4TH Year - Total Waste of Time & Money

[quickfeet]

Question for the SDN Nation:

Are rising M4 students (students who just finished their M3 year) more qualified to begin residency than graduating M4 students?

I would wager in the vast majority of cases the answer is yes, because at least rising M4s have more of the book knowledge fresh in their heads.

Since most M3 and M4 rotations are shadowing and minimal patient care activities, M4 seems to be just a giant rigamarole of interviewing, scam USMLE Step II CS, and garbage rotations that you'd rather watch paint dry than sit around at. Of course there are exceptions, but they are becoming relatively infrequent.

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

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[Instatewaiter]

Question for the SDN Nation:

Are rising M4 students (students who just finished their M3 year) more qualified to begin residency than graduating M4 students?

I would wager in the vast majority of cases the answer is yes, because at least rising M4s have more of the book knowledge fresh in their heads.

Since most M3 and M4 rotations are shadowing and minimal patient care activities, M4 seems to be just a giant rigamarole of interviewing, scam USMLE Step II CS, and garbage rotations that you'd rather watch paint dry than sit around at. Of course there are exceptions, but they are becoming relatively infrequent.

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

Well 4th year has many benefits. First, for those who want to do something competitive it allows you to do rotations in that specialty. Second it allows you to do away rotations. Third it allows you to do more (or some) ICU rotations.
Next, You do rotations where you act as an intern. Finally, because it is less structured, it gives you time to interview for residency, which would be essentially impossible during third year without interupting your core clinical rotations.

So to answer your question, those who take advantage of their 4th year are much more qualified than a third year to begin residency. Those who don't arent any more prepared. You will realize that from now on your education must be self directed. Nothing is going to be spoonfed to you. 4th year is the start.

 

[sliceofbread136]

Old men are always grumbling about the current generation. I would be very quick to ignore it

 

[jeffk805dent]

Old men are always grumbling about the current generation. I would be very quick to ignore it

my favorite part is when they grumble about the current generation and then turn on TV to tune into a football game to root for a whole bunch players from the current generation to win

 

[Perrotfish]

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

4th year being a waste of time and money isn't new. Its also not mandatory at most schools: odds are you have a lot of electives. You certainly can spend the second half of 4th year alternating between wards and ICU rotations at the best hospitals in the world. Failing that, you can at least do real subspecialty electives relative to your residency. Its only a waste if you waste it.

Your attending is right, though. Interns writing their first real note on day one of Intern year IS new. And insane.

 

[PL198]

4th year being a waste of time and money isn't new. Its also not mandatory at most schools: odds are you have a lot of electives. You certainly can spend the second half of 4th year alternating between wards and ICU rotations at the best hospitals in the world. Failing that, you can at least do real subspecialty electives relative to your residency. Its only a waste if you waste it.

Your attending is right, though. Interns writing their first real note on day one of Intern year IS new. And insane.

what is this crap. you mean they literally never wrote a note in medical school

 

[cbrons]

what is this crap. you mean they literally never wrote a note in medical school

Note the term "first real note".

At many MD schools these days, the med student notes do not go in the chart, they are just for "practice."

 

[SansaStarkMD]

Fourth year is a money grab. Efficiency isn't profitable. Anyone who believes otherwise probably thought undergrad was useful also.

 

[piii]

Fourth year is a money grab. Efficiency isn't profitable. Anyone who believes otherwise probably thought undergrad was useful also.

So edgy

 

[Levo]

Disagree. I spent my third year trying to figure out the pathophys of what was going on with my patients. Not once did I put in admission orders (and have to think about how to set the "call if" parameters so I wouldn't get paged twice every hour) or do much dispo planning. I also generally was not the one dealing with confrontational patients, or taking the phone calls of concerned family members. I'm really glad I got an additional year of medical school to learn those things and to practice the mechanics of being an intern before having to do all of them for 10 patients at a time.

 

[cbrons]

Disagree. I spent my third year trying to figure out the pathophys of what was going on with my patients. Not once did I put in admission orders (and have to think about how to set the "call if" parameters so I wouldn't get paged twice every hour) or do much dispo planning. I also generally was not the one dealing with confrontational patients, or taking the phone calls of concerned family members. I'm really glad I got an additional year of medical school to learn those things and to practice the mechanics of being an intern before having to do all of them for 10 patients at a time.

If all of your 4th year rotations allow you to get practice functioning as an intern, then you go to a great school. Vast majority aren't like this. Of course, you could do a ton of sub-Is, but most do not do this.

 

[deleted480308]

Question for the SDN Nation:

Are rising M4 students (students who just finished their M3 year) more qualified to begin residency than graduating M4 students?

I would wager in the vast majority of cases the answer is yes, because at least rising M4s have more of the book knowledge fresh in their heads.

Since most M3 and M4 rotations are shadowing and minimal patient care activities, M4 seems to be just a giant rigamarole of interviewing, scam USMLE Step II CS, and garbage rotations that you'd rather watch paint dry than sit around at. Of course there are exceptions, but they are becoming relatively infrequent.

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

>80% of my rotations I interview and look up all labs of patient before doc sees them, come up with an assessment and plan, present it all to the doc/resident and put in the entire note. I scrub in surgery and first assist on half of them. Only thing I don't do often is physically type the order...and we do that for some of the attending so all they have to do is "click approve" to make sure we did it right

If you are just shadowing your school is bad

 

[username456789]

>80% of my rotations I interview and look up all labs of patient before doc sees them, come up with an assessment and plan, present it all to the doc/resident and put in the entire note. I scrub in surgery and first assist on half of them. Only thing I don't do often is physically type the order...and we do that for some of the attending so all they have to do is "click approve" to make sure we did it right

If you are just shadowing your school is bad

I have heard from several students at various "prestigious" medical schools in NYC (NYU, Cornell, Columbia) that the patients at these hospitals are very much the type of people you'd expect to find in Manhattan. It is (allegedly) very difficult to get significant hands on experience for many of the students, as patients tend to have an abundance of entitlement and lack of patience for medical students being involved with their care (despite them being teaching hospitals).

Now, this information has been received from one student at each of the three schools I mentioned, so the sample size is very low. Perhaps their perception of their medical education is very skewed. But I suspect not.

 

[Mountaineer12]

My school's electives seem to be about half and half get ready for intern year/the 4th year does a lot of work vs. the 4th year gets to go home at 11am when we're done rounding and only does an H&P if they want to. Honestly, having almost finished 4 years of medical school and rounding out interview season from the beginning of October to January, I'm glad some of my last rotations are going to be like the latter. Sure, I may be a little lost at the beginning of intern year, but everyone is. It'll come back fast and I'll get the hang out of it. 4th year is your last time to relax, leave early, take a nap, go on a hike, etc. for a long time. I'm definitely going to take advantage of that. If I can learn some knew things about pediatrics along the way then that's awesome. Plus, sub-Is are amazing for getting a feel for intern life-lite.


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[NWwildcat2013]

I've always been confused about the following:

If Sub I's are so intense and you are supposed to be learning how to be an intern then why is MS4 universally acknowledge to be the easiest year in med school? Maybe you work less in total but it sounds like when you are actually working it would be a lot harder.

 

[PL198]

If all of your 4th year rotations allow you to get practice functioning as an intern, then you go to a great school. Vast majority aren't like this. Of course, you could do a ton of sub-Is, but most do not do this.

by choice, but you act like that is your schools fault. as others have said. nothing is stopped you from doing an ICU elective at mass gen/big university place near you in april/may if you want.

It seems ironic you're complaining about an elective year where the possibilities are basically endless. rotate in a specialty where you have no idea what they do, go international, do research, do a rotation somewhere near family or a region you always wanted to check out, etc etc

plus I just don't see an alternative. I don't see how you can apply and interview, do some electives and graduate in 3 years. I don't believe the 3 yr schools aren't cutting out significant portions of pre-clinical information in order to do so and still do some clinical training.

 

[PL198]

I've always been confused about the following:

If Sub I's are so intense and you are supposed to be learning how to be an intern then why is MS4 universally acknowledge to be the easiest year in med school? Maybe you work less in total but it sounds like when you are actually working it would be a lot harder.

you generally get 1+ month off for interviews, vacations, whatever. People actually start to value you and understand you will be a doc in less than a year. idk people just seem friendlier. not every rotation is a sub I, people generally take easier rotations so after you do your sub-Is it's pretty downhill.

 

[doggydog]

I've always been confused about the following:

If Sub I's are so intense and you are supposed to be learning how to be an intern then why is MS4 universally acknowledge to be the easiest year in med school? Maybe you work less in total but it sounds like when you are actually working it would be a lot harder.

The first few months of fourth year are among the most intense of medical school if you are going into a competitive speciality. An AI plus two away rotations is no joke. Probably the hardest I've worked in my life.

 

[deleted503015]

At my institution (well-regarded state school) I have been writing the "real" notes for the majority of my 4th year rotations--because of Epic tracking functions some of it does have to be changed for billing purposes, but these changes are usually minor. Was very surprised during an away at a "fancier" institution that I was not even allowed to pend orders (something I've been doing since day 1 0f 3rd year). As we've been going around interviewing, my classmates and I have been realizing how great our training is and are very thankful for it.

 

[mvenus929]

At my institution (well-regarded state school) I have been writing the "real" notes for the majority of my 4th year rotations--because of Epic tracking functions some of it does have to be changed for billing purposes, but these changes are usually minor. Was very surprised during an away at a "fancier" institution that I was not even allowed to pend orders (something I've been doing since day 1 0f 3rd year). As we've been going around interviewing, my classmates and I have been realizing how great our training is and are very thankful for it.

This same feeling goes for some residencies, where the autonomy is so low that residents don't feel like they can safely care for patients in their own when they graduate, and thus do a fellowship (in something like 'complex care patients' or 'Hospitalist medicine' to be more prepared. Then there are some residencies who value resident autonomy and push their residents t function more like attendings in their final year with some oversight backup.

 

[masaraksh]

Disagree. I spent my third year trying to figure out the pathophys of what was going on with my patients. Not once did I put in admission orders (and have to think about how to set the "call if" parameters so I wouldn't get paged twice every hour) or do much dispo planning. I also generally was not the one dealing with confrontational patients, or taking the phone calls of concerned family members. I'm really glad I got an additional year of medical school to learn those things and to practice the mechanics of being an intern before having to do all of them for 10 patients at a time.

The pathophys is not that difficult. Basically, for most inpatients in a hospital some organ system is not working.

 

[akwho]

For competitive specialities MS4 looks like:
July - November = Sub-i's home and away, hands down the hardest you will work in medical school on the wards.
December - January = Interview season crisscrossing the country, planes, trains and automobiles style. Stressful and not relaxing at all if you do 10+ interviews.
February - March = Sitting on your hands waiting for match day, do whatever you can to finish off required 4th year rotations and keep mind off match.
Mid-March = Match day!
March - May = plan move across country, find housing, prep for intern year. Fit in trips with friends, go hiking, workout, party.

You'll find out 4th year is a lot less chill than people make it out to be if you are applying into a competitive speciality.

 

[SansaStarkMD]

Fourth year is more stressful if applying to a competitive specialty but it's not that much harder, maybe one or two extra months for away rotations.

 

[deleted503015]

This same feeling goes for some residencies, where the autonomy is so low that residents don't feel like they can safely care for patients in their own when they graduate, and thus do a fellowship (in something like 'complex care patients' or 'Hospitalist medicine' to be more prepared. Then there are some residencies who value resident autonomy and push their residents t function more like attendings in their final year with some oversight backup.

Agreed. I think we're in the same small-person-loving field, and it's definitely been interesting to compare places where 2nd years sometimes don't always present plans to places where the attending doesn't show up during your 3rd year...

 

[Bancrofti]

Fourth year is more stressful if applying to a competitive specialty but it's not that much harder, maybe one or two extra months for away rotations.

I think it depends on your school. My school actually values us entering intern year well prepared as they tell us that's the feedback they get from residency programs, so we have a bunch of required rotations for 4th year. I'm applying to a competitive specialty, so I did my home rotation and 3 aways. I'll be going on a little less than 20 interviews. I literally have no time completely off outside of 2 weeks off in March. The current rotation I'm on... I have to take a GD shelf exam.. in 4th year -_- Basically though, I'm pretty sure come May, I'll definitely be exponentially more prepared to be a resident than I was at the end of third year.

4th year is only a waste because of the average mentality of med students these days (as alluded to by the older curmudgeon physicians). A lot of people in med school these days are in it I feel more as a good job opportunity more so than thinking of medicine as a calling. As such, most people these days try to take every opportunity they can get to have time off or take things easy. Even if you're doing family medicine, there's no reason to kill yourself at any point if you don't have to, but you could easily take ICU, ID, PM&R, Pulm, Crit Care, Cardiology, etc. electives to make yourself well prepared for residency year. Most people these days fill up on radiology electives or whatever elective at their school is well known for being kush on hours or attendance.

 

[Cskidd359]

Question for the SDN Nation:

Are rising M4 students (students who just finished their M3 year) more qualified to begin residency than graduating M4 students?

I would wager in the vast majority of cases the answer is yes, because at least rising M4s have more of the book knowledge fresh in their heads.

Since most M3 and M4 rotations are shadowing and minimal patient care activities, M4 seems to be just a giant rigamarole of interviewing, scam USMLE Step II CS, and garbage rotations that you'd rather watch paint dry than sit around at. Of course there are exceptions, but they are becoming relatively infrequent.

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

Sounds like you go to a lowsy med school if all your doing is shadowing.

 

[Mad Jack]

I have heard from several students at various "prestigious" medical schools in NYC (NYU, Cornell, Columbia) that the patients at these hospitals are very much the type of people you'd expect to find in Manhattan. It is (allegedly) very difficult to get significant hands on experience for many of the students, as patients tend to have an abundance of entitlement and lack of patience for medical students being involved with their care (despite them being teaching hospitals).

Now, this information has been received from one student at each of the three schools I mentioned, so the sample size is very low. Perhaps their perception of their medical education is very skewed. But I suspect not.

I've gotten to do a whole hell of a lot, personally. First assisting in surgery, seeing literally every patient in an outpatient office before the physician (18-20 patients a day), writing notes on all of the surgery patients I'd have to pre-round on every damn day, etc etc. That's just been third year- fourth year I could do more of the same, do sub-internships, etc, there's definitely a lot of opportunity to build skills if you want to. That many students are lazy and choose to spend as much of fourth year as possible screwing off is on them, and not a fault of fourth year itself.

As to entitled patients, stay out of Manhattan I guess? I'm doing my rotations in poor urban areas during fourth year for a reason.

 

[cbrons]

by choice, but you act like that is your schools fault. as others have said. nothing is stopped you from doing an ICU elective at mass gen/big university place near you in april/may if you want.

It seems ironic you're complaining about an elective year where the possibilities are basically endless. rotate in a specialty where you have no idea what they do, go international, do research, do a rotation somewhere near family or a region you always wanted to check out, etc etc

How much $ do you have to travel and possibly live somewhere else while you do a bunch of aways?

Plus the 4th year is just a huge waste of money for what you end up getting. The entire process needs to be shortened. 1.5 years preclinical, 1.5 years "clinical" (and there needs to be a massive reformation in what "clinical" means). They let Nurse Practitioners and PA students graduate and write triplicate Rxs for morphine the next day, but M4s can't write real notes. There's a major problem there.

 

[PL198]

How much $ do you have to travel and possibly live somewhere else while you do a bunch of aways?

Plus the 4th year is just a huge waste of money for what you end up getting. The entire process needs to be shortened. 1.5 years preclinical, 1.5 years "clinical" (and there needs to be a massive reformation in what "clinical" means). They let Nurse Practitioners and PA students graduate and write triplicate Rxs for morphine the next day, but M4s can't write real notes. There's a major problem there.

ok so crank out wards/ICU at your home base.

I really don't see how it could be shortened, still have time to study for steps, interview and learn clinical stuff. I truly have no idea how the 3 yr med schools work. Yes there's some pork but there's not 1 yr of pork .

 

[Bryan O’Blivion]

All the criticisms of 4th year may be true, but it is unlikely to be abolished any time soon. One could look at it as an opportunity to get extra training in important subjects, like cardiology. Most people benefit from ICU exposure. Furthermore, one can explore departments that one is may not interact with in residency, and may broaden one's greater understanding, like laboratory medicine, or forensic pathology, or toxicology. It isn't a light rotation, but ortho trauma can really teach you some important skills. Take advantage of having some freedom to steer your education, I say.

 

[Amygdarya]

I have heard from several students at various "prestigious" medical schools in NYC (NYU, Cornell, Columbia) that the patients at these hospitals are very much the type of people you'd expect to find in Manhattan. It is (allegedly) very difficult to get significant hands on experience for many of the students, as patients tend to have an abundance of entitlement and lack of patience for medical students being involved with their care (despite them being teaching hospitals).

Now, this information has been received from one student at each of the three schools I mentioned, so the sample size is very low. Perhaps their perception of their medical education is very skewed. But I suspect not.

Ha, do people on SDN love to hate the "various "prestigious" medical schools in NYC" I don't know if it has to do with the perceived elitism of these schools or what. Well, I go to one of the schools you mentioned and my experience is very different from the people you talked to. Sure, clinical experiences will vary depending on the site/service, attendings and residents, but in general I never felt like I had difficulty getting hands on experience, and how much I got mostly depended on my own level of enthusiasm.

I'd like to dispel the myth that NYC hospitals are full of entitled rich patients who won't allow students to be involved in their care, so NYC medical schools provide bad clinical experience. First of all, even the top hospitals serve plenty of poor people, and I've had my share of homeless, undocumented etc patients at two of the most prestigious hospitals in the country. (Second, at least at my school we have an option of doing at least some of our rotations at 6 community hospitals all over the greater New York and out of town.) On medicine, we were *expected* to carry 3-4 patients, preround on them, write admission and daily notes, place orders (to be approved by residents), talk to consults, communicate with families and do most of the things interns do. I did my surgery rotation at two very prestigious hospitals, and I'm still surprised how much I got to do in the OR at both of them (and I'm not even going into a surgical specialty!). I got to completely deliver a baby by myself at one of the fanciest hospitals in the city etc. In clinic, ED and on consult services I would be the first person to see a patient, take H&P, write a note and present to resident or attending with my impression and plan. Yes, there are services/rotation options that are known to be more "chill", but I avoided them because I wanted to learn by doing (which seems to work well for me) vs. shadowing and having a lot of time to relax and study.

I have just finished my year of core rotations and am looking forward to my sub-Is and electives where I expect to work hard and learn as much as I can from patient care without having to worry about shelves or other assignments.

So you can add me and my opinion to your sample

 

[fahimaz7]

Most good medical students could start PGY as a MS4. That wouldn't be a big deal. However, I wouldn't want to be the guy 2 months into MS3 that has to sign up for X, Y, and/or Z residency without ever even trying it as an elective. While I agree MS4 is an expensive and someone laid back year, it's also where you get to experience various specialties, take on some mild responsibility in the ICU, and become comfortable making some form of a decision without having to run it by everyone else on the team.

Medicine is a growing and slowly graduated experience. You'll get to the finish line eventually. Just enjoy the ride for now.

 

[cowme]

Its much more of a loss when you consider opportunity costs. One less year of partner salary, one less year to pay off loans and save for retirement and loss of compounding interest.

We're probably talking losing 500k for that one year, and that may be a low end estimate

 

[KnuxNole]

How much $ do you have to travel and possibly live somewhere else while you do a bunch of aways?

Plus the 4th year is just a huge waste of money for what you end up getting. The entire process needs to be shortened. 1.5 years preclinical, 1.5 years "clinical" (and there needs to be a massive reformation in what "clinical" means). They let Nurse Practitioners and PA students graduate and write triplicate Rxs for morphine the next day, but M4s can't write real notes. There's a major problem there.

A lot of people take out loans, which helps for always and interview fees

It depends how you make your med school experience, but sometimes your school can hinder you. I have interns working with me who have never written a SOAP note or done an assessment and plan, and it makes them have to do more catchup. With the 3rd years that work with me, I make it a priority that they are seeing several patients on their own, forumating plans, and seeing new admits with A+P daily. It sucks to hear that some people still have shadowing rotations in their 3rd year...those departments need overhauls then.

 

[Redpancreas]

Question for the SDN Nation:

Are rising M4 students (students who just finished their M3 year) more qualified to begin residency than graduating M4 students?

I would wager in the vast majority of cases the answer is yes, because at least rising M4s have more of the book knowledge fresh in their heads.

Since most M3 and M4 rotations are shadowing and minimal patient care activities, M4 seems to be just a giant rigamarole of interviewing, scam USMLE Step II CS, and garbage rotations that you'd rather watch paint dry than sit around at. Of course there are exceptions, but they are becoming relatively infrequent.

Was talking to one of my SUB-I attendings and he said that Interns today are a lot more incompetent and require much more hand-holding than previous generations. Do you agree with this?

He attributes this to declining quality of US medical education (where students become essentially shadowers who aren't even allowed to write real notes) coupled with the waste of time called 4th year.

Before we criticize years in medical school, we need to criticize the worth of requiring an entire 4 year undergraduate degree from medical students prior to matriculation. I really feel like 2 years in undergrad would suffice and frankly if high school was done properly (standards should be raised so everyone is completing AP/IB equivalents) students would arguably be academically ready after high school much less 4 years of undergraduate curriculum.

Now to respond to your year 4 stuff, I feel like your attending's comments would vary by institution in terms of responsibilities given to medical students. Also, I don't see how your attending's comments about supposedly undertrained medical students relates to getting rid of 4th year. If anything, 4th year should be an opportunity for SELF-DIRECTED learning gain those skills.

I feel like midway through 3rd year I can at least provide some perspective. Firstly, like someone said I feel like I am very much integrating pathophysiology with management in third year and am focusing much less on the mechanisms by which hospitals work as well as advanced aspects of management (when to contact social work, medication brand names, concentrations of well known IV injections, doing minor procedures, learning how actually to write real notes, learning to read imaging, EKGs, etc. formally). I know this may be covered in the remaining parts of 3rd year (I still have medicine and surgery to go) but I feel like asking for an extra year is not unreasonable.

Secondly, applications processes span months so it's not like they can apply right away after completing third year. Either we add 4th year time or third year grades won't be considered. Also, what would you propose medical students do in the mean time? Medicine is a very day-day field and you can't simply just have everyone take too many months off without a significant loss in memory. I think having a fourth year which is flexible to allow time for interviews benefits applicants greatly.

Also, for those in competitive fields, this is THE time to do electives and receive feedback to show for it. Every year we have medical students in first and second year gunning for Ortho or ENT saying they want more flexibility for electives 3rd year but that's what the entire 4th year is for.

Lastly on a personal note I took some time off during third year to study more for Step 1 and I know many who take some time at the beginning of third year to do things, some who delayed curriculum by a few months in first and second year, etc. 4th year becomes an affordable time for students to quicken the pace of a more relaxed curriculum in order to graduate at the same time everyone else has because I don't believe everyone who has had made a minor mistake in medical school deserves to graduate a year late.





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[bugsterizer83]

It depends how you make your med school experience, but sometimes your school can hinder you. I have interns working with me who have never written a SOAP note or done an assessment and plan, and it makes them have to do more catchup. With the 3rd years that work with me, I make it a priority that they are seeing several patients on their own, forumating plans, and seeing new admits with A+P daily. It sucks to hear that some people still have shadowing rotations in their 3rd year...those departments need overhauls then.

I did 18 weeks of Sub-is during M4 (one ICU, three medicine... one of the medicine ones was six weeks of outpatient and inpatient).

I wonder if these sub-I experiences will give me a leg up as a medicine intern next year. I've always thought it would (which is why I did them). All of them except one were at outside hospitals not directly affiliated with my med school.

If I didn't do these, I would've been forced to do a bunch of trash rotations where you basically shadow NPs on a GI or renal service. You can't really learn anything on such low-quality rotations.

 

[mimelim]

There are plenty of terrible US MD schools out there. By the same token, the time 'wasted' by the schools and their inefficiencies are dwarfed by the time wasted by students and their inability to grow/function on their own. Some of it is a sense of entitlement and an expectation that they will be spoon fed. But, mostly it is good old fashion laziness.

I have long since lost faith in the average medical student's bitching. I've worked with MS3s from 3 schools during my residency. Every single group had students complaining about how their school was screwing them over and they weren't getting XYZ. The problem is that in every single group there were still students getting their education despite what the others would complain about. Could schools make it easier? Of course. There are always ways of making schooling/education better. But, medical education depends a lot on self-learning and pursuit of knowledge/skills on one's own.

 

[SansaStarkMD]

There are plenty of terrible US MD schools out there. By the same token, the time 'wasted' by the schools and their inefficiencies are dwarfed by the time wasted by students and their inability to grow/function on their own. Some of it is a sense of entitlement and an expectation that they will be spoon fed. But, mostly it is good old fashion laziness.

I have long since lost faith in the average medical student's bitching. I've worked with MS3s from 3 schools during my residency. Every single group had students complaining about how their school was screwing them over and they weren't getting XYZ. The problem is that in every single group there were still students getting their education despite what the others would complain about. Could schools make it easier? Of course. There are always ways of making schooling/education better. But, medical education depends a lot on self-learning and pursuit of knowledge/skills on one's own.

$32,000-$56,000+ per year... I better be spoon fed. I better be greeted every morning with a cup of coffee and a "hi Sansa how are you? Can I get you anything else?" Jk, not really.

 

[Goro]

Can you name names??????

PM if necessary!

There are plenty of terrible US MD schools out there. By the same token, the time 'wasted' by the schools and their inefficiencies are dwarfed by the time wasted by students and their inability to grow/function on their own. Some of it is a sense of entitlement and an expectation that they will be spoon fed. But, mostly it is good old fashion laziness.

I have long since lost faith in the average medical student's bitching. I've worked with MS3s from 3 schools during my residency. Every single group had students complaining about how their school was screwing them over and they weren't getting XYZ. The problem is that in every single group there were still students getting their education despite what the others would complain about. Could schools make it easier? Of course. There are always ways of making schooling/education better. But, medical education depends a lot on self-learning and pursuit of knowledge/skills on one's own.

 

[Goro]

This is not unique to MD students; I've had plenty of my own students behave this way.

We Faculty were particularly galled when we had a 1st year class bitch at us that our 2nd year coursework "wasn't preparing them for COMLEX", and that "did they really need X hours on this particular subject [just a example, not the real thing: "4 hours on pneumonia"]?

By the same token, the time 'wasted' by the schools and their inefficiencies are dwarfed by the time wasted by students and their inability to grow/function on their own. Some of it is a sense of entitlement and an expectation that they will be spoon fed. But, mostly it is good old fashion laziness.

I have long since lost faith in the average medical student's bitching. I've worked with MS3s from 3 schools during my residency. Every single group had students complaining about how their school was screwing them over and they weren't getting XYZ. The problem is that in every single group there were still students getting their education despite what the others would complain about. Could schools make it easier? Of course. There are always ways of making schooling/education better. But, medical education depends a lot on self-learning and pursuit of knowledge/skills on one's own.

 

[sliceofbread136]

I do agree with you on this, and as I look back I realize that the rotations where I learned the most were the one where I put in the most self-directed work - not the ones where someone tried to spoon-feed me.

That said, I also think that many medical schools are failing their students by not letting them DO anything. Most rotations have become glorified shadowing. Yes, students need to be self-motivated, but it's really hard to get up in the morning and go work hard for 12 hours when you know that you're just going to be relegated to a corner somewhere. My outpatient peds rotation was literally shadowing well child visits. Those first couple of days I really, really tried to focus and learn something, but by about day 3 of sitting in a corner listening to a pediatrician ask questions about stool habits, I couldn't do it anymore. Hell, last year in the spring I had a 4th year med student going into EM, let her do a central line and it was her FIRST ONE. About to graduate med school and she had never placed a line. When I offered her the line she was in shock.

So yeah, students need to get their crap together, stop whining, and get the most they can out of their education. But schools also need to start treating them as physicians in training and not as pre-med shadowers.

Very few medical students place central lines. Residents usually need it to hit their quota. Really not surprising or unusual at all

 

[Perrotfish]

There are plenty of terrible US MD schools out there. By the same token, the time 'wasted' by the schools and their inefficiencies are dwarfed by the time wasted by students and their inability to grow/function on their own. Some of it is a sense of entitlement and an expectation that they will be spoon fed. But, mostly it is good old fashion laziness.

I have long since lost faith in the average medical student's bitching. I've worked with MS3s from 3 schools during my residency. Every single group had students complaining about how their school was screwing them over and they weren't getting XYZ. The problem is that in every single group there were still students getting their education despite what the others would complain about. Could schools make it easier? Of course. There are always ways of making schooling/education better. But, medical education depends a lot on self-learning and pursuit of knowledge/skills on one's own.

I went to a medical school that where just a handful of sites were not allowing students to write 'real' notes. and where procedures were strictly for residents. There was no question that those rotations were wasted, and it wasn't my fault for not finding any education in them. You can't always find water in a desert regardless of your motivation, and you can't practice medicine if no one will let you. Its not as though my work ethic improved dramatically when I did my rotations in public and military hospitals were MS3s could still be a functioning member of the team, but I can say confidently that those were the rotations where I learned to be a doctor. If all of my rotations were shadowing, rather than just a few sites, I would have started Intern year functionally identical to how I started MS3.

Students SHOULD complain about their schools screwing them over. Their schools are screwing them over! They are taking ever more money and providing ever less education. If M1-M2 is just studying Goljan in your room, and M3-M4 is just waiting quietly for residency to start without actually doing anything, then what value is the school providing in exchange for their 300K in tuition? Most of your students will need to earn nearly a million dollars just pay back their student loans, is it really so unreasonable that they should expect more than 'self-learning'?

 

[sliceofbread136]

Yep. And that's a huge problem.

Why? If you are in a specialty where you need to do it then you can learn in residency.

 

[Perrotfish]

Why? If you are in a specialty where you need to do it then you can learn in residency.

Agreed. I wouldn't want to waste central lines on future Pediatricians and Psychiatrists.

 

[Perrotfish]

And yet you just complained 3 or 4 posts above this that your rotations where notes or procedures weren't allowed were wasted.

Notes yes. There is no risk to a note other than the Intern having to rewrite it. Procedures should only be given to students who are going to do them as residents. There is a high risk of complications the first time anyone does a procedure, and the trade off has to be that they'll be able to help future patients. I think intubations and LPs are pretty much universal. Central lines, deliveries, surgeries, and chest tubes not so much. Those should be for Residents or students who have matches into a specialty that uses those procedures.

Non-surgical procedures also just don't take that long to learn, while the assessment and presentation of a patient takes a long time to get down. If you should start Intern year without having done an LP you'll get it down by month 3. If you show up without having written a note or presented a patient you might catch up to where the other Interns started from by R2.

 

[sliceofbread136]

Notes yes. There is no risk to a note other than the Intern having to rewrite it. Procedures should only be given to students who are going to do them as residents. There is a high risk of complications the first time anyone does a procedure, and the trade off has to be that they'll be able to help future patients. I think intubations and LPs are pretty much universal. Central lines, deliveries, surgeries, and chest tubes not so much. Those should be for Residents or students who have matches into a specialty that uses those procedures.

Non-surgical procedures also just don't take that long to learn, while the assessment and presentation of a patient takes a long time to get down. If you should start Intern year without having done an LP you'll get it down by month 3. If you show up without having written a note or presented a patient you might catch up to where the other Interns started from by R2.

Totally agree.

 

[Perrotfish]

If it's not important for people going into psych to learn how to do a line, for someone going into ortho to learn how to intubate, or for someone going into EM to learn how to do a MMSE, then maybe we should just get rid of medical school all together? Maybe the MD/DO degree is just a relic of the past? Perhaps we should just have "medical students" go to anesthesiologist schools, EM schools, ortho schools, etc, where they learn the skills only inherent to their specialties. Kind of like how nurse practitioner students can get a pscyh NP degree, geriatric NP degree, etc..

If I was going to completely overhaul medicine this is how I would do it, yes. Our system for medical education was 50 years behind the times when Osler made it up and hasn't really adapted to any of the changes in medicine since. In that sense the midlevels are right: the general -> specialized pathway doesn't make sense. They are, however, wrong about how much training it takes to actually make a competent practitioner. A Peds NP is still a 3 year degree that actually needs to be at least 5 or 6 years long after premedicine to create something equall to a Pediatrician. That's why NPs haven't replaced MDs entirely: they've called out a lot of the flaws in our system, but they've responded by creating a training system of their own that is so inadequate that (I think) doctors are still clearly the superior product.

The problem with midlevels isn't that they don't have our asinine 'general' training in Histology, biochemistry, and every medical subspecialty, it's that they don't have the career specific training that we go through in Residency.

 

[username456789]

I hate to say it, but if this is the attitude amongst medical students nowdays - that they should only learn what is relevant to their chosen specialty - then I guess the midlevels are right that the MD/DO degree is just a big waste of time. Honest to God we may as well just let PA's and NP's match into residencies now, because it's not like medical students are doing anything special anymore that they are not.

I've actually been really surprised and disappointed to see this sentiment passed around SDN a good bit recently. I'm in Dermatology, but I loved that in medical school I got to learn and do so many things that were not at all directly related to Dermatology. Some of it leads to a sense of "I have a good understanding of what goes on with other specialties" when I converse with patients or other physicians involved in subspecialty care other than my own. Some of it is just pretty cool. No, a Dermatologist doesn't need to place a central line or pull a chest tube or help put an ex-fix on a shattered tibia, but I got to do these things and very few people in the world will ever get to.

There are surely ways to make things more efficient in medical school. But having standard/core rotations truncated or voluntarily avoiding participating in activities related to these rotations is really not the answer.

Having rotated in the ICU as a student and an intern and cared for patients with SJS, DRESS Syndrome, toxic shock syndrome, meningococcemia, and RMSF gives me a very unique perspective when talking to the midlevels with whom I work who have never seen these conditions and/or don't understand why you don't just throw Bactrim at everything that oozes or has pustules (aside from the fact that it's often not infectious) and why you need to take a good medication history in a patient with a rash.

Plus it just helps relate to my patients. On a daily basis I have routine skin checks during which the patients might mention an upcoming surgery or a recent procedure or medical event they experienced. I can easily converse with them about this (and often help allay their fears) directly because of my participation as a student/intern.

 

[username456789]

The problem with midlevels isn't that they don't have our asinine 'general' training in Histology, biochemistry, and every medical subspecialty, it's that they don't have the career specific training that we go through in Residency.

I'd argue it's both.

I'd also argue that it's hard to effectively perform the latter without much of the former.

But please, rhetorically ask me why we need to know the 4th intermediary in the Krebs cycle to admit a CHF patient. I feel like these asinine strawman questions always arise in a discussion such as this.

 

[Perrotfish]

I'd argue it's both.

I'd also argue that it's hard to effectively perform the latter without much of the former.

But please, rhetorically ask me why we need to know the 4th intermediary in the Krebs cycle to admit a CHF patient. I feel like these asinine strawman questions always arise in a discussion such as this.

,

I would ask you that. I would also tell you that I cannot think of ANY knowledge I gained from my undergraduate histology, neuroanatomy, or biochemistry classes that are relevant to my practice. Or for that matter from my surgery/EM/IM rotations other than general knowledge of working in a hospital (like how to write a note) that I could have learned just as effectively on Pediatric wards. I would ask you why it was valuable enough for me to do those rotations that it was worth an opportunity cost of hundreds of thousands of dollars. Or, alternatively, an opportunity cost of NOT working in Pediatric cinic/wards/ICU. Once or twice a month I have I am called for a code Purple. Was it really worth not giving me an extra three months of NICU, night float, with all of those extra reps of neonatal resuscitation, so that I could spend three months holding a camera for cholecystectomies on an MS3 surgery rotation? What the ability to 'relate to my patients' when they talk about their upcoming stent worth me never having done the Peds Anesthesia rotations where I could have learned to place difficult IVs on their children? Were the months of titrating statins in Family medicine clinic worth me not having the extra months titrating the medicines I actually use every day in Pediatric clinic?

One of the best signs that this broad, general knowledge of medicine isn't relevant is that we don't maintain it. If this knowledge really mattered we would be forcing physicians to regularly update their knowledge. They certainly make sure I am up to date on Pediatrics, in fact I am posting so much today because I dragging myself through December's PedsRAP and I am posting as a break between each podcast. But everyone knows that Pediatricians don't actually need to know IM/Surgery/Adult EM, so everyone is happy to let me stay licensed even though my knowledge of adults is both fading quickly from my memory and hasn't been updated since 2011.