3rd year rotation sites: big vs small hospital?

[Espressso]

Is it more beneficial to:

spend third year in a big hospital seeing a wider variety of cases, but being 3rd or 4th assist behind residents and med students from other nearby medical schools

or

spend third year in a small hospital seeing a less variety of cases but being 1st assist and actually doing more stuff with the attending's


at my school, I keep getting so many mixed pieces of advice from upperclassman. It seems like more people here prefer the latter. But also because there's more smaller hospitals in our state than the bigger urban hospitals. But I'd like to hear what SDN thinks.

---

Members don't see this ad.

 

[AlbinoHawk DO]

Try to get a healthy mix. No hospital or rotation is perfect.

 

[kenjixshadow]

IMO only.
Big hospitals with residents: any specialties that you're interested in. Why? B/c of face time and getting LORs from PD(s) or clerkship director(s) and use the opportunities to rule in or rule out of what you wanna do.
Small hospitals with no resident: any specialties that you're not interested in for easier hours and less b/s yelling from staffs, residents, etc.

 

[AnatomyGrey12]

Have a good mix. Not all wards based rotations with residents are good, and not all preceptorbbased rotations are bad.

 

[meliora27]

Bigger is better.

As an intern, I don't care how many lap chole's you've assisted on or how many babies you caught. What I care is that you know how to pre-round, come up with at least a basic plan, write said plan, and be able to present said plan.

Working in a large academic hospital, with residents, will help you train for the role you will soon have.

 

[Jinxapotato]

I think it depends on the specialty too. For IM, surgery, psychiatry = definitely go to the bigger ward based rotations. For family medicine, pediatrics, OBGYN, outpatient/non-ward rotation will work just fine.

 

[68PGunner]

Bigger is better.

As an intern, I don't care how many lap chole's you've assisted on or how many babies you caught. What I care is that you know how to pre-round, come up with at least a basic plan, write said plan, and be able to present said plan.

Working in a large academic hospital, with residents, will help you train for the role you will soon have.

Not to sound like an arrogant a$$, but are the following things really that hard? 3/4 of those things should be automatic for someone who does well on both Step 1 and Step 2 already. Presentation skill is something that can take a few hrs in one day to work on to bring it to an expected baseline.

 

[68PGunner]

Is it more beneficial to:

spend third year in a big hospital seeing a wider variety of cases, but being 3rd or 4th assist behind residents and med students from other nearby medical schools

or

spend third year in a small hospital seeing a less variety of cases but being 1st assist and actually doing more stuff with the attending's

at my school, I keep getting so many mixed pieces of advice from upperclassman. It seems like more people here prefer the latter. But also because there's more smaller hospitals in our state than the bigger urban hospitals. But I'd like to hear what SDN thinks.

This is my take based from my research. Big hospital with a residency team for all interested residencies. This is not necessary for the experience but rather for the connection to the PD for LOR. Exp with a residency team could be good or bad.

If you're interested in a surgical specialty, I recommend doing it with a preceptor to get more hand based learning and an elective with a residency team.

In general, I would agree that you should try to get a mix of both kinds. It could be good or bad depending on your personality and learning style.

 

[heraclez]

Gonna agree with the bigger is better. If they have a residency program that you are interested in, even better. Assuming you don't make a BAD impression. It's good as a third year cause they just simply do not expect as much out of you- but doesn't mean you can slack off in anyway.

But generally speaking, prioritizing connections, letters of rec, and how to behave with residents is in my opinion, top priority. The residents can give you the common PIMP questions attendings ask, and if they're cool with you, can also give you the answers. It's the best preparation for residency life and audition rotations during fourth year.

The idea that I think most medical students have when they are a 2nd or 3rd year is that they are going to learn SO MUCH on rotations, etc. etc., but the "medicine" aspect of rotations isn't really the main thing you're learning- that stuff you can read and explore in your own time as well as learn in a hospital, but learning how residents interact, the overall culture of the residency's program, the preferences of the attending physicians, and HOW to NOT get in the way while also being positive, helpful, and funny... THAT is the skill you're trying to perfect.

The downside: these types of rotations can be very taxing. It's basically an audition rotation where you're just less prepared and still very green.

 

[ricksimmonsrafowens]

Not to sound like an arrogant a$$, but are the following things really that hard? 3/4 of those things should be automatic for someone who does well on both Step 1 and Step 2 already. Presentation skill is something that can take a few hrs in one day to work on to bring it to an expected baseline.

It took me 1/2 year of MS3 to get to a pre-rounding routine where I was actually efficient - like starting with checking patient's vitals, I&Os, labs, imaging, overnight events, how to write a good SOAP note that's not too detailed but is detailed enough, making a good assessment and plan that's evidence-based. Yea I think these things take time to master, and these things are best done when you are in a large hospital. I really advocate for large hospital experience, as learning what role interns/senior/chief residents have on the team on different services is invaluable. 1st assisting, catching babies, etc is pretty glamorous and fun, but being on teams with residents, fellows, attendings, etc. and knowing what role everyone plays and how to communicate efficiently in the team, and how to work within the chain of command is invaluable. Just my thoughts though.

 

[Preston Garvey]

Small hospital if you want easy hours and cool procedures that you will probably never perform in practice (catching a baby). large hospital if you want to learn how to work as a team, see crazy pathology, and be prepared to hit the ground running intern year. In my opinion a 3rd years main goal should be learning as much as humanly possible, learning to write good notes and becoming an effective presenter during rounds.

 

[medicaldepot]

I will go for bigger instead of small Because we will learn more in a bigger urban hospital rather than small one.

 

[Candidate2017]

This thread is the equivalent of a premed "should I pre-study for med school" thread. I rotated at a small hospital where I rarely wrote notes, rarely presented, left early often and had free time. I had no problems acclimating to a large hospital in residency. The cush student life at a small hospital is something I don't regret for one bit. Willingly eating a spoon of bull dung in med school to prepare for being forced to eat a metric ton of bull dung for years in residency is crazy talk.

 

[ortnakas]

Not to sound like an arrogant a$$, but are the following things really that hard? 3/4 of those things should be automatic for someone who does well on both Step 1 and Step 2 already. Presentation skill is something that can take a few hrs in one day to work on to bring it to an expected baseline.

Easy to do. Hard to be good at.

 

[NuttyEngDude]

+1 for bigger is better

 

[ricksimmonsrafowens]

This thread is the equivalent of a premed "should I pre-study for med school" thread. I rotated at a small hospital where I rarely wrote notes, rarely presented, left early often and had free time. I had no problems acclimating to a large hospital in residency. The cush student life at a small hospital is something I don't regret for one bit. Willingly eating a spoon of bull dung in med school to prepare for being forced to eat a metric ton of bull dung for years in residency is crazy talk.

what field are you a resident in?

 

[Candidate2017]

The best. Psych.

 

[ortnakas]

SDN always splits it up "small" versus "big" but I think the real question is "teaching" vs "non-teaching." As long as you do at least some rotations that allow you to work on your presentation/plan formulation skills, write notes and (at least some of the time) work with residents, you can have a solid learning experience. As long as you're doing things vs. just shadowing, you'll be okay.

 

[ricksimmonsrafowens]

The best. Psych.

hell yeah

 

[BorntobeDO?]

I will tell you when I try both. Actually I already worked at both, I prefer very large(>1000) over very small (<100), but in the middle (200-400 beds) is actually my favorite. Have enough specialist you don't have to ship everything out, but small enough you get to know people.

As far as teaching, that depends on whether your preceptor wants to teach. If they want to, it will be great. If you are there so they can have an extra 1k a month, well it probably won't be (and don't underestimate this, there are docs who are that greedy).

It always amazed me at some of the scummy docs I used to work with who would have students (actually one in particular who would only take female students) 'working' with them. No surprise they (students) were from the Caribbean. But what can you say? 'Don't trust a surgeon who started a used car dealership.' Actually that seems like a good life motto.

 

[Mt Kilimanjaro]

Small hospital if you want easy hours and cool procedures that you will probably never perform in practice (catching a baby). large hospital if you want to learn how to work as a team, see crazy pathology, and be prepared to hit the ground running intern year. In my opinion a 3rd years main goal should be learning as much as humanly possible, learning to write good notes and becoming an effective presenter during rounds.

Wut? Doctors don’t do this? The OB program lied to me...