A lot of DO rotations aren't so good...

[AnatomyGrey12]

And this is why I am grateful we have a teaching hospital that is essentially resident and student run. Our clinical training is supposed to be excellent according to reports from 3rd and 4th years, unfortunately the types of experiences described in this thread taint every DO student including the ones who will get great clinical training.

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[SLC]

…The "amazing rotations" described in this thread should be the absolute bare minimum. Oh you're pre-rounding/seeing patients before attending then presenting? Discussing A/Ps? Wow! Shocker. Suturing and tiny I/Ds, whoa now! Even if you have a truly amazing rotation, it's likely an outlier.

Wow, you misread my post and missed the point of it.

Randomly posting about it in some thread isn't going to remove the perception that most of DO rotations are not up to par.

If you think my motivation for responding was to change that perception in Any meaningful way then I don’t know what to say.

But I notice that you’re almost offended that someone might suggest that DO rotations aren’t all horrible. Why is that?

 

[DrfluffyMD]

Wow, you misread my post and missed the point of it.




If you think my motivation for responding was to change that perception in Any meaningful way then I don’t know what to say.

But I notice that you’re almost offended that someone might suggest that DO rotations aren’t all horrible. Why is that?

DO rotations aren’t all horrible, but you can’t deny that perceptor based learning is incredibly variable and much more so than the resident based system most LCME school used.

Another issue is waterdown of clinical grades when people don’t show up for a month and grade themselves at the end (example included in this thread). It casts doubt in the mind of an ACGME PD whether someone’s honor is worth as much as the honor from Drexel, for example.

 

[17DOmed]

DO rotations aren’t all horrible, but you can’t deny that perceptor based learning is incredibly variable and much more so than the resident based system most LCME school used.

Another issue is waterdown of clinical grades when people don’t show up for a month and grade themselves at the end (example included in this thread). It casts doubt in the mind of an ACGME PD whether someone’s honor is worth as much as the honor from Drexel, for example.

There's an immediate issue with preceptor based learning when the preceptor works at multiple hospitals and is in his clinic a bunch of the time.

 

[17DOmed]

Lol that's not how it works here. Any case that is mildly complex beyond a simple chole or pancreatitis gets referred out to the university hospital. My previous peds rotation was shadowing a NP in an outpatient clinic for a month, and my current Ob rotation we're not allowed into the room during deliveries or exams "too many bodies in the room, makes patient uncomfortable"

This is at a school that's well regarded on this forum. I saw the other side during my post bac and interviews at Rosalin franklin and SIU. Low tier MD schools were miles ahead of KCU, MSU, CCOM, and my current school.

Well I can't say mine is this bad lol. You get like 2 deliveries in, and see the occasional complex case.

 

[deleted480308]

OP, You’re like the guy whose wife won’t sleep with him so he’s always making jokes about how sexless all marriages are.......and all your married guy friends feel too sad for you to mention they had sex last night

Your school sucks, don’t project that on everyone else

 

[17DOmed]

OP, You’re like the guy whose wife won’t sleep with him so he’s always making jokes about how sexless all marriages are.......and all your married guy friends feel too sad for you to mention they had sex last night

Your school sucks, don’t project that on everyone else

I think this thread is enough evidence. At least we can move on from the blatantly false claim that DOs are worse students or whatever. The focus should be inconsistency among clinical sites at DO schools.

 

[Trollest]

I think this thread is enough evidence. At least we can move on from the blatantly false claim that DOs are worse students or whatever. The focus should be inconsistency among clinical sites at DO schools.

So OP, are you going to name your school or not?

Lol that's not how it works here. Any case that is mildly complex beyond a simple chole or pancreatitis gets referred out to the university hospital. My previous peds rotation was shadowing a NP in an outpatient clinic for a month, and my current Ob rotation we're not allowed into the room during deliveries or exams "too many bodies in the room, makes patient uncomfortable"

This is at a school that's well regarded on this forum. I saw the other side during my post bac and interviews at Rosalin franklin and SIU. Low tier MD schools were miles ahead of KCU, MSU, CCOM, and my current school.

This is sad.

 

[AnatomyGrey12]

Low tier MD schools were miles ahead of KCU, MSU, CCOM, and my current school.

Lol, DO schools like MSU and OSU have excellent rotations that are definitely not worse than any low tier MD school. You can make the claim you are making for your school if you have direct experience with it as we can’t argue that, but you can’t project it to schools you have no idea about.

 

[AlbinoHawk DO]

Lol, DO schools like MSU and OSU have excellent rotations that are definitely not worse than any low tier MD school. You can make the claim you are making for your school if you have direct experience with it as we can’t argue that, but you can’t project it to schools you have no idea about.

Don't the MSU and Rowan students rotate with the MD students? Must suck that the DOs are getting that terrible experience while the MD students are getting a good one at the same time.

 

[Goro]

Don't the MSU and Rowan students rotate with the MD students? Must suck that the DOs are getting that terrible experience while the MD students are getting a good one at the same time.

This is like the joke from Annie Hall:
Therapist A to Alvy Singer: "How often do you have sex?"
Alvy: [glum] Hardly ever...2-3x/week

Therapist B to Annie Hall (Alvy's SO): "How often do you have sex?"
Annie: [Annoyed] Constantly!!! 2-3x/week!

 

[DO2015CA]

Don't the MSU and Rowan students rotate with the MD students? Must suck that the DOs are getting that terrible experience while the MD students are getting a good one at the same time.

CCOM also I believe

 

[IsWhat]

I have friends who attended my state MD school (a ~top 20 School in research funding) and they b*tched and moaned about rotations all the time. There was a point where the PA/NP students at the University hospital were handling more patients on the medicine teams than the medical students.

There was a post a few years back with someone from AZCOM who described his terrible rotations experience, but he made up for those bad experiences in other ways and ultimately ended up matching Ortho. You guys just need to make it happen. SDN likes to do the whole, “grass is greener on the other side” thing way too much. It’s a losers mentality and it’s getting old.

 

[NotAProgDirector]

We regularly match a few DO students each year. My sense of the situation is that you're all correct to some extent. There is variability in training experiences in both MD and DO school. I have had both MD and DO students who seemed unprepared for internship.

However, the variability appears to be much greater in DO schools. I have matched students from the same school, who appear to have similar performance, but have wildly different clinical experiences and readiness for internship. DO schools appear to have more training locations, hence the risk of students having different experiences is higher. Also, most DO schools tend to rotate their students in non-GME settings, which increases the risk of a pure shadowing experience. These are broad statements, and it's quite possible that some DO schools do a better job than others.

This is why it's more difficult for me to evaluate DO applicants. It's not uncommon for the MSPE evaluation to have 1 or 2 sentences about a clerkship. For MD schools, usually there's multiple paragraphs that give me a good sense of how the student has done. I often can't figure out what the DO student's experience really is.

 

[arcus]

It's not uncommon for the MSPE evaluation to have 1 or 2 sentences about a clerkship. For MD schools, usually there's multiple paragraphs that give me a good sense of how the student has done. I often can't figure out what the DO student's experience really is.

What would your redommendation be to such an applicant?

IOW, what would it take for you to be persuaded the applicant has the skills you are seeking in lieu of those 1 or 2 sentences, and what can the applicant do beforehand to help you reach that decision?

 

[DrfluffyMD]

I have friends who attended my state MD school (a ~top 20 School in research funding) and they b*tched and moaned about rotations all the time. There was a point where the PA/NP students at the University hospital were handling more patients on the medicine teams than the medical students.

There was a post a few years back with someone from AZCOM who described his terrible rotations experience, but he made up for those bad experiences in other ways and ultimately ended up matching Ortho. You guys just need to make it happen. SDN likes to do the whole, “grass is greener on the other side” thing way too much. It’s a losers mentality and it’s getting old.

I think the issue here is that the grass, being clinical education, is greener on the MD side.

Grasping at straws by attempting to find rare examples of poor clinical education in LCME schools are thrown around in this thread a lot, trying to obscure the fact LCME schools have more uniform, and often time better clinical training.

Suppressing such discussion or attempt to handwave it away by a handful of posters, going as far as personal attacks, aren’t going to make that magically go away in the eyes of ACGME PDs, of which at least two (radiologypd and aprogramdirector) posted, one in this very thread.

 

[AnatomyGrey12]

Grasping at straws by attempting to find rare examples of poor clinical education in LCME schools are thrown around in this thread a lot

They really aren’t as rare as you are making them out to be. A lot of MD schools utilize a good number of preceptor rotations, and you are actively choosing to ignore that if you don’t think it isn’t true. I agree overall the MD schools will have better rotations on average.

trying to obscure the fact LCME schools have more uniform, and often time better clinical training.

Yes overall the grass is greener on the MD side but once again I want to point out that the LCME and COCA have the EXACT same clinical requirements. You keep saying “LCME schools” When it isn’t LCME vs. COCA but is school dependent.

Suppressing such discussion or attempt to handwave it away by a handful of posters, going as far as personal attacks, aren’t going to make that magically go away in the eyes of ACGME PDs, of which at least two (radiologypd and aprogramdirector) posted, one in this very thread.

We aren’t suppressing discussion. There absolutely are things that need to be done to build up clinical education on the DO side, but it needs to be pointed out that experiences like OPs are not the majority. The variability in DO rotations quality is a problem, but for rational discussion to happen it needs to be acknowledged that the majority of DOs do get adequate training, instead of just assuming every DO student is shadowing in Dr. Bobs FM clinic and never doing anything.

 

[ortnakas]

Hey, we haven’t had this argument for what, a week?

I do have a question for @aProgDirector. You mentioned that you do take a few DOs per year, but also that DO students’ clinical experiences are less reliable. What did these applicants do and/or what would you recommend students do to alleviate your concerns and illustrate adequate prep for residency?

 

[deleted831695]

Suppressing such discussion or attempt to handwave it away by a handful of posters, going as far as personal attacks, aren’t going to make that magically go away in the eyes of ACGME PDs, of which at least two (radiologypd and aprogramdirector) posted, one in this very thread.

There's a difference between "suppressing discussion" (which nobody is doing BTW) and not blindly accepting an unfair criticism.

 

[DrfluffyMD]

They really aren’t as rare as you are making them out to be. A lot of MD schools utilize a good number of preceptor rotations, and you are actively choosing to ignore that if you don’t think it isn’t true. I agree overall the MD schools will have better rotations on average.



Yes overall the grass is greener on the MD side but once again I want to point out that the LCME and COCA have the EXACT same clinical requirements. You keep saying “LCME schools” When it isn’t LCME vs. COCA but is school dependent.



We aren’t suppressing discussion. There absolutely are things that need to be done to build up clinical education on the DO side, but it needs to be pointed out that experiences like OPs are not the majority. The variability in DO rotations quality is a problem, but for rational discussion to happen it needs to be acknowledged that the majority of DOs do get adequate training, instead of just assuming every DO student is shadowing in Dr. Bobs FM clinic and never doing anything.

Adequate clinical training means different things to different people. To a PD at MGH or Columbia, they maybe accustomed to student who are trained in regional or national teritary referal centers, having exposures to multiple clinical site settings including the VA, community sites and perceptorships in certain specialities like fanily medicine. They may desire a student with structured clinical programs.

If that’s the case, I am not sure if many DO schools own exclusive access to a range of training site from top teritary centers, to the VA, to the community sites like say, UCLA do.

In that way, the average DO clinical training isn’t sufficient for those PDs. I imagine some of the worst MD school may have a similar problen, but as of my application time to med school (2008) all USMD school I am familar with had at least regional teritary referal centers, and we are talking about random schools with low rankings. For example, Howard, an institution often unfairly gets blasted here, have their own teritary university hospital.

Now, if you are talking about a primary care specialty ACGME PD or someone who do not expect the student to have teritary center experience then it’s less of a problem.

 

[DrfluffyMD]

There's a difference between "suppressing discussion" (which nobody is doing BTW) and not blindly accepting an unfair criticism.

Yet I persistently have people launching personal attacks at me rather than rational, legitimate discussion about how the COCA can contribute to improve the DO clinical training on the average (hint: stop opening new schools)

 

[DO2015CA]

I would agree there needs to be improved clinical rotations for DO schools as a whole but my response was aimed at the title that was more clickbait than saying “hey I’ve been having ****ty rotations and I go to X school”. My intent was never to sweep anything under the rug

 

[IsWhat]

I think the issue here is that the grass, being clinical education, is greener on the MD side.

Grasping at straws by attempting to find rare examples of poor clinical education in LCME schools are thrown around in this thread a lot, trying to obscure the fact LCME schools have more uniform, and often time better clinical training.

Suppressing such discussion or attempt to handwave it away by a handful of posters, going as far as personal attacks, aren’t going to make that magically go away in the eyes of ACGME PDs, of which at least two (radiologypd and aprogramdirector) posted, one in this very thread.

Medical students get drowned out by the amount of hands in the pot at many of these “ivory tower” schools. Most American medical students - no matter which school you go to - receive adequate clinical training in spight of the program, not because of it.

Now I’m not saying there aren’t differences in training, but it’s almost never so different that a self directed student couldn’t make up for it in other ways. A PD in this thread talked about the variability in DO students in his/her program - and even mentioned the differences between students at the same school. To me, this reflects more on the wide quality spectrum of DO students compared to our MD counterparts. The difference between the top quarter and bottom quarter of DO schools is massive. The quality spectrum at most MD schools is pretty narrow.

 

[DrfluffyMD]

Medical students get drowned out by the amount of hands in the pot at many of these “ivory tower” schools. Most American medical students - no matter which school you go to - receive adequate clinical training in spight of the program, not because of it.

Now I’m not saying there aren’t differences in training, but it’s almost never so different that a self directed student couldn’t make up for it in other ways. A PD in this thread talked about the variability in DO students in his/her program - and even mentioned the differences between students at the same school. To me, this reflects more on the wide quality spectrum of DO students compared to our MD counterparts. The difference between the top quarter and bottom quarter of DO schools is massive. The quality spectrum at most MD schools is pretty narrow.

A self directed student isn’t gonna learn how to exchange an internal external biliary stent if there isn’t an IR doc in the community hospital that student rotates in doesn’t matter how much he/she is a go getter. And yes, this is something I will show a very motivated student how to do.

 

[IsWhat]

A self directed student isn’t gonna learn how to exchange an internal external biliary stent if there isn’t an IR doc in the community hospital that student rotates in doesn’t matter how much he/she is a go getter. And yes, this is something I will show a very motivated student how to do.

I understand that, but most schools have an elective heavy 4th year. There is no excuse for any American medical graduate - MD or DO - to be unprepared for internship year. It’s just that simple.

Edit: The case could probably be made that learning to “exchange an internal external biliary stent” in medical school is pretty low yield when it comes to a students development. Do we start students in flight school with a tricked out Boeing 777 Dreamliner? No. It’s a nice thing to experience, but nowhere near required to become a competent pilot. Medicine is the same way.

 

[jrlob91]

I was at ATSU-SOMA, I first assisted on all surgeries. I even sutured an aortic valve replacement in place during one day on my gen surg rotation when they allowed me to join a CT surgeon. I delivered 15-20 babies vaginally and 1st assisted on around that many c-sections. It was scary at first but my preceptor was great at teaching me.

On IM, I carried 4-5 patients at a time, wrote H&p’s and daily notes on them, presented them in rounds, and basically functioned as a subintern during 3rd year. During outpatient rotations I generally did less, but still went in to see every patient before the attending did, and gave a mini-presentation before we’d go in and see them together.

I was very satisfied with my clinical training. And in residency, from day 1 my evaluations generally contained comments like “excellent clinical acumen, advanced procedure skills” etc. My PD commented on this multiple times during intern year when he precepted me on GYN procedures and I&D’s etc.

I don’t think my school was considered to be a “top” DO program (whatever that means). And I don’t think it would be on your “list”.

I’m not sure where you go, but it sounds like either you’re getting shafted, or your attendings may not trust you to do stuff (because that definitely happens). I’ve done that to med students here in residency. If they don’t inspire confidence that they’ll perform a pelvic exam or office procedure well, I generally don’t offer to let them do it. I’m not the only one who does this either. And this is at a top 20 MD school.

Will second this experience for ATSU-SOMA. Always first assist. Always doing everything. Multiple LORs from these physicians stated as such and was a major selling point on my app. Not all DO schools are like the OP, and it’s not just relegated to top tier DO schools. My experience has been amazing.

 

[shadowlightfox]

Unless he's at my school or our neighbors up north, this is nothing uncommon. I had an OB/Gyn rotation where I saw zero deliveries or pelvic surgeries and half the time was doing the doctor's billing. It was atrocious.

This. I, too, go to a school where clinical rotation site having high quality is a rare thing.

 

[rg2o3]

Would be nice to hear which schools in particular are being represented within this thread.

 

[NotAProgDirector]

Hey, we haven’t had this argument for what, a week?

I do have a question for @aProgDirector. You mentioned that you do take a few DOs per year, but also that DO students’ clinical experiences are less reliable. What did these applicants do and/or what would you recommend students do to alleviate your concerns and illustrate adequate prep for residency?

The best option is a rotation at an ACGME/LCME program with at least one LOR from the rotation.

Another option is to fix the DO MSPE's, not sure how to do that.

 

[MedicineZ0Z]

The best option is a rotation at an ACGME/LCME program with at least one LOR from the rotation.

Another option is to fix the DO MSPE's, not sure how to do that.

Could you clarify what you mean here?

 

[IslandStyle808]

The best option is a rotation at an ACGME/LCME program with at least one LOR from the rotation.

Another option is to fix the DO MSPE's, not sure how to do that.

If one is ill prepared working with residents, would you suggest doing a rotation with residents but in a different field? For example, if one were wanting to do EM but felt ill prepared for a sub-I, should he or she do a rotation in anesthesia or IM (a similar field) with residents for their elective?

 

[Goro]

The best option is a rotation at an ACGME/LCME program with at least one LOR from the rotation.
Another option is to fix the DO MSPE's, not sure how to do that.

Could you clarify what you mean here?

My learned colleague mentioned earlier how poorly written and uninformative some DO MSPE's are. At my school, we use a template modeled on one from a Really Top School. But even theirs can be lacking in certain things, like how the student performed relative to his/her peers in particular electives. Their attitude is almost "this is one of our students, and thus you know s/he's trained well".

At any rate, aPD was kind enough to share more definitive comments about this, and they were eye opening to our Clinical Dean.

tldr? read post #66 in this thread.

I wish more DO Clinical deans would get on SDN, and learn from our MD colleagues in this subject. The idea of asking a PD from, say NYU IM as to why their program won't take DOs will probably be eye opening. Sure, they may say "we get plenty of qualified MD grads", but I'll bet some will tell us something informative like aPD has.

I'm kicking myself because some time ago, a PD or attending wrote at length as to the deficits in clinical training that some DOs have had in his/her program. It's wasn't aPD, alas, and unfortunately, I can't find the post! I'd immediately show it to my Dean. If that person is reading this, I hope that you can drop me a line!

 

[DrfluffyMD]

If one is ill prepared working with residents, would you suggest doing a rotation with residents but in a different field? For example, if one were wanting to do EM but felt ill prepared for a sub-I, should he or she do a rotation in anesthesia or IM (a similar field) with residents for their elective?

I would say if you are able, do a medicine subI or surgery subI depends on what you are going into really early on, then do another subI at the institution you want your letters to be written from. If you never rounded with people, your first subI is going to suck and you should try to get letters from the second. I doubt people will care which subI wrote you the letter as long as you do have a good one by the time apps are due.

 

[IslandStyle808]

I would say if you are able, do a medicine subI or surgery subI depends on what you are going into really early on, then do another subI at the institution you want your letters to be written from. If you never rounded with people, your first subI is going to suck and you should try to get letters from the second. I doubt people will care which subI wrote you the letter as long as you do have a good one by the time apps are due.

My concern is more what if a PD see a something like a pass on my transcript for the field I am interesting in my first sub-I and even if my second experience goes well, would that first sub-I hurt my chances? Wouldn't it be better to do it in another similar field before the field I am interested in?

 

[deleted831695]

Yet I persistently have people launching personal attacks at me rather than rational, legitimate discussion about how the COCA can contribute to improve the DO clinical training on the average (hint: stop opening new schools)

Who launched a personal attack on you? People here in general seem to accept fair criticism, but nobody is going to stand for untrue generalizations.

 

[Cryc_to_the_point]

So... DCOM. Anyone want to provide some insight?

 

[DrfluffyMD]

Who launched a personal attack on you? People here in general seem to accept fair criticism, but nobody is going to stand for untrue generalizations.

Oh, just read every thread about this I posted in.

One poster in particular seem to have something untoward to say, but can’t seem to bring it out in writing.

 

[deleted831695]

Oh, just read every thread about this I posted in.

One poster in particular seem to have something untoward to say, but can’t seem to bring it out in writing.

I've seen your posts in some of this subforum's threads, and almost all of the replies that challenged something you wrote were more than fair.

 

[IsWhat]

My learned colleague mentioned earlier how poorly written and uninformative some DO MSPE's are. At my school, we use a template modeled on one from a Really Top School. But even theirs can be lacking in certain things, like how the student performed relative to his/her peers in particular electives. Their attitude is almost "this is one of our students, and thus you know s/he's trained well".

At any rate, aPD was kind enough to share more definitive comments about this, and they were eye opening to our Clinical Dean.

tldr? read post #66 in this thread.

I wish more DO Clinical deans would get on SDN, and learn from our MD colleagues in this subject. The idea of asking a PD from, say NYU IM as to why their program won't take DOs will probably be eye opening. Sure, they may say "we get plenty of qualified MD grads", but I'll bet some will tell us something informative like aPD has.

I'm kicking myself because some time ago, a PD or attending wrote at length as to the deficits in clinical training that some DOs have had in his/her program. It's wasn't aPD, alas, and unfortunately, I can't find the post! I'd immediately show it to my Dean. If that person is reading this, I hope that you can drop me a line!

I don’t feel bad for anyone unprepared for internship year. An American graduate (MD or DO) has access to adequate clinical training. Every. Single. Student. Maybe instead of scheduling an easy peasy 4th year you schedule a butt kicking ICU rotation for 8 weeks - everyone can do this if they want.

 

[DrfluffyMD]

I don’t feel bad for anyone unprepared for internship year. An American graduate (MD or DO) has access to adequate clinical training. Every. Single. Student. Maybe instead of scheduling an easy peasy 4th year you schedule a butt kicking ICU rotation for 8 weeks - everyone can do this if they want.

Some people don’t have a flexible 4th year, again a problem seem to be endemic to certain DO schools.

 

[NuttyEngDude]

Is it normal for MD (or DO) students to have a quota for procedures or is this purely an intern thing?

 

[AnatomyGrey12]

Some people don’t have a flexible 4th year, again a problem seem to be endemic to certain DO schools.

This shows that you don’t really know what you are talking about on some DO topics, DO schools are notorious for having wide open 4th years.... to the point where you wonder why you even pay tuition that year...

 

[AlbinoHawk DO]

This shows that you don’t really know what you are talking about on some DO topics, DO schools are notorious for having wide open 4th years.... to the point where you wonder why you even pay tuition that year...

Issue is more complex than that. Many people are doing auditions or have to schedule some rotations just to be able to go to interviews. For example, at my school they will give you Max 3 days off the entire rotation to go on interviews, so most students feel forced to schedule bs that will let them skip so they can match. Also, it's not easy to find all the rotation you want that go according to your school dates or are available to take you or you know in advance that's a site that will prepare you adequately. Stop taking a failing from schools and blaming students for them not going out of their way to amend errors in a system they pay 50K a year in tuition

 

[AnatomyGrey12]

Stop taking a failing from schools and blaming students for them not going out of their way to amend errors in a system they pay 50K a year in tuition

I never did that. However, it’s not like MD schools offer mountains of time to go on interviews either. My response was directed to the one I quoted that stated that DO schools have rigid 4th year schedules and every single 4th year I’ve ever talked to has complained about the opposite. Medical education as a whole has issues, and yes DO schools have more issues on average than MD schools. However, simply being passive and saying “well the school needs to fix this” is stupid. Yeah they need to fix it but that doesn’t mean you shouldn’t actively seek out ways that you can overcome the system. I absolutely blame students if they simply just go with the flow and say, “well this is how it is, my school just sucks” without trying to find ways to make their situation better. Even if the effort is fruitless, if you don’t try them a small piece of the blame falls on you.

 

[Lawpy]

I'm kicking myself because some time ago, a PD or attending wrote at length as to the deficits in clinical training that some DOs have had in his/her program. It's wasn't aPD, alas, and unfortunately, I can't find the post! I'd immediately show it to my Dean. If that person is reading this, I hope that you can drop me a line!

There are several examples so I’m not sure which one you have in mind. Here’s one example: ACGME Merger and USMLE/COMLEX

I'd be with you, if you could determine "qualified" by test scores only. You can't. We had a visiting DO fourth year who had never done inpatient OB rounds, because her "clerkship" preceptor didn't do them, and she just followed him all day. You want to see fear in a PD's eyes? Tell her that one of her entering interns will need extra catching up to even reach competence in things you expect Day 1 interns to be able to do. You can talk about suboptimal allopathic rotations all you want, and they do exist, but at the end of the day there are experiences you can reasonably expect 99% of new MDs to have. I think when you can say the same about new DO grads, then you will see that discrimination subside.

Competency at the material it tests? Sure! Competency at everything that comes with being a resident? Of course not, that's why rank lists aren't simply an excel file sorted by step scores.

My point was, you can't call one person "categorically less qualified" based on only one component of what is being evaluated. Someone with a 260 who doesn't know how to check a fundal height isn't automatically "more qualified" than someone with a 210 who does.

...What? You're going to have to work on being so literal. Life can't be boiled down to "But is there evidence?"

In any case, I was referring to the example I gave, in which a fourth-year student had to get a primer on OB rounding because she did not do that during her clerkship. Unfortunately, that contributed to my program being reluctant to take DOs. My point was simply to respond to the statement that an applicant with a higher test score is "more qualified."

It's more complex than I ever imagined before becoming involved with it. There is a significant human aspect, as algorithmic as it may seem. So an "unknown" aspect- in this case, clinical training- can make people really cautious/wary. My own motivation in learning about the setup at different schools is because I think we are missing out on some strong potential applicants because of this caution. Unfortunately I haven't been involved in selecting visiting students, or the initial filtering of ERAS applications, for a couple of cycles due to other obligations.

 

[Goro]

There are several examples so I’m not sure which one you have in mind. Here’s one example: ACGME Merger and USMLE/COMLEX

Many thanks for the detective work. I sure miss Alum's post.s. But it wasn't her, alas. The post had mentioned the deficits of DO rotations, but also mentioned that if s/he had a qualified candidate, then they'd go advocate hard for the person.

 

[arcus]

This shows that you don’t really know what you are talking about on some DO topics, DO schools are notorious for having wide open 4th years.... to the point where you wonder why you even pay tuition that year...

it is not just DO students wondering about the ROI for 4th year

 

[hallowmann]

I had like, none of the problems you named. Your site sucks, don't make it sound like all DOs have bad clinical educations.

This. I actually had mostly solid to great rotations. To be fair virtually all were with residents, and there were some people at my school that had terrible experiences.

The real problem isn't that all DO rotations are terrible, its that at even the same school you could have a wildly different rotation experience. This is true from the "top" DO schools to the bottom.

Unless he's at my school or our neighbors up north, this is nothing uncommon. I had an OB/Gyn rotation where I saw zero deliveries or pelvic surgeries and half the time was doing the doctor's billing. It was atrocious.

Yeah, you had a horrible rotation. I saw a ton of deliveries and C-sections on my OB rotation. Plenty of NOB/ROB visits, some pelvics, some gyn surgeries (not a lot, but some).

I go to a "fairly good" DO school and I happen to know where the OP goes and it is a "fairly good" DO school too. This is not uncommon. I had a friend that went into the first day of his internal medicine rotation and the preceptor was not there. He called the preceptor and was told to take the month off and just come in on the last day to fill out the eval and add any comments he wanted. This was not some one off situation. It has happened at this one rotation site over and over again. I have many more stories that are similar. Some of my classmates (6 at the same time) were rotating at a major hospital in the area that's a residency site for that specialty and only saw 1 patient a day because they don't care about students.

Again, never had a remotely similar experience on my rotations.

lol.
Curious now, how many patients daily is typical for IM (our 2nd best rotation)? Our site does have a residency program + rotating 4th years but they only see 2 patients daily.

3rd years start at 2 and ramp up to 4 by the end if the first week. Depending on how busy the service was and how many students were on, I might have gone up to 6, but officially we didn't "need" to see more than 4. 4th years usually started at 4.

I've had some bad rotations experiences already too. Not uncommon. Luck of the draw where you get to do your clinicals. Just move along and study for step 2 and hope like hell you learn enough to pass level 2 PE.

Yeah, as long as you are interviewing patients in an outpatient setting and you actually practice/study for the PE, you'll be fine. Its not that heavy on the actual knowledge. Its more about going through the motions.

Can this happen at school such as KCU? I am seriously confused because my undertsanding was that we were ok as long as we had the clinical sites?

It can literally happen anywhere. Med school (MD and DO) rotations are highly variable, and dependent upon your site, residents/attendings, the service, and even the time of year. At MD schools there is less variability because there's usually enough room for people to rotate through the same handful of sites. At DO schools its more variable because we often go to smaller (not necessarily small) and a greater number of different sites. On top of that, you have the preceptor rotations which are wildly variable from amazing to terrible.

I've heard a lot from MD students about what they've done on rotations before intern year. It varied widely from virtually unchecked autonomy and a sink or swim attitude to glorified shadowing and just overall coddling. It was also not consistent from service to service. That said, the individuals from the same schools had pretty consistent experiences across the board.

The variability within the same DO school is something that really needs to be fixed, because it always makes us more of a gamble for residency programs.

It is so unfair that some DO schools have substandard rotations like this. When I was a med student I had the fortune of doing backtable work on a liver graft with a transplant fellow during my core surgery rotation. I wish every med school is like that.

Yeah, I can tell you that plenty of the MDs I know didn't have your same experience.

To your knowledge does your school pay for rotations

Mine didn't officially, but they'd pay the hospital system in other ways.

MD student here, state university that is flush with cash and palacial buildings, and yet ... well structured? highly regarded residencies? in every field we rotate through?

Not true at all. I get asked often whether I want to do my Residency at my university and I never answer them. Not impressed with the hospital in the slightest. It is one of the largest in my state too.

You are going to be a Doctor. You are doing what few Americans can do. You are entering a profession where you will make a massive impact on people (immediate and delayed) and get paid well regardless of third party payers. Keep your eye on the prize.

Fact: in MD schools once students pass Step 1, we are pushed through 3rd year rotations like cattle with little to any assurance the physicians will give a rat’s about you. The complaints by MD students are legion, both about physician faculty and admins being disengaged. Once third year is done, you are on your own. No guidance on how to prepare for Step 2.

medical education is a business regardless of MD or DO program.
this talk of “millions upon millions in grants” does not translate into physician faculty who are passionate about engaging medical students, mentoring us or showing interest in our chosen career. They are mostly trying to make the best out of their own dismal existence to encourage us or show us anything worth their time.



And you would still be in the same scenario either way.

What I get out of my medical education has everything to do what I put into it despite the burnt out, bitter, angry majority faculty physicians and craven admins.

Do yourself a favor: embrace your rotations, crack the books and be pleasantly surprised when a physician faculty shows interest in you. I love my time in the hospital because I give my patients and any staff that get near me my heart and soul. For those who are misanthropic physician faculty, it is their loss. It will get better down the road because I am committed to my future regardless of those around me

This.

Many DO schools have far too many clinical sites. Each of those has their own rotations and subsites. It gets too confusing and hard to really trash one school. It's the lack of broad regulation that is the problem.

This is true.

This is all nice and dandy but when you have a very limited number of procedures or deliveries or suture practice (or whatever) under your belt. If any at all... it's a much bigger challenge to look good on subIs and be well prepared for intern year. Repetition matters and doing something 0 times or once makes you look incompetent later on.

I don't know, most people seem relatively unprepared for intern year. It wasn't just this lowly DO intern.

You could fix most deficits with a single ACGME rotation with residents. I used some selective and elective time to do that in 3rd and early 4th year, and it was fine.

DO rotations aren’t all horrible, but you can’t deny that perceptor based learning is incredibly variable and much more so than the resident based system most LCME school used.

Another issue is waterdown of clinical grades when people don’t show up for a month and grade themselves at the end (example included in this thread). It casts doubt in the mind of an ACGME PD whether someone’s honor is worth as much as the honor from Drexel, for example.

Virtually all of my rotations were resident based ones, in a hospital with that type of training program. Not all DO schools have preceptor only rotations.

Clinical grades are definitely watered down. That said, the same thing is happening for students at the MD program where I'm in residency. I see some rotations with limited structure where you basically pick the nicest person to do your evals, and then I see other rotations where you basically have to walk on water to get Honors. Its unfortunate but subjective evaluations by residents and attendings really do dilute clinical grades.

Lol that's not how it works here. Any case that is mildly complex beyond a simple chole or pancreatitis gets referred out to the university hospital. My previous peds rotation was shadowing a NP in an outpatient clinic for a month, and my current Ob rotation we're not allowed into the room during deliveries or exams "too many bodies in the room, makes patient uncomfortable"

This is at a school that's well regarded on this forum. I saw the other side during my post bac and interviews at Rosalin franklin and SIU. Low tier MD schools were miles ahead of KCU, MSU, CCOM, and my current school.

It's hard to make blanket statements because it really does vary school to school, and doesn't necessarily follow the tiers. There are some low tier MD schools that have way better clinical rotations than midtiers.

The best option is a rotation at an ACGME/LCME program with at least one LOR from the rotation.

Another option is to fix the DO MSPE's, not sure how to do that.

As a matter of policy my school didn't allow you to see your MSPE. Basically, the only way to see it would be to have all the quotes taken out, and to turn it into a really generic sounding one. Most opted not to do that, and just hope for the best.

If one is ill prepared working with residents, would you suggest doing a rotation with residents but in a different field? For example, if one were wanting to do EM but felt ill prepared for a sub-I, should he or she do a rotation in anesthesia or IM (a similar field) with residents for their elective?

It might help some, but you'd be better off doing one in the same field you plan to do aways and auditions in. E.g. if you're going to apply EM, do an EM rotation at an ACGME program that you think will be low on your list or completely out of your league, so you don't lose much. Get some SLOEs and based on feedback and how many other SLOEs you get, then decide if you want to send that first one to residency programs.

I don’t feel bad for anyone unprepared for internship year. An American graduate (MD or DO) has access to adequate clinical training. Every. Single. Student. Maybe instead of scheduling an easy peasy 4th year you schedule a butt kicking ICU rotation for 8 weeks - everyone can do this if they want.

Dude, literally everyone is unprepared for intern year. Everyone. There are just some parts of it that you are less unprepared for.

Don't do ICU post match 4th year... I mean unless you really want to. Intern year is going to kick your butt either way, so no point burning out before you even get there.

 

[Gray Fox]

Lot of anecdotes here. Here's mine:

I'm in a state with a lot of big MD schools. I have friends that attend these schools, and naturally we like to talk and compare. All our clinical experiences have been outstanding. We all have had outstanding mentorship and research opportunities. We are all very satisfied with the quality of our education, although there is obviously always room for improvement. Because of this sample size, my sense is that MD schools prioritize high quality clinical rotations for their students.

At my Institution, almost every MD resident I worked with was an absolute rock star. Just my experience. I have no reason to lie on an anonymous website.

 

[kenjixshadow]

Issue is more complex than that. Many people are doing auditions or have to schedule some rotations just to be able to go to interviews. For example, at my school they will give you Max 3 days off the entire rotation to go on interviews, so most students feel forced to schedule bs that will let them skip so they can match. Also, it's not easy to find all the rotation you want that go according to your school dates or are available to take you or you know in advance that's a site that will prepare you adequately. Stop taking a failing from schools and blaming students for them not going out of their way to amend errors in a system they pay 50K a year in tuition

I rarely find myself disagree with you, but interviews run from Oct-Jan. A 4th year can set up July-Sept and Feb-April for good rotations, but who the hell still wanna work after the match.

It might help some, but you'd be better off doing one in the same field you plan to do aways and auditions in. E.g. if you're going to apply EM, do an EM rotation at an ACGME program that you think will be low on your list or completely out of your league, so you don't lose much. Get some SLOEs and based on feedback and how many other SLOEs you get, then decide if you want to send that first one to residency programs.

Many EM residents strongly advised me not to do a sub-i that is completely out of my league. One example is UCLA as they do not send a guarantee interview to their rotators plus they have stricter standards in order to obtain an honor. In another words, it can be a waste of month when a student can learn as much at a community program compare to a top notch county program. Moreover, some programs now play a game where they will blindside their SLOEs. One example is JPS in Fort Wort of Texas. There have multiple reviews that they would tell you that you're doing fine during the rotation then trash you later on the SLOE letters. Btw, unless you attend an institution that has an EM home program and have someone who can get access to the SLOE, you usually do not know what the content is written about you.