicated to academic hospitals, but for the sake of learning how to be a proficient intern it definitely helps if most of them are there.
  21. myhandsarecold

    myhandsarecold

    Joined:
    Dec 2, 2009
    Messages:
    400
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    STAY AWAY FROM THE COMMUNITY HOSPITALS!!! you will not get any teaching there. the attendings dont want you anyway, you're there to slow them down. believe me. im on my 4th community hospital (by my own choice 'cause it's close to home and I get to save rent) and i've not learned a thing and the residents here are idio*s. Agree with above, academic hospitals are so much better because the residents dont really know much more than you and so the teaching is good (because you all need a lot of teaching) plus being around other trainees is nice.
  22. drizzt3117

    drizzt3117 chick magnet

    Joined:
    Oct 29, 2006
    Messages:
    14,696
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Our community affiliates all have residents, but the environment is a bit less academic than our home institution. I enjoyed my community rotations a lot, in some ways more than the main academic teaching hospital.
  23. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    I think much of this boils down to perception. The perception students have is that they're training to behigh functioning physicians. The perception of programs is they want an intern functional enough to handle a high load and education.

    I tend to think the programs perception matters more.
  24. unsung

    unsung

    Joined:
    Mar 12, 2007
    Messages:
    1,356
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Being a proficient intern means being able to take care of sh!t by oneself. This involves everything from forming the dx to finding out where the marker is in the supply room.

    IME, rotations at academic centers tend to be highly structured, so that students never learn how to do stuff for themselves... because guess what, they have no real responsibility, so they don't have to figure out how to do things.

    In contrast, at the community hospital, students have more liberty & function more autonomously. So they gain more practical skills. I'm not talking about pulling out the gallbladder... I'm talking about simple things like figuring out that EMR by yourself. In contrast to the 2-hr formal tutorial you're liable to get at a university hospital.

    My main point isn't about doing more *procedures*. It's just the simple fact that the more you DO, the more you learn. At an academic center, students are often treated exactly like students- coddled, shadowing, and never learning how to do stuff on their own. Internship, as we all know is about figuring out how to do sh!t, much of which is scut work. Everything from how to enter that weird order, to calling that consult, to doing that quick exam.

    -----------------------------------------

    Btw, I loved pharm, so I don't know what you're talking about lol... required meetings as an attending would be just fine. After I'm comfortable working up bread & butter, it would be quite useful & interesting to spend hours discussing more obscure cases. I just don't think it's that helpful at the student level, when we're still honing our basic skills.

    As for your idea "get used to it"... well, not all residencies are at academic centers. I mean, so far I've really disliked many aspects of the academic experience-- everything from hierarchy, red tape, required meetings, to decreased time with the patient.

    Personally, I would NOT choose to be seen or have my family be seen at an academic teaching hospital in the future... unless it's some obscure disease or complicated procedure, of course.

    Things don't get done at the teaching hospital! I mean, that morning labs/morning meeting example is just one... where a patient at a private hospital would've been d/ced by noon after a simple chole, he could be staying til 5pm for no good reason at a teaching hospital.

    Exception: the meetings I DON'T mind are the "patient panel" meetings. They have been uniformly memorable & interesting. I can still remember a sickle cell patient talking about the excruciating pain & how people didn't believe he was in that much pain so they wouldn't give him painkillers. Stuff like that- directly applicable to our clinician work. Makes an impact.
    ------------------------------------------

    So yeah. I think for residency, I won't pick one that is largely centered at a academic institution. A large part of learning is VOLUME of bread & butter cases. Learning how to deal with all the manifestations of the common stuff, including complications, etc. Learning how something common like pancreatitis manifests in some woman with 2 transplants & some rare immune disorder ? I don't know how helpful that is. I think it's more helpful to learn the uncommon *presentations* of the common stuff.

    I think ideally for residency, there would be several institutions- university, VA, community, to rotate through. Come fellowship time? Yeah, of course the university hospital with the renowned specialist is obviously the only place to be. And by that time, all those Grand Rounds & required meetings will actually be useful & meaningful.
  25. unsung

    unsung

    Joined:
    Mar 12, 2007
    Messages:
    1,356
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Sooo, after all is said & done, I would do:

    Community hospital:
    Gen Surgery, Medicine, OB/GYN, Neuro, Pediatrics

    University hospital:
    EM, Family Practice, Psych

    The rotations I'd do at an academic center are basically rotations that kind of depend on the diversity of the patient population. You're going to learn more if you see sicker ER patients than patients there for social visits. Family Practice is like the odd one, 'cuz I think out in the community the skill level can vary- again it's a patient population problem. After practicing for a while & seeing the same types of patients, you might lose some of the important book knowledge or awareness of current guideline recommendations.
  26. MossPoh

    MossPoh Textures intrigue me

    Joined:
    Apr 24, 2006
    Messages:
    8,006
    Location:
    Tally/Willkillya County
    Status:
    Medical Student
    SDN 7+ Year Member
    Seems a bit much to say one won't get good teaching at community hospitals. It depends on the structuring and how they recruit attendings. We are at community hospitals but every attending signs up to do it and most of them are eager to teach. I have multiple attending's cell phones and email address and none of them would hesitate to answer a question or help if I called them.
  27. coffeeeandtea

    coffeeeandtea Caffeine Abuser Lifetime Donor

    Joined:
    Jul 21, 2008
    Messages:
    324
    Location:
    King's Landing
    Status:
    Resident [Any Field]
    Navy SDN 5+ Year Member
    sorry, but at community hospitals (esp those without residents) students are also coddled, sometimes doing nothing but shadowing because the attending "doesn't think students need to write SOAP notes," or the students get in the way of the attending seeing as many patients as he/she needs to see in a certain amount of time. one infamous attending is a preceptor for IM, the one who "doesn't think students should write SOAP notes" - only comes in 3 times a week, and subsequently, the students also only come in 3 times a week. there was a student in my class who did his entire IM rotation at this subset of community hospitals without residents - and managed to go through 2 entire months without writing a single H&P. i mean... are you f-cking kidding me?! in addition, (at least at the community hospitals my school is affiliated with) the words "liberty" and "autonomy" are often code words for starting the day at 9am and then going home at 11am for the rest of the day because there's no work left to do at the hospital. and i'm SURE they're going home and studying for those next 12 hours... :rolleyes:

    obviously the quality of community hospital rotations varies, and some people may have awesome experiences, as it seems you have. others, like myself, have not had such great experiences. and for specialties like surgery, it probably would be beneficial to do one month at a community hospital where you could get more opportunities to be first assist. however, the way i see it is that i have my entire residency to learn how to do procedures. i won't even get into a residency if i don't know how to present a patient and work them up medically.
    Last edited: Feb 19, 2012
  28. GraceEuphoria

    GraceEuphoria

    Joined:
    Feb 17, 2009
    Messages:
    810
    Status:
    Medical Student
    SDN 2+ Year Member
    There was no way I could skim through and respond to all the posts, but this one, being the most recent, caught my attention. You may have that experience, but I would never say you can generalize that to all community hospital based rotations at other schools. I can say for sure this is NOT the case at my school at least (and yes, I'm an OMSII but I keep up with stories from upperclassmen to know that it is indeed not true).

    Point being, someone should not shy away from community hospital rotations simply because some are not the best learning experiences. Some academic centers don't provide the best learning experience either....I know I've heard those stories too.

    All in all, does it really matter that much, if you're going to experience both settings throughout your 3rd and 4th years? Even in my rural medicine focused program, we get 11 months to go anywhere we want, so if you think IM and peds isn't good at community hospital, there are ample opportunities to explore them at an academic center. This is just my perception at this point and I'm sure I'll understand more after the next 2 years have passed. It seems unfair, though, to say the community hospital docs ALL don't want to teach and aren't good at teaching....I've heard some stories that reflect this from upperclassmen, but I also know that some of them have been amazing. A lot of our sites have directors that make sure to get only the docs that really want to teach to be our preceptors. That seems like a tremendous advantage. At an academic center, aren't residents/interns required to teach? Who says they'll all be good teachers if they're mandated to do so? Just a thought...
  29. myhandsarecold

    myhandsarecold

    Joined:
    Dec 2, 2009
    Messages:
    400
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    lol
  30. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    I'm not sure about this, but does your school have a significant number of academic-style rotation sites or just the community ones.

    I ask this because the deficits seen by CoffeeAndTea (who is at the same school as myself) are at their most obvious when compared to people from the same school who are at more academic-style sites. Its one of those "you don't know how much you don't know" situations. Without other style nearby for comparison, its hard to realize how much more you could be getting and how much you are missing.

    The above applies no matter what, but how much it applies to your comment sort of hinges on the academic-vs-community balance at your school. and as I said in an earlier post, a community hospital can give a truly outstanding education, but it will never give the intern training (which you need a decent exposure to) and has lower odds of giving that outstanding education if you're just going to gamble and pick one style over the other.
  31. coffeeeandtea

    coffeeeandtea Caffeine Abuser Lifetime Donor

    Joined:
    Jul 21, 2008
    Messages:
    324
    Location:
    King's Landing
    Status:
    Resident [Any Field]
    Navy SDN 5+ Year Member
    well... maybe if you'd read more than the first line of my post, you would have gotten to the part where i said, "obviously the quality of community hospital rotations varies, and some people may have awesome experiences".

    of course i know not ALL community hospitals are equal, especially if they have a history of working with students or if they have residents around. i was simply pointing out that the "coddling" and "shadowing" can definitely happen at community hospitals as well, not just at academic centers.
  32. KnuxNole

    KnuxNole Sweets Addict

    Joined:
    May 3, 2006
    Messages:
    3,960
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Community hospitals, seem more down to earth and happy. But that's one example, there might be an academic center which focuses more on learning the MEDICINE behind things, and there are some community places which don't care that you exist and don't treat you like a student.

    Residents are hit or miss compared to people who have been doing it for years. Some are good, but I would rather want to spend time learning with an attending. I mean, a 3rd year students primary job is to learn medicine, and the intern(unless they are exceptional) knows very little to really teach someone a lot. They might teach basics(i.e. stuff that will be on the shelf exam/Step 2), but noone should expect an intern to be an expert on XXX speciality. I would never expect an OB/GYN first year to know an extensive amount on fetal heart tracing, unless they are a rare bird and/or have read an intense amount before starting.
  33. copes

    copes

    Joined:
    Dec 27, 2011
    Messages:
    109
    Location:
    USA
    Status:
    Medical Student
    SDN 2+ Year Member
    My best rotation of 3rd year so far was at a community hospital with a residency program.
  34. WonderBoy

    WonderBoy PGY1

    Joined:
    Jan 16, 2001
    Messages:
    707
    Location:
    NY
    Status:
    Resident [Any Field]
    SDN 10+ Year Member
    I am guessing your talking about the Consortium Hospitals? I am stuck there for next year after getting a crappy lottery number. Dreading starting rotations there but have't given it much thought yet because of boards.
  35. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    You'll be fine. Its about pushing yourself. There is a lot of room for laziness at those hospitals. There is no room for laziness at places with a good education system and residents abound. Beat the laziness and you'll be fine.
  36. msupaintballer

    msupaintballer

    Joined:
    May 18, 2011
    Messages:
    17
    As a third year medical student you want to do your training in undeserved community areas. Some students will tell you to do academic because of the superior teaching, I have found that both places offer good teaching the difference being the hands on approach. As a third year medical student you want to get your hands dirty and be doing small procedures, doing the physical exams on patients, placing IVs, getting to operate in the OR.

    I am now a 4th year osteo medical student & did my training in Newark NJ, at a community program. I cannot thank that place enough for the hands on. As a student going into Ob/gyn I got just under 20 solo delivers and in the OR was able to do 13 unassisted D&C's 4 ablations and got suture and close all the time, all as a third year. By the time i was on my 4th year "audition" rotations at large academic places, I felt extremely comfortably doing so much. In talking to other students who trained as third and even forth year students at large academic places, they received very little hands on and you could easily tell.
  37. ericL

    ericL Member

    Joined:
    Nov 20, 2005
    Messages:
    552
    Location:
    Where the wild things are
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    So far, I kinda regret going to a place that farms us out to community hospitals around the state. I've enjoyed my time at the academic center far more, and felt the teaching to be far better there. I actually learn how to work up a problem, formulate a ddx, execute treatment plans, and generally get things done, while at an academic center.

    I feel kinda deceived. Our school really shoves this BS down our throat about what a great experience it is to go to these tiny little corners of hell to do rotations. Citing some kind of weird pride in the state. I thought, "Awesome, fewer residents, more attending face time, blah blah blah, it'll be awesome!" Good god was I wrong.
  38. scotchtapetest

    scotchtapetest

    Joined:
    Sep 23, 2007
    Messages:
    597
    Status:
    Resident [Any Field]
    SDN 5+ Year Member
    IMHO it is not about academic vs. community but instead about rotations with house staff vs. rotations without house staff.

    99% of the time you should go to rotations with house staff (Unless it is a really malignant program). It doesn't matter if it's a big name academic or no name community.

    Having residents on your rotation is crucial as they are the best for teaching medical students since they are closer to our level than an attending will ever be. Also what you need to learn as a MS3, doesn't really require an attending. A junior resident is well qualified to teach you most of what you need to know. Also they do a better job because they have more time as opposed to attendings.

    I also think for MS3, there is even something to be said about community places with house staff as you will probably have more access to patients. You don't really need to see the rarest genetic diseases as a third year but should be exposed/learn the bread and butter stuff which you get plenty of in community hospitals without the competition from too many residents/fellows. But at the same time, you don't want all of your training at community joints as some exposure to "academia" is also important.
    Last edited: Feb 22, 2012
  39. KnuxNole

    KnuxNole Sweets Addict

    Joined:
    May 3, 2006
    Messages:
    3,960
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    Really?

    I found that I HATE having to work with residents, they taught very little to nothing. I felt if I had to learn 3rd year through residents only, I'd be pathetic as a doctor. Most of my learning was through either
    A) Books
    B) Attendings

    Also, for asking questions, I feel like only the seniors or attendings feel comfortable answering stuff. Since, we're here to learn about the diseases that encompass X speciality, and what people do to treat/manage them. I'm sure non-senior residents are able to teach how to diagnose, treat and manage those too...but they are always so busy running around, while the students are just sitting around, or taking 2 hour lunches or going to study, so there's a huge disconnect.
  40. DocEspana

    DocEspana I shall cast a spell on your roster

    Joined:
    Mar 1, 2010
    Messages:
    12,359
    Location:
    New York
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    I just.... I couldnt disagree with this more. But yes, i acknowledge that your subjective experience is yours.
    [​IMG]
  41. KnuxNole

    KnuxNole Sweets Addict

    Joined:
    May 3, 2006
    Messages:
    3,960
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
    LOL

    Well, I guess we'll agree to disagree. I'm sure 1st year interns and residents are able to teach medical students about diseases, diagnostic tools, and management, cause of course the main reason we are there is to learn about the diseases of XXX specialty, seeing/watching patients which have that disease, and being taught how to manage and such, and as 3rd years, things that will be on the shelf and Step 2. I feel the only learning time is with attendings, since residents are so busy doing work and feeling tired, while us students are busy playing on Iphones, chilling and sneaking away for lunch, due to noone teaching them about stuff, lmao.

Share This Page


About the ads