Last second advise

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Hey skippy

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I need a little help/guidance. Here’s my background: graduated medical school 2008 and started pediatric res. I did poorly…my PD pulled me into her office and told me that my contract wasn’t going to be renewed. I told her I hadn’t been enjoying pediatrics and had been thinking about switching. We had several helpful chats. Anyway, I am on good terms with the PD and got a letter. I walked away with credit for 4 months of the year. I think one of the other factors that contributed to my difficulties was poor exposure as a medical student in my 3rd and 4th year (i.e., never rounded on surgery patients, I had 1 month of inpatient medicine, ect.). The year of Peds helped with that.

Since leaving I have done research and have worked doing H&P for Same Day surgery patients in an effort to beef up my application for anesth.
Questions:
1. I am having serious doubts about getting in with my history so as a back up I have thought about doing FP and I am wondering how I should rank the traditional intern year positions? Should I rank them and get started again down the residency tract or would I have better luck scrambling into a FP position?
2. One thing I don’t understand is how the Medicaid reimbursement plays into a programs equation if I have started into the traditional intern year and try to slide over into a PGY-2 position.

Sorry about the long post and thank you for your input. I appreciate those of you put in the time with this site...very helpful!
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Hey skippy said:
I think one of the other factors that contributed to my difficulties was poor exposure as a medical student in my 3rd and 4th year (i.e., never rounded on surgery patients, I had 1 month of inpatient medicine, ect.).
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I have no useful input, but was wondering if you would be willing to share where you attended school.
 
2. One thing I don't understand is how the Medicaid reimbursement plays into a programs equation if I have started into the traditional intern year and try to slide over into a PGY-2 position.
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The reimbursement situation is that a program will only get funding for whatever is left of the total number of residency years you were initially approved for, which in your case is 3-1 for peds. So your future program only gets two years of funding for you from the government no matter what.

Whether or not that precludes you from getting a position in a particular program depends on the institution, and so you should probably call a lot of program directors and find out if they could work it out for you.

As an aside, your lack of experience with inpatient medicine, surgery rounds, etc. is unfortunately endemic to osteopathic medical education, and does present a pretty big road block for us in terms of matching at some of the big academic residencies. I was asked multiple times on the interview trail this year questions along the lines of "we've had problems with osteopathic students in the past who came here unprepared, with significant deficiencies in their ability to do bread and butter wards medicine. How are you different?" Fortunately I was able to break it down for them and point to sub-internships and away rotations I had done from my home institution that had a more 'traditional' atmosphere, and the PDs seemed happy with that. Not everyone is getting that though.

I add this to the list of things I wish I knew about DO school before I signed up.

Good luck!
 
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I had the same experience third year by and large and had to make up for it 4th year by electing to repeat most of the same basic rotations at decent hospitals.
Many, many of my classmates have had similar experiences. Regardless, it is ultimately your responsibility to learn the material and hopefully your institution allows you some flexibility to learn real medicine at academic/teaching institutions.
 
I would recommend not counting on the scramble as a way of getting into FP. I think your best bet is to try to match into a good, solid traditional rotating internship at a place you think you would be well supported at and then focus on getting an osteopathic family medicine spot next year (I am not certain, but I believe that an osteopathic FM program can count a traditional rotating internship as your PGY-1 and start you as a PGY-2).
If you scramble you might very possibly wind up at a malignant or very uneducational program that could lead to another problem with getting your contract renewed and really spoil your career. I also suspect that in the heat of the scramble, you won't be given a full opportunity to explain your circumstances in a way that represents you well.
Best of luck!
 
Thanks for the input everyone! This point by Peppy is one that I wonder about.

peppy said:
(I am not certain, but I believe that an osteopathic FM program can count a traditional rotating internship as your PGY-1 and start you as a PGY-2).
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I have thought that this would work as well...and in this situation I may have to try to find a program that would be okay not having the Medicaid funding for the balance of my time. If anyone has any other input on this I would very much welcome it.

I purposefully left out the name of the school that I attended at the request of my wife. I was going to mention it out of spite...but she makes the point that it really wont change things now. If this was a Pre-Osteopathic forum I would mention it for the benefit of others. It is interesting to hear that it is an issue at other Osteopathic schools...makes me feel like I have a little support group.

Thanks again
 
Hey skippy said:
I purposefully left out the name of the school that I attended at the request of my wife. I was going to mention it out of spite...but she makes the point that it really wont change things now. If this was a Pre-Osteopathic forum I would mention it for the benefit of others. It is interesting to hear that it is an issue at other Osteopathic schools...makes me feel like I have a little support group.

Thanks again
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I understand not wanting to share information, but I think it would be helpful. Plenty of the pre-meds check out this forum, because we are researching our school choices. I recognize that some schools clinical educations are lacking, and the only way I found that out was through the DO section, and some of us are trying to spread that info to the pre-DO section.

Did your school let you set up your rotations, and you didn't know where to set them up or were the sites just lacking in exposure? Could you have set them up yourself? Thanks! Good luck on finding another residency.
 
My general bit of advice to pre-meds is, I would recommend avoiding schools that place a heavy emphasis on "preceptor"/outpatient based rotations where most of the time you are one on one with an attending. Try to make sure most of your rotations are in hospitals that will have interns/residents on the rotations with you. I know that some people try to say that having "one on one" time with an attending is a bonus. That can be true if you are fortunate and are matched up with an attending who is very gung ho about med student education. However, in many cases the reality is that attendings have other priorities and don't have the time or interest to focus on the med student that happens to be hanging around.
Having more than one senior person present means that if one of them happens to be a bad teacher, then you may have better luck with one of the other people on the rotation (i.e., learning from a good resident on a rotation with an attending who doesn't pay attention to you, or vice versa, rather than being stuck with one attending who may or may not be a good teacher).
A lot of times the interns will be grateful to have a med student around who can help pick up some of the work and be happy to give you as much responsibility as you want. On the other hand, many attendings would really rather just do the work themselves since they can do it faster and more efficiently, and letting the student have responsibilities will just slow them down.
 
Good job for looking up this info in advance beckhunter! I wish I would have had the forethought to do that when I was in your position. I went to Touro CA and spent my third year in Vegas. The Touro-NV campus was just putting it's first group of third year students into clinicals and so the good rotations were spread thin. They were suppose to set up our third year rotations and it was a disaster! 4-5 months of the year I was without a rotation three days into the month and calling/emailing the office in Calif and Vegas to find out where I should go. Nobody knew who was responsible for us.

Fourth year we were suppose to set up ourselves. This short fall was my fault. I should have set up rotations at better locations and a couple of sub-interships. I got married just after graduation and this over shadowed a lot of my decisions for fourth year. I should have done our relationship a favor and moved away for a solid chunk of the year for some good rotations.

Key: When applying to medical schools get to know where they do their clinical rotations and don't be afraid of the tough ones...it's only a month.

I hope this helps
 
Peppy brings up some good points... a lot of my fourth year was "one on one" with attendings that were willing to take med students in a geographic location I wanted. Cool people, got good letters too but educationally I payed the price.
 
I have been hearing more and more about the Touro-NV rotations and lack of good clerkships...thank you for letting us know which school it was, skippy.
 
Makes me super happy about getting to go to the rotation site I wanted that already has an allo residency program set up and another osteopathic school sends students in to rotate there as well.
 
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Hey skippy said:
Good job for looking up this info in advance beckhunter! I wish I would have had the forethought to do that when I was in your position. I went to Touro CA and spent my third year in Vegas. The Touro-NV campus was just putting it's first group of third year students into clinicals and so the good rotations were spread thin. They were suppose to set up our third year rotations and it was a disaster! 4-5 months of the year I was without a rotation three days into the month and calling/emailing the office in Calif and Vegas to find out where I should go. Nobody knew who was responsible for us.

Fourth year we were suppose to set up ourselves. This short fall was my fault. I should have set up rotations at better locations and a couple of sub-interships. I got married just after graduation and this over shadowed a lot of my decisions for fourth year. I should have done our relationship a favor and moved away for a solid chunk of the year for some good rotations.

Key: When applying to medical schools get to know where they do their clinical rotations and don't be afraid of the tough ones...it's only a month.

I hope this helps
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Well, your problem is crystal clear. Like most osteopathic students, you actually expected to be human while in medical school and have some life not shattered by fat, overpaid, underworked, over-complimented faculty that raise your tuition 5% annually who fail to understand what education is or how to provide it to people that are overpaying for it. I mean, common, getting married, what were you thinking?

You know, I have a REAL problem with people who blame themselves for what is not their fault. I also have a problem with one-legged hookers, but that is a different story.

IT IS NOT YOUR JOB TO PROVIDE YOU WITH GREAT ROTATIONS AND EDUCATION. THAT IS THE JOB OF THE FU**EN SCHOOL THAT YOU BORROW A QUARTER OF A MILLION DOLLARS TO PAY. PERIOD.

I AM SICK AND TIRED OF THESE FU**ED UP SCHOOLS SUCKING THE LIFE OUT OF PEOPLE TO STAY IN BUSINESS AND PROFIT, INSTEAD OF INVESTING YOUR HARD BORROWED MONEY THAT YOU HAVE TO AT LEAST DOUBLE TO RETURN INTO THEIR MOST VALUABLE ASSETS, THEIR STUDENTS.

I WILL TELL YOU, I HAVE BEEN AROUND THE COUNTRY AND HAVE DONE SUB-Is AT HOPKINS, MAYO, TEMPLE, UNIV. PITT AND WHAT I HAVE FOUND IS NOT A SUPERIOR QUALITY IN THEIR STUDENTS, BUT A SUPERIOR INVESTMENT IN THEM.

ITS SAD, BUT REALITY IS THAT OUR STUDENTS HAVE TO WASTE TREMENDOUS TIME, GO THROUGH TREMENDOUS STRESS, TRAVEL TREMENDOUS MILAGE AWAY FROM THEIR HOMES AND SPEND A SHI*LOAD OUT OF THEIR POCKETS IN ADDITION TO WHAT THEY BORROW TO PAY THEIR FU**ED UP SCHOOLS JUST SO THEY CAN GET A GOOD EDUCATION. I CAN'T EVEN CALCULATE HOW MUCH I HAD TO BORROW AND SPEND OUTSIDE OF MY TUITION, JUST TO TRAVEL AND DO ROTATIONS OUTSIDE MY SCHOOLS "LOTTO SYSTEM" SO I WOULD NOT BE FU**ED FOR LIFE.

TELL ME, WOULD YOU BET YOUR EDUCATION ON THE "LOTTO" COMPRISED OF HALF-ASSED PRECEPTOR ROTATIONS IN WANKER-VILLE OR PODUNK?

I MEAN WHEN I THINK ABOUT THE PEOPLE THAT WERE IN CHARGE OF MY CLINICAL EDUCATION AND COMPARE THEM TO PEOPLE THAT I WORK WITH NOW, THEY SIMPLY SHOULD HAVE NEVER BEEN ALLOWED NEAR MEDICAL SUTDENTS. THEY DID NOT EVEN CARE ABOUT WHAT HAPPENED TO THE STUDENT. JUST WANTED TO GIVE YOU A ROTATION AND GET YOU ON YOUR WAY. ONE OF THEM WAS ACTUALLY FIRED BY THE INSURANCE COMPANY HE WORKED FOR AND SOMEHOW GOT A HOOKUP INTO FACULTY AT THE SCHOOL.

Anyways, this is probably the longest post of my SDN career. But there are real problems in the osteopathic education model that have to be repaired in order to better the lives and careers of our students. It simply unethical to double the class size every 2 years, open a new osteopathic school every weekend, charge a ridiculous and continuously rising tuition annually, when the basic education structure (Hospital based rotations, residencies, fellowships) is not even there to support all these increases. Instead, people are forced into desparate crap like going away from their home for a year just to complete maybe fair 3rd and 4th year rotations.

To the OP, don't give up. Search and find yourself an awesome residency program DO or MD to get into, where they will train you to be an awesome physician.

I will tell you about the one-legged hooker another time.
 
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Hey skippy said:
Fourth year we were suppose to set up ourselves. This short fall was my fault.
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Skippy, thanks for divulging that info so that we can better prepare ourselves for the future. Unfortunately, all of the Touro's seem to have a pretty bad record.

About the above statement I wanted to say that in no shape/form was I implying it was your fault. Unfortunately, some of the knowledge needed to successfully learn what we need to during our clinical years aren't shared with us and that is why I presonally am so grateful that I found SDN, so that I am armed with this knowledge. I hope the best for you in your situation and that once you have found a residency you bump this thread so that we can share in your success!
 
Goober,

I understand your frustrations and your rant. Are you willing to share what school you went to so that others know better than applying there or so that if we do go there we can prepare ourselves so that we find our own rotations?
 
Good-old AZCOM. If you can, avoid it. They will tell you about their brand new facilities, their state-of-art monitors, the beautiful weather year-round. They won't say much about their rotation situations or at least much truth about it.
 
goooooober said:
Good-old AZCOM. If you can, avoid it. They will tell you about their brand new facilities, their state-of-art monitors, the beautiful weather year-round. They won't say much about their rotation situations or at least much truth about it.
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I don't go to Touro Ca, NV or AZCOM but I've heard many bad experience stories during rotations at these schools (maybe its a west coast thing except for Western). I'm just curious, if these school's rotations suck so much, how come they are able to have such good match results almost every year? Is it luck that they recruit hardworking students that pull their own legwork? Or are rotations just a hit or miss?

OP, sorry to hear about your situation. Goodluck!
 
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goooooober said:
Well, your problem is crystal clear. Like most osteopathic students, you actually expected to be human while in medical school and have some life not shattered by fat, overpaid, underworked, over-complimented faculty that raise your tuition 5% annually who fail to understand what education is or how to provide it to people that are overpaying for it. I mean, common, getting married, what were you thinking?

You know, I have a REAL problem with people who blame themselves for what is not their fault. I also have a problem with one-legged hookers, but that is a different story.

IT IS NOT YOUR JOB TO PROVIDE YOU WITH GREAT ROTATIONS AND EDUCATION. THAT IS THE JOB OF THE FU**EN SCHOOL THAT YOU BORROW A QUARTER OF A MILLION DOLLARS TO PAY. PERIOD.

I AM SICK AND TIRED OF THESE FU**ED UP SCHOOLS SUCKING THE LIFE OUT OF PEOPLE TO STAY IN BUSINESS AND PROFIT, INSTEAD OF INVESTING YOUR HARD BORROWED MONEY THAT YOU HAVE TO AT LEAST DOUBLE TO RETURN INTO THEIR MOST VALUABLE ASSETS, THEIR STUDENTS.

I WILL TELL YOU, I HAVE BEEN AROUND THE COUNTRY AND HAVE DONE SUB-Is AT HOPKINS, MAYO, TEMPLE, UNIV. PITT AND WHAT I HAVE FOUND IS NOT A SUPERIOR QUALITY IN THEIR STUDENTS, BUT A SUPERIOR INVESTMENT IN THEM.

ITS SAD, BUT REALITY IS THAT OUR STUDENTS HAVE TO WASTE TREMENDOUS TIME, GO THROUGH TREMENDOUS STRESS, TRAVEL TREMENDOUS MILAGE AWAY FROM THEIR HOMES AND SPEND A SHI*LOAD OUT OF THEIR POCKETS IN ADDITION TO WHAT THEY BORROW TO PAY THEIR FU**ED UP SCHOOLS JUST SO THEY CAN GET A GOOD EDUCATION. I CAN'T EVEN CALCULATE HOW MUCH I HAD TO BORROW AND SPEND OUTSIDE OF MY TUITION, JUST TO TRAVEL AND DO ROTATIONS OUTSIDE MY SCHOOLS "LOTTO SYSTEM" SO I WOULD NOT BE FU**ED FOR LIFE.

TELL ME, WOULD YOU BET YOUR EDUCATION ON THE "LOTTO" COMPRISED OF HALF-ASSED PRECEPTOR ROTATIONS IN WANKER-VILLE OR PODUNK?

I MEAN WHEN I THINK ABOUT THE PEOPLE THAT WERE IN CHARGE OF MY CLINICAL EDUCATION AND COMPARE THEM TO PEOPLE THAT I WORK WITH NOW, THEY SIMPLY SHOULD HAVE NEVER BEEN ALLOWED NEAR MEDICAL SUTDENTS. THEY DID NOT EVEN CARE ABOUT WHAT HAPPENED TO THE STUDENT. JUST WANTED TO GIVE YOU A ROTATION AND GET YOU ON YOUR WAY. ONE OF THEM WAS ACTUALLY FIRED BY THE INSURANCE COMPANY HE WORKED FOR AND SOMEHOW GOT A HOOKUP INTO FACULTY AT THE SCHOOL.

Anyways, this is probably the longest post of my SDN career. But there are real problems in the osteopathic education model that have to be repaired in order to better the lives and careers of our students. It simply unethical to double the class size every 2 years, open a new osteopathic school every weekend, charge a ridiculous and continuously rising tuition annually, when the basic education structure (Hospital based rotations, residencies, fellowships) is not even there to support all these increases. Instead, people are forced into desparate crap like going away from their home for a year just to complete maybe fair 3rd and 4th year rotations.

To the OP, don't give up. Search and find yourself an awesome residency program DO or MD to get into, where they will train you to be an awesome physician.

I will tell you about the one-legged hooker another time.
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Well put.
 
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Septo Shock said:
I don't go to Touro Ca, NV or AZCOM but I've heard many bad experience stories during rotations at these schools (maybe its a west coast thing except for Western). I'm just curious, if these school's rotations suck so much, how come they are able to have such good match results almost every year? Is it luck that they recruit hardworking students that pull their own legwork? Or are rotations just a hit or miss?

OP, sorry to hear about your situation. Goodluck!
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In short, the superb quality of osteopathic students and their quick realization that they are on their own. I have to say that (I can only speak for my class), when I look back on my classmates, even now, they were simply amazing people. They were all mature, motivated, knew what they wanted and fought for it tooth and nail. Almost everyone got what they wanted at the end, but they all paid for it one way or another and unfortunately made the school look good in the process.

In fact our entire class formally and unanimously complained to the clinical education department, Dean and the President about the quality of our rotations multiple times. Their response?

The former head of surgical clerckships stood in front of the entire class and said "Instead of complaining, you should all be grateful that we gave you a chance to become doctors, none else would."

Most recently, they increased the class size from 140 to 250 students.

Everyone is the same, they get all excited about their school when they get accepted, they tell the world and are happy. But then they get there and I will say, the first two years are pretty solid at most osteopathic school, including AZCOM. But, the last 2 years, the most important years where what you learned in your first 2 years is suppose to be tied to clinical medicine and where you set yourself up for the residency of your dreams, are simply missing or horrible at best. So people become desparate, travel, leave loved ones behind, spend lots of money they shouldn't just to expose themselves to good rotations so they can do well on their SubIs, so they can get the ever so important letter and phone call from the Big Cheese, so they can land the spot at the place that will trian them to become a confident and competent physician.
 
Septo Shock said:
I don't go to Touro Ca, NV or AZCOM but I've heard many bad experience stories during rotations at these schools (maybe its a west coast thing except for Western). I'm just curious, if these school's rotations suck so much, how come they are able to have such good match results almost every year? Is it luck that they recruit hardworking students that pull their own legwork? Or are rotations just a hit or miss?

OP, sorry to hear about your situation. Goodluck!
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I think part of it may be that they may not allow everyone to move on unless they "feel" like the student is ready. I know that they hold students back or very strongly suggest that they postpone boards at some schools so that only students who they feel will pass are allowed to take the STEP/COMLEX. Thats how the majority achieve such high pass rates year after year. Not everyone gets to take them.

Not sure that it works the same with the match, just a thought. ::shrug::
 
goooooober said:
In short, the superb quality of osteopathic students and their quick realization that they are on their own. I have to say that (I can only speak for my class), when I look back on my classmates, even now, they were simply amazing people. They were all mature, motivated, knew what they wanted and fought for it tooth and nail. Almost everyone got what they wanted at the end, but they all paid for it one way or another and unfortunately made the school look good in the process.

In fact our entire class formally and unanimously complained to the clinical education department, Dean and the President about the quality of our rotations multiple times. Their response?

The former head of surgical clerckships stood in front of the entire class and said "Instead of complaining, you should all be grateful that we gave you a chance to become doctors, none else would."

Most recently, they increased the class size from 140 to 250 students.

Everyone is the same, they get all excited about their school when they get accepted, they tell the world and are happy. But then they get there and I will say, the first two years are pretty solid at most osteopathic school, including AZCOM. But, the last 2 years, the most important years where what you learned in your first 2 years is suppose to be tied to clinical medicine and where you set yourself up for the residency of your dreams, are simply missing or horrible at best. So people become desparate, travel, leave loved ones behind, spend lots of money they shouldn't just to expose themselves to good rotations so they can do well on their SubIs, so they can get the ever so important letter and phone call from the Big Cheese, so they can land the spot at the place that will trian them to become a confident and competent physician.
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... And that is the nature of osteopathic medicine. It is purely a business run by cynical, vicious people who prey on those desperate enough to become physicians that they fall for the allure of "The D.O. difference" which is simply a moral platitude to justify the money machine. They prey on students who have essentially nowhere else to turn either academically or personally such that they CAN charge ridiculous tuition; provide the absolute legal-mandated minimum in clinical education; and ultimately TELL YOU to be "GRATEFUL" for the plate of sh__ that they have served on the silver platter inscribed with "The D.O. Difference." (Reading that statement, Goooooober literally put me up to 210 systolic, lol).

Yes, I absolutely agree that D.O. students are amazing people, because it requires infinite depths of moral, professional, and intellectual conviction to tolerate such treatment and see their goals to the end.
 
There are some amazingly well-thought out and perceptive comments on this thread. I couldn't have elaborated it better. Well done.

As a DO grad, and now a resident at a very large tertiary care center, I saw firsthand what the original poster complained about.

My 3rd year rotations were >400 miles from my school and they SUCKED. I had little to no inpatient experience, and spent the majority of my time with volunteer 'preceptors' (essentially pre-med shadowing) and barely-understandable FMG family practice residents who had no interest in teaching med students at all. (they were too busy trying to figure out how to write a SOAP note)

I was called on this by my interviewers during residency interviews. Don't think they don't know whats going on at some of these DO schools. I think the only reason I matched at my #1 was because of a Sub-I where I worked my ***** off. I spent my 4th year furiously trying to make up lost ground.

And I paid a quarter of a million dollars for this experience.
 
I am curious, how much is a person expected to know on Day 1: of Internship year?
 
I hope not much. I'm going to be there in five months. :scared:

It is program specific. Most programs expect you to be able to do a thorough assessment, write a good note, and formulate a decent plan of action. You are expected to know how to write a prescription and how to present to an attending. You're not expected to be a fully competent physician able to function on your own.
 
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ShyRem said:
Most programs expect you to be able to do a thorough assessment, write a good note, and formulate a decent plan of action. You are expected to know how to write a prescription and how to present to an attending.
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Yep, that was pretty much it.

They also expect a certain level of emotional and mental maturity as well - i.e. that you're mature enough to be able to get up and get into work on time, that you're responsible enough to recognize your boundaries and know when to ask for help, etc.
 
smq123 said:
Yep, that was pretty much it.

They also expect a certain level of emotional and mental maturity as well - i.e. that you're mature enough to be able to get up and get into work on time, that you're responsible enough to recognize your boundaries and know when to ask for help, etc.
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I'd be ecstatic if that's truly the expectation. I'm comfortable with that I think. What scared me was that I'd be expected to walk in day one and be able to manage patients with little/no support.

I can't believe the whole "maturity" thing is still much of an issue for intern year...but then again.. :)
 
Villiers said:
There are some amazingly well-thought out and perceptive comments on this thread. I couldn't have elaborated it better. Well done.

As a DO grad, and now a resident at a very large tertiary care center, I saw firsthand what the original poster complained about.

My 3rd year rotations were >400 miles from my school and they SUCKED. I had little to no inpatient experience, and spent the majority of my time with volunteer 'preceptors' (essentially pre-med shadowing) and barely-understandable FMG family practice residents who had no interest in teaching med students at all. (they were too busy trying to figure out how to write a SOAP note)

I was called on this by my interviewers during residency interviews. Don't think they don't know whats going on at some of these DO schools. I think the only reason I matched at my #1 was because of a Sub-I where I worked my ***** off. I spent my 4th year furiously trying to make up lost ground.

And I paid a quarter of a million dollars for this experience.
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Villiers wanna share your school name. Was it one of the schools that's been previously mentioned or another school? Thanks!
 
MJB said:
I'd be ecstatic if that's truly the expectation. I'm comfortable with that I think. What scared me was that I'd be expected to walk in day one and be able to manage patients with little/no support.

I can't believe the whole "maturity" thing is still much of an issue for intern year...but then again.. :)
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I was shocked by some of the maturity issues I saw at my away rotations from many medical students. Not going in "because I was out late drinking", going back to student housing to take nap at 10am "because I'm tired", totally inappropriate comments and behavior towards other staff members... Yeah, I can see "maturity" being an issue.
 
MJB said:
I can't believe the whole "maturity" thing is still much of an issue for intern year...but then again.. :)
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I remember being an MS3 and having an intern who was routinely ~30 minutes late everyday. When I was an MS4, I had an intern who allowed herself a whopping 30-35 minutes to see 10 very complicated patients. :rolleyes: I had to do a lot of her work as well as mine....the only rotation I ever had in med school where I would go to the bathroom after AM rounds and either cry or punch the wall.
 
MLT2MT2DO said:
I am curious, how much is a person expected to know on Day 1: of Internship year?
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Ideally you should be able to take over for the intern that just finished the day prior (if on a ward or ICU service)

In real life, your attendings and seniors will know it's your first day. You're expected to ask a lot more questions about patient care (I just got paged that Patient X has a fever, what should I do? I was checking the labs and saw Patient Y has a Mag of 1.2, what should I do? I was pre-rounding and Patient Z was acutely short of breath on a non-rebreather and his sats were 87%, what should I do?)

What people expect you to be able to do on Day 1 is to know the culture of medicine - to pre-round, check out the patients and thier labs, and be able to present the patients to your team on rounds. If an intern has never done inpatient service or spent a lot of time "shadowing" an attending, that intern may not know the logistics of how an inpatient ward team (whether it's surgery, medicine, pediatrics, FM, etc) works.

It's hard enough trying to find where your patients are located, the computer system, where charts are kept, etc. on Day #1 - you shouldn't have to learn the culture of medicine too. That's what MS3 is for.

Several years ago, when I was interviewing for residency, I ran into a applicant from AZCOM who told me that she did not have any inpatient experience during her MS3 and MS4 years. I was shocked at this admission. How can a school let a student not do any inpatient month during all of her clinical years?

I guess I'm fortunate that at my alma mater (PCOM), I was able to do my MS3 Internal Medicine, Surgery, OBGYN, Family Medicine and Emergency Medicine at core sites that also have ACGME residencies affliated with them.
 
After reading these posts and hearing about the pitfalls of MWU AZCOM, I was just wondering if CCOM in Chicago has those same problems? I will be starting CCOM in the fall and am told they have great rotations, but I guess every school says that about themselves. Can anyone provide some insight into the 3rd and 4th years at CCOM and if they encountered any problems when applying for ACGME residencies?
 
Ari1584 said:
After reading these posts and hearing about the pitfalls of MWU AZCOM, I was just wondering if CCOM in Chicago has those same problems? I will be starting CCOM in the fall and am told they have great rotations, but I guess every school says that about themselves. Can anyone provide some insight into the 3rd and 4th years at CCOM and if they encountered any problems when applying for ACGME residencies?
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CCOM is really old and I personally thought (as a pre-med) they had very good 3/4 year clinical sites. AZCOM does not seem to have the same reputation, and I think it stems from a huge class expansion + several bigger, allopathic institutions in AZ + being a 'newer' school.


I feel so bad for some of the people in these threads. I guess the best advice is just to furiously research the 3/4 years of your school, and pick somewhere established (if you can).
 
This is concerning that these types of problems are so common throughout the DO community. I am rotating through the OH CORE program and I feel that I am getting good clinical exposure during my 3rd year. My Internal Medicine, Surgery, OBGYN, Psychiatry, Anesthesia, and part of Family Medicine rotations have all been or will be inpatient settings in a medium sized hospital.

It is true that residents and interns can contribute significantly to your learning as an MS3-4. I am fortunate that I had an adviser at during MS1-2 that was honest and straightforward about the limitations of one-on-one preceptor rotations. His advice: "get the heck out of _____ and go somewhere where you will be in an organized, large center with residents." I had to travel a few states away and relocate my family, but in hind site it was the best thing I could have done for my education.

One of the things that struck me was during my MS1-2 years was when I would see MS3-4's in the library at my school bragging about how they got sent home at 1 or 2 in the afternoon and that they were bored so they came to hang out. I would feel ripped off or short changed if that happened to me, so I made sure that I only entered locations in the lottery that were far away from my home school, in locations that had decent sized hospitals.

Sure, I'm not at huge academic center like the Cleveland Clinic, but I do get in my opinion, rigorous training at medium sized hospitals and I usually work 10-18 hour days, 5-6 days a week. Some of my colleagues have had a "not so rigorous" rotation here and there, especially in Pathology, but overall, I'd say they work us pretty hard.

We are expected to write our own notes, dictate and sign off notes, dictate discharge summaries, round and see on our own patients, give reports to our attendings, come up with assessments and treatment plans, write orders (signed off by the attendings) and be competent in procedures (suturing, foley's, intubation, central lines, IV's, biopsies etc).

I'd highly recommend trying to go to the OH CORE program if your school is part of the program (KCOM, DMU, KCUMB etc).
 
kazuma said:
This is concerning that these types of problems are so common throughout the DO community. I am rotating through the OH CORE program and I feel that I am getting good clinical exposure during my 3rd year. My Internal Medicine, Surgery, OBGYN, Psychiatry, Anesthesia, and part of Family Medicine rotations have all been or will be inpatient settings in a medium sized hospital.

It is true that residents and interns can contribute significantly to your learning as an MS3-4. I am fortunate that I had an adviser at during MS1-2 that was honest and straightforward about the limitations of one-on-one preceptor rotations. His advice: "get the heck out of _____ and go somewhere where you will be in an organized, large center with residents." I had to travel a few states away and relocate my family, but in hind site it was the best thing I could have done for my education.

One of the things that struck me was during my MS1-2 years was when I would see MS3-4's in the library at my school bragging about how they got sent home at 1 or 2 in the afternoon and that they were bored so they came to hang out. I would feel ripped off or short changed if that happened to me, so I made sure that I only entered locations in the lottery that were far away from my home school, in locations that had decent sized hospitals.

Sure, I'm not at huge academic center like the Cleveland Clinic, but I do get in my opinion, rigorous training at medium sized hospitals and I usually work 10-18 hour days, 5-6 days a week. Some of my colleagues have had a "not so rigorous" rotation here and there, especially in Pathology, but overall, I'd say they work us pretty hard.

We are expected to write our own notes, dictate and sign off notes, dictate discharge summaries, round and see on our own patients, give reports to our attendings, come up with assessments and treatment plans, write orders (signed off by the attendings) and be competent in procedures (suturing, foley's, intubation, central lines, IV's, biopsies etc).

I'd highly recommend trying to go to the OH CORE program if your school is part of the program (KCOM, DMU, KCUMB etc).
Click to expand...

Do you know anything about the Southpointe hospital?
 
Southpointe is overrated. Except for the plastics and vascular surgery rotations. I knew a third year student doing "internal medicine" which she said was basically cardiology and she was in bed sleeping at 10am several times during the week "because I already finished with my patient and there's nothing else to do" when I ran back to the dorms to change or grab my car to drive to the office or another hospital. I also knew a third year doing general surgery who hadn't actually scrubbed in on a surgery in over a week (and this kid wanted to do orthopaedics, so he was itching for surgery experience of ANY kind). There are a lot of students there and not many surgeons that will take students so they end up taking turns.

Rumor is Southpointe may not be around for long. University Hospital is building a huge new facility very nearby and Cleveland Clinic is making noises about "consolidating" services. It's a dying hospital.
 
ShyRem said:
Southpointe is overrated. Except for the plastics and vascular surgery rotations. I knew a third year student doing "internal medicine" which she said was basically cardiology and she was in bed sleeping at 10am several times during the week "because I already finished with my patient and there's nothing else to do" when I ran back to the dorms to change or grab my car to drive to the office or another hospital. I also knew a third year doing general surgery who hadn't actually scrubbed in on a surgery in over a week (and this kid wanted to do orthopaedics, so he was itching for surgery experience of ANY kind). There are a lot of students there and not many surgeons that will take students so they end up taking turns.

Rumor is Southpointe may not be around for long. University Hospital is building a huge new facility very nearby and Cleveland Clinic is making noises about "consolidating" services. It's a dying hospital.
Click to expand...

Is this the case with a lot of these DO residency programs? If so, that's disappointing.
 
There are good and bad programs. One can't claim Southpointe as representative of all DO residencies. You will just have to research a place before applying.
 
psy said:
There are good and bad programs. One can't claim Southpointe as representative of all DO residencies. You will just have to research a place before applying.
Click to expand...

I get that you can't generalize. Also, "research" can only get you so far, no hospital is going to truly trash their own program or hospital. Hence, my question on here - people have rotated through a majority of these hospitals, and I'm only a 3rd year, so I'd like input about a lot of these hospitals before I choose to spend a precious month rotating at a hospital/residency program. If anyone has examples of great DO hospitals with good teaching, please provide any and all input (also, which ones to steer clear of).
 
goooooober said:
Well, your problem is crystal clear. Like most osteopathic students, you actually expected to be human while in medical school and have some life not shattered by fat, overpaid, underworked, over-complimented faculty that raise your tuition 5% annually who fail to understand what education is or how to provide it to people that are overpaying for it. I mean, common, getting married, what were you thinking?

You know, I have a REAL problem with people who blame themselves for what is not their fault. I also have a problem with one-legged hookers, but that is a different story.

IT IS NOT YOUR JOB TO PROVIDE YOU WITH GREAT ROTATIONS AND EDUCATION. THAT IS THE JOB OF THE FU**EN SCHOOL THAT YOU BORROW A QUARTER OF A MILLION DOLLARS TO PAY. PERIOD.

I AM SICK AND TIRED OF THESE FU**ED UP SCHOOLS SUCKING THE LIFE OUT OF PEOPLE TO STAY IN BUSINESS AND PROFIT, INSTEAD OF INVESTING YOUR HARD BORROWED MONEY THAT YOU HAVE TO AT LEAST DOUBLE TO RETURN INTO THEIR MOST VALUABLE ASSETS, THEIR STUDENTS.

I WILL TELL YOU, I HAVE BEEN AROUND THE COUNTRY AND HAVE DONE SUB-Is AT HOPKINS, MAYO, TEMPLE, UNIV. PITT AND WHAT I HAVE FOUND IS NOT A SUPERIOR QUALITY IN THEIR STUDENTS, BUT A SUPERIOR INVESTMENT IN THEM.

ITS SAD, BUT REALITY IS THAT OUR STUDENTS HAVE TO WASTE TREMENDOUS TIME, GO THROUGH TREMENDOUS STRESS, TRAVEL TREMENDOUS MILAGE AWAY FROM THEIR HOMES AND SPEND A SHI*LOAD OUT OF THEIR POCKETS IN ADDITION TO WHAT THEY BORROW TO PAY THEIR FU**ED UP SCHOOLS JUST SO THEY CAN GET A GOOD EDUCATION. I CAN'T EVEN CALCULATE HOW MUCH I HAD TO BORROW AND SPEND OUTSIDE OF MY TUITION, JUST TO TRAVEL AND DO ROTATIONS OUTSIDE MY SCHOOLS "LOTTO SYSTEM" SO I WOULD NOT BE FU**ED FOR LIFE.

TELL ME, WOULD YOU BET YOUR EDUCATION ON THE "LOTTO" COMPRISED OF HALF-ASSED PRECEPTOR ROTATIONS IN WANKER-VILLE OR PODUNK?

I MEAN WHEN I THINK ABOUT THE PEOPLE THAT WERE IN CHARGE OF MY CLINICAL EDUCATION AND COMPARE THEM TO PEOPLE THAT I WORK WITH NOW, THEY SIMPLY SHOULD HAVE NEVER BEEN ALLOWED NEAR MEDICAL SUTDENTS. THEY DID NOT EVEN CARE ABOUT WHAT HAPPENED TO THE STUDENT. JUST WANTED TO GIVE YOU A ROTATION AND GET YOU ON YOUR WAY. ONE OF THEM WAS ACTUALLY FIRED BY THE INSURANCE COMPANY HE WORKED FOR AND SOMEHOW GOT A HOOKUP INTO FACULTY AT THE SCHOOL.

Anyways, this is probably the longest post of my SDN career. But there are real problems in the osteopathic education model that have to be repaired in order to better the lives and careers of our students. It simply unethical to double the class size every 2 years, open a new osteopathic school every weekend, charge a ridiculous and continuously rising tuition annually, when the basic education structure (Hospital based rotations, residencies, fellowships) is not even there to support all these increases. Instead, people are forced into desparate crap like going away from their home for a year just to complete maybe fair 3rd and 4th year rotations.

To the OP, don't give up. Search and find yourself an awesome residency program DO or MD to get into, where they will train you to be an awesome physician.

I will tell you about the one-legged hooker another time.
Click to expand...


Excellent post. I think you hit the nail on the head with your comment about MD schools 'investing' in their students, while DO schools generally do not. The impression I got in my experience is that MD programs take great pride in their students doing well, while the trend in osteopathic schools is to crank out more graduates while providing questionable education for them.

I would like to add that even in the so-called "established" osteopathic schools there can be issues with getting quality rotation sites. Due to the increase in class size in many of the schools, as well as competition from US MD, DO, and foreign schools for rotation sites, many times sites in questionable locations of dubious quality need to be added in order to accomodate all the students.
 
Doctor4Life1769 said:
Is this the case with a lot of these DO residency programs? If so, that's disappointing.
Click to expand...
You asked about ONE PROGRAM. I gave information about ONE PROGRAM. How do you get from ONE PROGRAM to "a lot of these DO residency programs"?????? I will definitely be more careful in the future to put a large, annoying disclaimer on any opinion regarding ONE PROGRAM THAT WAS ASKED SPECIFICALLY ABOUT to state my opinion is for ONE PROGRAM and NO MORE THAN THAT ONE SPECIFIC PROGRAM.

But to answer this new question, I have no background to answer this question as I have no personal knowledge or interaction with a majority of all DO residency programs and thus cannot possibly give an opinion as to "a lot" or "a few". I can only give an opinion as to the few I have rotated through. I have rotated through other DO residency programs that were very strong in both didactics and clinical teaching.
 
ShyRem said:
Southpointe is overrated. Except for the plastics and vascular surgery rotations. I knew a third year student doing "internal medicine" which she said was basically cardiology and she was in bed sleeping at 10am several times during the week "because I already finished with my patient and there's nothing else to do" when I ran back to the dorms to change or grab my car to drive to the office or another hospital. I also knew a third year doing general surgery who hadn't actually scrubbed in on a surgery in over a week (and this kid wanted to do orthopaedics, so he was itching for surgery experience of ANY kind). There are a lot of students there and not many surgeons that will take students so they end up taking turns.

Rumor is Southpointe may not be around for long. University Hospital is building a huge new facility very nearby and Cleveland Clinic is making noises about "consolidating" services. It's a dying hospital.
Click to expand...

Interesting, I figured southpoint would have been a lot more rigorous than the community hospitals I have rotated through in smaller OH cities.

I scrubbed/assisted in every Ortho case between my two preceptors (for reference, they each do between 400-600 cases each per year) during my month rotation, and I worked a minimum of 13+ hours, 6 days per week on IM. The only rotations I've had that were light were Path and part of my FP rotation (half day on Friday, but a 13 hour day on Wednesday).
 
Interesting debate. I go to an osteopathic school based on "one-on-one" preceptorships. The benefits I've found to be are:

1) Better practice w/ H&Ps: I'm always the first person of the day/visit to interview and examine the patient. I've had patients tell me they were examined by 12 students in the course of a day in the MD teaching hospital. Medical grads also comment that they were often like the 16th person to examine a patient during their training which sucked. I feel the patients respect me more as part of their healthcare team as opposed to feeling used for the amusement of a dozen medical students.

2) More hands-on-experience: I always scrub on surgical cases b/c I'm the only student there. If there were more students/residents present this would not be the case. Plus, the surgical field already feels crowded with myself, the surgeon, and the assistant...I can't imagine what it would feel like with more students scrubbed in.

3) Teaching done by an attending: Although, an intern or resident may have more time to sit and discuss cases with students they themselves are still in training and don't know everything. This tradition of residents teaching students often mean that mistakes are propogated through generations of physicians.

4) LOR: No brainer. More time with attending=better LOR. LORs are high on the list of things PDs weigh.

5) #Hours worked/Education: I work a 9-5 schedule on rotations. While you may get exposed to more cases with longer hours, you have to keep in mind that you will never be exposed to everything you will be tested on and you'll have less time to study it. For example: In general surg. I can watch 3 lapcholes then go home and study the trauma, cardiovascular, pediatric, etc. surgeries that are on the shelf exam to which I will not be exposed to in gen. surg no matter how many hours I'm there. On the other hand, the student who spent 16hrs in surgery will see 8 lapcholes + maybe a whipple or fundoplication, but they will not have any time left in the evening to study the rest of the testable material for the Shelf/Step II.

I've had many physician's say that this type of curriculum sounds better than what they experienced in their training.

I can see pro's to the teaching hospital method as well as con's to the one-on-one method but I don't want to make this post any longer. (IMHO, "One-on-one">>>multi-resident preceptorship and in-patient>>>out-patient when it comes to education).
 
Well, I must admit I'm quite shocked at what I've learned here. I have 4 more interviews coming up, where can I search to find out which school will put me in such a predicament and which won't? Will school websites be any help? Or should I just read all I can in the osteo threads? I'm not even sure exactly what I should be looking for... If anyone is willing to help me, please PM me thanks.
 
Hey skippy said:
Since leaving I have done research and have worked doing H&P for Same Day surgery patients in an effort to beef up my application for anesth.
Questions:
1. I am having serious doubts about getting in with my history so as a back up I have thought about doing FP and I am wondering how I should rank the traditional intern year positions? Should I rank them and get started again down the residency tract or would I have better luck scrambling into a FP position?
2. One thing I don’t understand is how the Medicaid reimbursement plays into a programs equation if I have started into the traditional intern year and try to slide over into a PGY-2 position.
Click to expand...
sorry to hear about all that's happened. they only gave you 4mo credit? are you finishing up your contract for 09-10 year? I don't know what would be the best track for you but I can answer the 2nd q. each resident gets 5 years total reimbursement. you graduated and started residency in 08 so you used 2, so 3 years left of reimbursement but don't let that hinder you in any way. if a program wants you, regardless of your years left for reimbursement, they can always eat up the $$. some of my friends are residents that either partly or completed a previous residency and the current program has to eat up the costs.....unless something changes with the upcoming health care bill. good luck :thumbup:
 
The Poet Sings said:
Well, I must admit I'm quite shocked at what I've learned here. I have 4 more interviews coming up, where can I search to find out which school will put me in such a predicament and which won't? Will school websites be any help? Or should I just read all I can in the osteo threads? I'm not even sure exactly what I should be looking for... If anyone is willing to help me, please PM me thanks.
Click to expand...

Ask students/interviewers:

1) How long has the school been around? Older will have more structured curricula and faculty that are familiar with teaching.

2) How weeks in-patient experience on core rotations (should be number): Internal Medicine (8 weeks) , Pediatrcs (4 weeks), Ob/Gyn (8 weeks), and Psychiatry (4 weeks).

3) how much of teaching in each of these settings: Teaching hospital vs. Community vs. Office/Clinic training?

If the numbers on those are low ask:

5) How much flexibility or elective time is there to set up away rotations so that you can make up in-patient experience or experiences that didn't work for you?
 
The Poet Sings said:
where can I search to find out which school will put me in such a predicament and which won't?
Click to expand...

Did your school survive Flexner, yes or no? If yes, you're fine ....


I'm kidding. It's not an easy task, and some of the regrets in this thread are proof of that. These are extremely intelligent people were dealing with here, they didn't buy magic beans, ya know? It's difficult to research and get honest opinions. I personally think this site is a great resource. You can always sleuth around a little bit, find 3/4 years who attend Xcom and PM them.

You can PM me too if you want, I can probably get you started or maybe pointed in the right direction at least.
 
Why didn't you rotate in California?
 
GreenShirt said:
5) #Hours worked/Education: I work a 9-5 schedule on rotations. While you may get exposed to more cases with longer hours, you have to keep in mind that you will never be exposed to everything you will be tested on and you'll have less time to study it. For example: In general surg. I can watch 3 lapcholes then go home and study the trauma, cardiovascular, pediatric, etc. surgeries that are on the shelf exam to which I will not be exposed to in gen. surg no matter how many hours I'm there. On the other hand, the student who spent 16hrs in surgery will see 8 lapcholes + maybe a whipple or fundoplication, but they will not have any time left in the evening to study the rest of the testable material for the Shelf/Step II.
Click to expand...

I always found it ammusing that the surgeons felt that we learned SO much in the OR. Standing up for 2 hours and seeing the same procedure over and over again without doing much, worthless.



GreenShirt said:
Ask students/interviewers:

1) How long has the school been around? Older will have more structured curricula and faculty that are familiar with teaching.

2) How weeks in-patient experience on core rotations (should be number): Internal Medicine (8 weeks) , Pediatrcs (4 weeks), Ob/Gyn (6-8 weeks), and Psychiatry (4 weeks).

3) how much of teaching in each of these settings: Teaching hospital vs. Community vs. Office/Clinic training?

If the numbers on those are low ask:

5) How much flexibility or elective time is there to set up away rotations so that you can make up in-patient experience or experiences that didn't work for you?
Click to expand...

Good questions to ask.
 
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