6yr Program Off Service/Med School Time: What does your program do? What would you change?

[White_Sponge_Nevus]

Currently done with my program's med school requirements, in the thick of the off-service gen-surg, with anesthesia still to go. Done with Step 1,2,3.

Overall, I am happy with the way my program handles the off service/med school time. We have PGY-1, 5, 6 as all 12 months OMFS. PGY-2 is M2. PGY-3 is M3. PGY-4 is 7 months gen surg rotations (not specifically catered to OMFS relevance) and 5 months anesthesia. 36 months on service, with no obligations for OMFS while off. 2 years of in-state med school tuition. PGY-2 salary during gen surg/anesthesia. Keep health insurance the whole time. One location, no moving for med school.

This isn't necessarily meant to be a venting session, nor a 4 vs 6 debate, but I can't help but feel like I've wasted a lot of time. If not for moonlighting, M2 would've been a huge lost opportunity to do anything that prepares me for the workforce/increase skills. M3 was a let down; after functioning as a resident and then moonlighting as a dentist, going back to a student role was tough, and while life was good, I didn't learn nearly as much as I thought I would, despite spending a not insignificant amount of time in the hospital. Also not making money sucks. So far, gen surg rotations have been what I expected; nice to get paid again, but you're a source of labor for the service you're currently on. Learning is by osmosis on floor/clinic duty, very little OR time. Not a complaint for this aspect, I understand it's part of the game.

I guess I'm just curious to hear what people who are currently in residency, or already out, think about their off-service time. Was it a let down? Do you think it was worth it? What would you change if you could?

For me, I wish there could be some combination of additional time on service with no call as an M2, so you could still have some gain of skill in OMFS and still fulfill the light med school obligations, also while getting paid. Or skip the year entirely in lieu of more OMFS. For M3, I do think my experience could've been compressed to about 8 months without losing any time. However, I almost wish they paid us as PGY-1s and made us function as residents on each of the clerkship services, and just made us take the shelf exams on schedule with the rest of the class.

I hope this opens up a dialogue just to see what other people think, and not only allows people to get some frustration off their chest, but also helps people like me still in it gain some perspective from the other side. Also hoping it helps applicants currently hearing back about interviews make the right rank list choices.

Thanks in advance!

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[Bupivacaine Bear]

I think Case has shown that you can effectively have Med School integrated into a 5-year program, but I imagine the politics and bureaucratic red tape associated with approval from the med school and your ACGME accredited years is what stops most programs.

Speaking with friends who went to med school, it seems many schools also think their preclinical years are truly revolutionary and that all of their students don’t just buy subscriptions to BnB/Sketchy/Bootcamp and self teach step material.

 

[White_Sponge_Nevus]

I think Case has shown that you can effectively have Med School integrated into a 5-year program, but I imagine the politics and bureaucratic red tape associated with approval from the med school and your ACGME accredited years is what stops most programs.

Speaking with friends who went to med school, it seems many schools also think their preclinical years are truly revolutionary and that all of their students don’t just buy subscriptions to BnB/Sketchy/Bootcamp and self teach step material.

I think you hit the nail on the head in that each program is bound by the parameters of the affiliated med school, and that a lot of the "how could I fix this" scenarios are pipe dreams because of this

 

[piratewow]

I'm done with the med school portion of my residency, and tbh didn't gain much from it. At my program we do PGY 1 12 months MS3, PGY 2 10 months OMFS intern, 2 months MS4 BS electives, PGY 3 Gen surg 6 mo, Anesthesia 5 mo, ED 1 mo, then PGY 4-6 36 months on service OMFS for a total of 46 months OMFS training. My program has pretty much the shortest med school amount possible and I still thought it was too much by the end lol.

If it's important enough, you'll have it hammered into you during residency, if it's not, it's probably esoteric so who cares if you forget it is my point of view. Ask an orthopod or a PRS attending to read an EKG, or ask a heme-onc doc about ottawa ankle rules, what you learned or forgot during MS1-4 is not what makes you a physician.

Ideally 8 weeks ea of gen surg and IM (with electives) , 4 weeks OB,FM, Pysch, Peds, 4 weeks dedicated for step 2 =36 weeks or 9 months total is what I personally feel would be the ideal med school curriculum. Even elective stuff like ENT or plastics would be better served as residency level rotations rather than med school level rotations.

 

[White_Sponge_Nevus]

I'm done with the med school portion of my residency, and tbh didn't gain much from it. At my program we do PGY 1 12 months MS3, PGY 2 10 months OMFS intern, 2 months MS4 BS electives, PGY 3 Gen surg 6 mo, Anesthesia 5 mo, ED 1 mo, then PGY 4-6 36 months on service OMFS for a total of 46 months OMFS training. My program has pretty much the shortest med school amount possible and I still thought it was too much by the end lol.

If it's important enough, you'll have it hammered into you during residency, if it's not, it's probably esoteric so who cares if you forget it is my point of view. Ask an orthopod or a PRS attending to read an EKG, or ask a heme-onc doc about ottawa ankle rules, what you learned or forgot during MS1-4 is not what makes you a physician.

Ideally 8 weeks ea of gen surg and IM (with electives) , 4 weeks OB,FM, Pysch, Peds, 4 weeks dedicated for step 2 =36 weeks or 9 months total is what I personally feel would be the ideal med school curriculum. Even elective stuff like ENT or plastics would be better served as residency level rotations rather than med school level rotations.

Couldn't have said it better myself. I'm glad you guys are able to get 46 months, that's impressive!

 

[Life of Pablo]

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[Ivy.ch]

PGY-0: Retake CBSE, then take STEP 1.
PGY-1: Intern year, with one night a week doing seminars with MS1/MS2 students.
PGY-2: ~10 months of MS3. Take Step 2.
PGY-3: OMS year, graduate with MS4s in May.
PGY-4: Take STEP 3 at some point during GenSurg rotation.
PGY-5: OMS chief

We have one of the “best” setups at our program. But even then, waking up for MS3 most days was hard. Not because it was difficult, but because I felt utterly useless coming off a year of being a doctor. Moonlighting and friends kept us sane.

I learned a lot during my surgery rotation (my elective was ENT) and Emergency Medicine. Internal Medicine and Pediatrics were also nice some days just to have better general medical knowledge. Otherwise, it was miserable most days. Most days was walking around like a zombie until I was dismissed so I could go and study for Step 2.

Looking back, I would say it was a net positive for me. Though I am likely biased because I want to do a fellowship. But I’m not sure if I would have felt the same at a program doing 24 months of med school. Props to you all for surviving that many months of med school.

 

[DMD12345]

Side bar question: where do you make friends in os residency? Is it mainly through your med school class?

 

[Ivy.ch]

Side bar question: where do you make friends in os residency? Is it mainly through your med school class?

I definitely made some med school friends. On the one hand, all the cliques are already settled by the time you get there, but on the other hand, they like being around someone who doesn’t give a **** about kissing up and getting a good grade.

I was also involved in some undergrad clubs at the university. That helped meeting new people.

 

[White_Sponge_Nevus]

Here is our timeline:

PGY1 - 1 month OMFS, 11 months med school
PGY2 - 12 months med school
PGY3 - 12 months OMFS intern year
PGY4 - 6 months gen surg, 5 months anesthesia, 1 month OMFS
PGY5 - 12 months OMFS
PGY6 - 12 months OMFS

As I stood there doing a DRE during my gen surg clerkship on someone with bowel obstruction, I honestly thought to myself why did I choose to go to med school.....If it weren't for being able to moonlight a ton during med school, it would be way more miserable, and I would have a lot more regrets. We also just started getting paid a resident's salary during med school which has really helped out.

I know I’m kind of jaded, but I seriously don’t think the preclinic years of med school are needed if you’ve passed the cbse. I think all programs should adopt the system where you have to pass step 1 before starting med school, so you start out as an MS3. We took the CBSE again 3 months into MS2 and my coresident and I passed it by a mile, but we weren’t allowed to sit for step 1 for another few months. I wish we could’ve just immediately took and passed step 1, and then moonlighted the rest of M2 or been back on service.

Amen brother

 

[White_Sponge_Nevus]

PGY-0: Retake CBSE, then take STEP 1.
PGY-1: Intern year, with one night a week doing seminars with MS1/MS2 students.
PGY-2: ~10 months of MS3. Take Step 2.
PGY-3: OMS year, graduate with MS4s in May.
PGY-4: Take STEP 3 at some point during GenSurg rotation.
PGY-5: OMS chief

We have one of the “best” setups at our program. But even then, waking up for MS3 most days was hard. Not because it was difficult, but because I felt utterly useless coming off a year of being a doctor. Moonlighting and friends kept us sane.

I learned a lot during my surgery rotation (my elective was ENT) and Emergency Medicine. Internal Medicine and Pediatrics were also nice some days just to have better general medical knowledge. Otherwise, it was miserable most days. Most days was walking around like a zombie until I was dismissed so I could go and study for Step 2.

Looking back, I would say it was a net positive for me. Though I am likely biased because I want to do a fellowship. But I’m not sure if I would have felt the same at a program doing 24 months of med school. Props to you all for surviving that many months of med school.

Case certainly dose have the best set up. I was unaware that you guys get two years on service prior to the gen surg time/anesthesia time, which I find interesting/prob would've liked. I'm sure it was tough having to do some MS1/MS2 fluff on top of intern year, but I'm sure it and taking the CBSE prior to starting are well worth the saved time.

 

[White_Sponge_Nevus]

Side bar question: where do you make friends in os residency? Is it mainly through your med school class?

You'll make friends with the small but not insignificant amount of fellow med students on your clerkships who are normal, and the larger and less insignificant amount of fellow residents on your off-service gen surg/plastics/ent rotations who are normal

 

[PatsMan1]

Most programs do way too much med school IMO (usually out of their control, the med school dictates)

Only a few programs do minimal medical school (which is beneficial, usually translates to more months on service): case western, Rutgers, I think LSU as well? I forget which ones exactly

 

[Contach]

My advice is worry about what is in your control.
Do everything with a smile and try to make the most of it while keeping balance (mental health, self care). Many medical residencies also have to do rotations that aren't aligned with what they will do eventually.
And go to sleep at night knowing you are part of a great profession; and may not ever have to step into a hospital ever again; and you'll be compensated very well.

 

[carabelliscusp]

Can anyone from UCSF comment on their time considering I believe they have the longest med school?