3rd Year Rotation with or without Residents?

[maddogmurphy]

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I tried searching, but couldn't really find anything that was too helpful. For 3rd year sites some hospitals have residents and some do not. I'm trying to figure out the pros and cons of that. All I have so far is with residents: pro-structure; con-you may not get to do as much. Without residents: pro-get to do more and do more with attendings

 

[Daiphon]

I tried searching, but couldn't really find anything that was too helpful. For 3rd year sites some hospitals have residents and some do not. I'm trying to figure out the pros and cons of that. All I have so far is with residents: pro-structure; con-you may not get to do as much. Without residents: pro-get to do more and do more with attendings

Those types of rotations depend *heavily* on the attendings. My med school was the same (no residents 3rd year) and I loved it... but had attendings who really enjoyed teaching and wanted us around.

Effectively turned 3rd year core into a series of Sub-I's. Made my 4th year auditions awesome.

If your attendings suck, though, you need residents in order to get good bedside clinical teaching. Books can only teach so much.

Talk w/ your upperclassmen & get their input. Only way to really know.

Cheers!
-d

 

[Punkn]

Agree, it's very attending dependent. Definitely talk to your upper classmen. My Ob/Gyn and Family Med rotations were sans residents and both were great experiences, also my longest hours in MS3. These attendings wanted students, taught often, let me do a lot of procedures, let me formulate plans, and gave constructive feedback. In general, I think procedure-heavy specialties can be good experiences without residents. It's more hit or miss with others.

 

[JJMrK]

Those types of rotations depend *heavily* on the attendings. My med school was the same (no residents 3rd year) and I loved it... but had attendings who really enjoyed teaching and wanted us around.

Effectively turned 3rd year core into a series of Sub-I's. Made my 4th year auditions awesome.

If your attendings suck, though, you need residents in order to get good bedside clinical teaching. Books can only teach so much.

Talk w/ your upperclassmen & get their input. Only way to really know.

Cheers!
-d

This is pretty good advice. The most important thing is probably to talk with those who have gone before and figure out the best places to be.

 

[ruralsurg4now]

No residents =/= get to do more. It's not like since there is no resident the attending will be like "hey, why don't you close the patient today? You don't need me around, right?"

 

[Wordead]

No residents =/= get to do more. It's not like since there is no resident the attending will be like "hey, why don't you close the patient today? You don't need me around, right?"

That's exactly what it meant for me.

I'd say any procedure based specialty - OB, Surgery, FM you get to do more. I might prefer residents around for IM

 

[ruralsurg4now]

That's exactly what it meant for me.

What did you get to do?

 

[Wordead]

What did you get to do?

Nothing ultra spectacular, but you mentioned closing and for gen surg they started off letting me do subcuticular closures and eventually the entire closure after laparatomies. I did half of a lap chole (last half, after structures identified) a couple times, put in wound vacs, stapled, that sort of thing. I don't think you're going to get to do as much if there are residents and fellows in front of you.

 

[ruralsurg4now]

Nothing ultra spectacular, but you mentioned closing and for gen surg they started off letting me do subcuticular closures and eventually the entire closure after laparatomies. I did half of a lap chole (last half, after structures identified) a couple times, put in wound vacs, stapled, that sort of thing. I don't think you're going to get to do as much if there are residents and fellows in front of you.

That's amazing ...ly stupid for that surgeon to have let a medical student do any part of a lap chole or a laparotomy closure. No offense, but if anything went wrong at all, he'd basically be screwed. Of course, at that point he'd probably lie and deny you did any part of it because he or she sounds like they'd be that kind of person. But from your perspective, yeah, that's a pretty good experience.

 

[Wordead]

I suppose you're right, but the question was do you get a better experience with or without residents. For what it's worth, the structures had been identified and the cystic duct divided. It was also a GB that was only loosely attached. I just clipped/divided the artery, finished dissecting it off the bed, and pulled it out. There is pretty minimal damage that I can do short of going haywire with the scissor-thingy.

 

[ruralsurg4now]

I suppose you're right, but the question was do you get a better experience with or without residents. For what it's worth, the structures had been identified and the cystic duct divided. It was also a GB that was only loosely attached. I just clipped/divided the artery, finished dissecting it off the bed, and pulled it out. There is pretty minimal damage that I can do short of going haywire with the scissor-thingy.

Yeah, I understand. And there's really no difference between you versus, say, an intern or whatever. I mean, whenever someone does their first gallbladder, even if they were a fifty-year-old PGY-6000, that would be the first time. I'm not trying to say "you're in med school, so you're not allowed to touch any instruments!!!" I'm merely speaking from a legal perspective. There's no reason I couldn't let a medical student place a central line. If they get a pneumothorax, you could just say "so what? That's a known complication and I could have been doing it and gotten the same pneumothorax." But it really looks bad if a medical student is doing it. I'm just being honest, not trying to be some old-timey dude lecturing you.

 

[eablackwell]

I think that it is also attending dependent even if you are in a program with residents. Some attendings just let the residents run you around, others let you do procedures. I've had resident-free rotations where the attending basically wanted me to shadow, and high-volume resident rotations where I was able to practically do entire surgical procedures and the attending made the resident retract for me. So... it could really go either way. 🙂 However, if there are specific sites that are known to have attendings that like to teach and let you be hands on, and there are no residents, I would go for that one before anything else.

 

[evilbooyaa]

Nothing ultra spectacular, but you mentioned closing and for gen surg they started off letting me do subcuticular closures and eventually the entire closure after laparatomies. I did half of a lap chole (last half, after structures identified) a couple times, put in wound vacs, stapled, that sort of thing. I don't think you're going to get to do as much if there are residents and fellows in front of you.

That's awesome. I wish I didn't have residents at all of my procedures. Even just closing SubQ lap ports made me happy to at least do something besides (maybe) run the camera for a full lap chole.

 

[alpinism]

I think that it is also attending dependent even if you are in a program with residents. Some attendings just let the residents run you around, others let you do procedures. I've had resident-free rotations where the attending basically wanted me to shadow, and high-volume resident rotations where I was able to practically do entire surgical procedures and the attending made the resident retract for me. So... it could really go either way. 🙂 However, if there are specific sites that are known to have attendings that like to teach and let you be hands on, and there are no residents, I would go for that one before anything else.

Exactly. For the most part it depends on the attendings you work with and to a lesser extent the culture of the hospital.

The best advice would be to talk to M4s about their favorite rotation sites and where they got to do the most procedures.

Don't forget, some of it also depends on how assertive and proactive you are on rotations. I've seen plenty of med students doing the same rotation with the same attendings and ending up with significantly different experiences.

 

[Wordead]

That's awesome. I wish I didn't have residents at all of my procedures. Even just closing SubQ lap ports made me happy to at least do something besides (maybe) run the camera for a full lap chole.

Yeah, that made for a better experience but on the other hand I didn't have access to big time attendings or productive labs to do research and have had to bust my ass going to other institutions and trying to get in touch with program directors. And you have all of residency to train your skills. So I don't necessarily think I had the better deal.

 

[evilbooyaa]

Yeah, that made for a better experience but on the other hand I didn't have access to big time attendings or productive labs to do research and have had to bust my ass going to other institutions and trying to get in touch with program directors. And you have all of residency to train your skills. So I don't necessarily think I had the better deal.

True. Thing is, I never really had a desire to do surgery for the rest of my life. Being able to cut and tie some stuff as a med student would've been more interesting than standing there for the length of the procedure while falling asleep standing.

 

[Kaustikos]

I tried searching, but couldn't really find anything that was too helpful. For 3rd year sites some hospitals have residents and some do not. I'm trying to figure out the pros and cons of that. All I have so far is with residents: pro-structure; con-you may not get to do as much. Without residents: pro-get to do more and do more with attendings

Heres my experience so far:
I did fm and only had my preceptor. it was amazing to have this experience and one on one. I did a lot and learned a lot. I even scrubbed in and helped on surgeries.
Surgery; I had residents which meant less doing. My friends did surgery at satelite hospitals and were doing so much. No residents meant they were the only assist. I was jealous. I still learned a lot and did get to do something, just not like they did.

 

[PTPoeny]

It is going to vary a lot by attending and resident. Sometimes you get to do more with just an attending, but my experience was I got to do a lot more with residents. I did part of my surgery rotation at a hospital where there were only 3 residents at a time so most days I would choose the rooms without a resident. I was first assist and they did a lot of teaching, but they are also used to doing it on their own and didn't want to slow down their room that much by letting me do a whole closing or anything. On the other hand at a big university program when I scrubbed into a case without an intern as soon as the attending left the uppers would start teaching me how do do stuff and I got to do a lot more.

I think resident rotations will also vary more by time of year. I did ob in June and the attendings were having the cheif residents operate and deliver with only a third year medical student scrubbed in to get them used to operating and teaching without support. So in that case wet had residents but it was attending driven that we got to do a lot.

 

[EMDO2018]

That makes DO school a lot more appealing, most of the rotations for DO schools do not have a resident there.

 

[SouthernSurgeon]

That makes DO school a lot more appealing, most of the rotations for DO schools do not have a resident there.

I think it is a huge fallacy to conflate "no residents" with "awesome". There are some good stories out there, but also many bad ones. There are also plenty of med students who had great rotations with residents.

I also think it's a fallacy to think that "doing stuff" automatically means a great rotation. The goal of third year isn't to teach you how to first assist on basic surgical cases and place IVs.

Some of my best learning experiences I had as a student came from some amazing residents.

And some of my best "getting to do stuff" moments came with residents - the resident on trauma who sat in the corner while I floated my first swan - the chief who did an ex-lap for a perforated colon cancer with only me to assist while the attending was driving in from home - etc.

 

[VisionaryTics]

That makes DO school a lot more appealing, most of the rotations for DO schools do not have a resident there.

This is very dumb reasoning. If you want to go into a particular specialty, it helps a ton for your school to have that department for the purposes of letters, relationships, research, etc.

As SouthernIM stated, most of my best rotations wrt to "hands on" stuff had residents. They are used to teaching and letting juniors find their feet.