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

Discussion in 'Medical Students - DO' started by 17DOmed, Dec 18, 2017.

  1. DrfluffyMD


    Dec 15, 2016
    Please reference the ACGME faq above.
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  3. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    You're missing the part where if the DO is coming from a pre-accredited (as in only a program that has applied for a ACGME accreditation - says nothing about whether they'll attain it) AOA program, then fellowship requirements are based on the 2013 eligibility requirements.

    Yeah, that literally makes no mention of inadequacy of AOA training. You're extrapolating that. They made a policy change in order to "streamline" (read: take over) GME training. It was the best way to strong-arm the AOA without significantly screwing over ACGME programs (which is fine, I honestly don't care, and think the merger is overall a pro for the DO profession).

    The point you're missing is what SLC and AnatomyGrey12 have said. ACGME fellowships were already taking AOA graduates. In fact they continued to do so, even when no programs had transitioned (agreeing to the merger MOU happened in 2014, but the first applications to transition didn't open until 2015). You can just as easily extrapolate the argument that since this was the case, it had little to do with the quality of AOA grads going into ACGME fellowships.

    Now that too is an extrapolation. Unfortunately none of us can be certain, but our extrapolation and the belief that the merger had little to do with quality and everything to do with money and power is a bit more believable based on the facts than yours.

    As I've already said ~50% of programs that have applied have already attained initial ACGME accreditation, ~17% haven't even been reviewed once yet (but its likely at least half will get accredited once reviewed), and again I wouldn't be surprised if another 25% that submitted managed to implement changes in the next 2 yrs to attain accreditation. The majority of AOA programs are able to get ACGME with basically no change, and another chunk need to make doable changes. This doesn't really paint the picture of most AOA programs having training below that of ACGME requirements that you seem to be implying throughout this thread.

    Don't get me wrong, there are/were some really bad AOA programs out there, but be careful not to translate that into "most AOA programs are bad, and therefore most AOA grads have insufficient training".

    EDIT: Also, to be clear, I'm saying this as someone in a university ACGME training program, so I have no dog in this fight. I just happen to come from a state with a lot of quality AOA programs. I also rotated at some that are now ACGME accredited and were in the process of doing the apps when I was there. Little had to change, they were already meeting the requirements, they just had to put it out on paper.
    Last edited: Dec 24, 2017
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  4. SLC

    SLC Lock, Step, & Gone (Graduated!!!) Physician 7+ Year Member

    Mar 24, 2010
    The Empire
    Show us where in the FAQ it says AOA grads were not adequately trained, and this being the driving force behind the merger.
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  5. AnatomyGrey12

    AnatomyGrey12 2+ Year Member

    Sep 8, 2015
    Dude you are simply wrong and are completely misunderstanding the link you quoted. The bolded is extremely ignorant as ACGME programs (yes I know not all fellowships are ACGME accredited and no I am not talking about those) have been taking AOA graduates for years, long before the merger became a thought. You have a fundamental misunderstanding of all of this.
    Last edited: Dec 24, 2017
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  6. NurWollen

    NurWollen Strong with the Force 10+ Year Member

    Dec 27, 2007
    United States
    At my one of my required (not elective) rotations, at a site with ACGME residents and fellows, I got told to come ever other day because there were too many students. Same thing happened to the MD students. This obviously isn't representative of every (or even most) rotations, but it goes to show that there is variable quality at MD and DO programs alike.

    Now, I've met DO students who got precious little experience with writing H&Ps, progress notes, etc. But the MD students from my program's med school don't get to write notes that count either. Sometimes they write notes for practice, but since they don't count there usually not emphasized much.

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  7. Natural Killer Cell

    Natural Killer Cell Go Blue! Go...Green?

    Feb 16, 2017
    Do you get a kick out of trolling/jabbing at DOs?
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  8. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    So technically our students' notes "don't count" as well, but we got a lecture at the beginning of the year saying never to tell them that their notes don't count. My solution to this was to initiate and share notes (copy forwarded), and I had them updating 1-4 progress notes (patients they were following and depending on how busy the day was - less if they couldn't knock it out by the end of the day with down time). Obviously I reviewed and corrected/updated them, but made sure to put their names at the bottom as being involved in care. They seemed to like that and felt it was a valuable experience.

    For H&Ps and DC summaries, I probably had them do 1-2 throughout the block, just to experience it. They tended to spend a long time on them, so it just didn't seem worth it from a time standpoint.

    I mean you transition to writing so many notes in intern year, it just makes sense to get used to writing at least some of them on rotations. Half of my 3rd yr rotations involved writing notes, so it just made sense.
  9. Reveler


    Mar 13, 2017
    I'm curious about the whole 'notes don't count' thing. On my rotations, my notes are either co-signed (where they 'count' as part of the record), or they are filed under my name with a 'medical student' identifier front and center. Either way, they should count from the standpoint that these are real patients that need progress notes, H&Ps, etc. and as students, there's definite utility in writing these up. That being said, when I had rotations where my notes entered the record under 'medical student,' no one gave af about them and even though they were available to everyone, no one actually read them.

    I'm sure we could all argue about the value of note-writing throughout 3rd and 4th year, but I don't think I've ever said to myself: "dang, I sure wish I could write more notes." I had one rotation where my attending told me not to write notes because it was mostly busy work and I should be focused on seeing patients and learning management. His point was twofold: (1) if you've gotten to this point in your medical career and don't know how to write notes, you're a pitiful excuse for a med student and I won't be the one that tries to spray perfume on the piece of garbage that you are and (2) you will write more notes during the first 2 months of your intern year than you did during your entire 4 years of medical school, so just chill and learn.
  10. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    So note writing has two primary purposes:
    1. To relay information about the presentation and care of patients - its important, especially when you're signing off for the day
    2. Billing - med student notes are meaningless from a billing perspective

    The majority of notes are for billing purposes. That's it. It really is meaningless to me to make sure that a med student pulled in the right ICD-10 diagnosis with extra modifiers, or asked enough ROS questions to get all the field (if its not necessary), or put in any number of random things that we are told by coder we "need" for good notes. That's why I don't make them deal with that part.

    There are parts of notes that I believe are valuable for med students to do, specifically the HPI (you spent the time talking to the patient after all), the physical/mental status exam (you should know how to document and describe findings before leaving med school), and the bare bones plan (this is where students actually have to think about what we're doing for the patient and why).

    As far as note writing in residency, yeah I'd say its more like the first month of intern year. Besides, that's when you have to learn a million other things that suck up your time, in addition to the whole billing crap. If you could avoid having to learn how to document the basics during residency because you learned it as a med student when you actually have the time to learn it, why not?
    Reveler likes this.
  11. t5Nitro

    t5Nitro 5+ Year Member

    Apr 14, 2011
    I've interviewed patients in an outpatient setting for 2 weeks out of the last 5 months of rotations. My site is really lacking. If PE were job shadowing I'd handle it well. I literally plan on OLDCARTS for every encounter of PE because that's all I know to go on. I haven't developed any natural flow. I've already got it in my head that I won't be passing PE on the first attempt. It's a horrible feeling. I did well in the first two years too and am passing/high passing rotations purely based on COMAT scores, but I can't get that idea out of my head.
    Last edited: Dec 25, 2017
  12. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    Get the COMLEX PE book by JBReview and watch the Kauffman videos associated with it. You'll be fine. OLDCARTS is fine. I used CODIERS-SMASH-FM myself. The whole exam is a checklist. If you can get your hands on a used copy of the First Aid for the CS with the clinical cases, that's also helpful because it lays out a lot of things you could say. I'm sure a PDF is floating around your school somewhere.

    Sorry for your rotation experiences. Its ridiculous for you to have to deal with that.
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  13. t5Nitro

    t5Nitro 5+ Year Member

    Apr 14, 2011
    It is what it is man. I'm just ready to get out of here in 5 more months. I really appreciate the resource tips. I'll look into these if I can find some of them.
  14. Geraltofrivia


    Jul 20, 2016
    My rotations were done at a community hospital for every single rotation. I will admit, the vast majority of my rotations severely underperformed. My IM rotations consisted entirely of shadowing, which was fine, however when I "tried to be aggressive" and ask for "more teaching", I was berated publicly and humiliated by one attending. The other two were really excited and glad I was asking to learn and why stuff was done the way it was done which was fine, but I never once wrote an H&P or presented a patient case or anything along those lines. I did not learn how to do that skill actually until the ACP (medical students get free membership so I strongly suggest becoming a member) sent an email before I took Step 2 lol and did my sub-internships. If I was smart, I would've realized Step 1 questions were presented in H&P format but I wasn't smart I guess so whatever. I was not taught how to do a differential at all, something I realized during my sub-internships when I just overheard M3s on IM rotation (I did Sub-I for psychiatry) being asked to "work on their differential". They were annoyed, but I saw value in that.

    My OB rotation was the only one rotation where I routinely wrote notes and presented patients to my attending. I was rotating with MD students as well and it was very clear, this rotation, that I had in April, I was behind my colleagues when it came to presenting and formulating A&P. However, the skill came pretty quick but it was still somewhat annoying. I did not deliver babies, but this was by choice as I basically fainted after my first vaginal delivery and nearly contaminated the field (it was twin vaginal delivery, had C-section stuff just in case). Anesthesiologist had to hold me to make sure I didn't faint.

    My surgery rotations were okay. Very little H&P and A&P but I was able to do stuff during surgery, which was ok. Missed the whole resident experience though so it wasn't until I saw SDN people complain about surgery did I think "I probably shouldn't do this with my life". That's fine.

    My psychiatry rotation was phenomenal and probably one of the big reasons why Im going into it now. Yes I was worked hard, but I did enjoy every minute of it.

    My peds rotation was done at a community hospital that was just beginning to develop a peds program. It was rare for me to have more than 2 patients at a time. I was actually okay with this as it was my last rotation and it gave me plenty of time to chill, sorry I mean read.

    Family med were great actually no complaints here.

    That's just my experience. Feedback to the university went straight to the paper shredder. I think having strict limitations in what is and what is not allowed is important in terms of clerkship years. I also think it's imperative for university faculty to punish, by not allowing students to rotate with, medical staff who berate and humiliate clerks. It was so bad several other attendings and nurses came up to me and just told me to keep my head up.
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  15. DO2015CA

    DO2015CA 2+ Year Member

    Apr 21, 2014
    After seeing the mixed bag, like what has already been said on sdn, I think applicants should Pick their school on rotation based merits and not just location. And like others said earlier people should be calling out their school on here so that applicants know what to avoid.
  16. Natural Killer Cell

    Natural Killer Cell Go Blue! Go...Green?

    Feb 16, 2017
    Inb4 "top DOs" and "low-tier DOs".
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  17. BorntobeDO?

    BorntobeDO? SDN Bronze Donor Bronze Donor Classifieds Approved 2+ Year Member

    Nov 13, 2013
    I tend to just categorize myself as a top DO and let my school worry about themselves. They can be whatever tier they want, and I will try to be the highest tier I can stand working upto.
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  18. ortnakas

    ortnakas OMS-IV 2+ Year Member

    Jul 23, 2013
    I’d agree, but it seems like it’s highly variable within every school and even between each school’s rotation sites. I could call out which rotations at my school have been awesome and which are crappy, but my classmates at a different hospital might have the opposite experience, and I think that’s probably the case everywhere.
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  19. AlbinoHawk DO

    AlbinoHawk DO Student Osteopath 2+ Year Member

    Oct 19, 2013
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  20. chasm-e-baddoor

    chasm-e-baddoor 2+ Year Member

    Feb 11, 2014
    I mustve been lucky then because none of my school-affiliated rotation sites had these problems.

    Ob Gyn - I was a workhorse on this rotation. From rounding on patients in post partum and writing official progress notes, to drawing blood, to setting up the electrofetal monitors, to scrubing into c-sections and gyn surgeries (sometimes as first assist), to doing initial consults.

    Surgery - I did everything during this rotation. Daily rounding, seeing patients in the clinic by myself and then presenting to the attending, writing official notes at clinics and on wards, scrubbing into multiple cases per day sometimes as first assistant lol, suturing, active role on trauma team, learn how to cast on the plastic surgery portion, blood draws, ultrasound use, take out chest tube, consults, etc...then there were like 1-3 education conferences per day, including grand rounds M&M and journal club.

    Medicine - Again I did everything. Basically did what an Intern did but with fewer patients and a lot more supervision of course. Was able to blood draws, assist with paracentesis, thoracocentesis, etc. Grand rounds and lecture every day at noon.

    Pediatrics - Basically same as medicine, except this time i got clinic experience, Peds ED experience, and there were more clinical education sessions.

    Psychiatry - basically followed attendings around all day and interviewd patients, discussed treatment diagnosis and treatment plans, and wrote notes with him. When I was on call I followed resident. Except when I was on the chemical dependency unit - I got to do a lot more.

    Family medicine - basically saw patients myself and presented to attending.

    It's funny that you bring this up because let's be real many doctors out there write garbage ass notes
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  21. scpod

    scpod Physician Moderator Emeritus 10+ Year Member

    Oct 13, 2005
    Attending physician here and that's a pretty good generalization, considering you couldn't have possibly seen "most" DO rotations that are available.

    Mine were all great, because I made them that way. I even picked most of my own by myself. I wasn't willing to let my school make the choices for me. During 3rd year I delivered 9 babies by myself. Usually the attending was in the room but once he was next door as two were coming at the same time. In 4th year I performed a surgery from start to finish by myself. Yes, it was simple, but I made all the decisions and did all the work. I put in chest tubes, intubated patients, performed liposuction, sewed for hours on multiple cases. In 4th year I saw all the patients in one outpatient rotation for a couple days by myself. The attending was sick and she stayed in the back room on a cot in case of emergency and signed all the prescriptions... but again, I did all the work. I removed more suspicious moles and did more I&D's than I can remember. Closed every surgery in one rotation 4th year. Can't even remember how many codes I ran.

    The funny thing is that some of my classmates claimed they had crappy rotations at the same hospital, with the same attending physicians. They never got to do anything. Why do you think that is?
  22. MedicineZ0Z

    MedicineZ0Z 2+ Year Member

    Oct 5, 2015
    You can only get turned down so many times. Being aggressive and pursuing more is generally an excuse for poor structure & poor teaching.
  23. Mr Kenobi

    Mr Kenobi Jedi Member 5+ Year Member

    Jul 10, 2012
    Although I admit I haven't read the whole thread yet--I'm currently doing my preliminary medicine intern year at a top 10 MD medicine program...I went to a brand spankin' new DO school. While I'd say my med school generally sucked le nuts overall (mainly politics/organizational etc), my rotations were pretty legit purely based off of the great hospital affiliations we had--was less about the school itself, but more about the hospitals I was able to work in and docs I was able to work with. I feel I am just as prepared/competent for intern year as the other MD interns I work with--many went to top tier (MD) medical schools.

    tldr; calm down
  24. Señor S

    Señor S 2+ Year Member

    Jul 28, 2014
    Because they're not as amazing as you are, obviously.

    Let me just clarify for anybody who didn't already know that your whole post is a load of bull****. Most med students in the year of 2018 wouldn't get to do 99% of what you listed under any circumstances. Running a code? **** off.
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  25. sab3156

    sab3156 5+ Year Member

    Oct 10, 2011
    I am convinced it is a troll post.
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  26. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    He's not a troll. He used to post on here a lot when he was in school/residency. He's been out of school for some time though.

    Most hospitals and docs don't let students work like that anymore. Even a decade ago things were different. A lot has changed in the last 10-20-30 years. Most attendings and hospitals won't let med students do the majority of the stuff he mentioned on their own anymore, with the exception of running a code until someone better showed up, that definitely happened at some of the sites I rotated at, but they were usually the smaller places with only an FM residency - almost anyone ran the code until someone better showed up.

    Under supervision, I also did some intubating, knew someone else that put in a chest tube, multiple I&Ds, staple closed a few surgeries (didn't do a ton of suturing on my surgery rotations - but I sure did on EM), and definitely in some of my outpatient rotations I saw most of the patients myself, made a plan, 95%+ of the time the attending didn't change it, and just stepped in for a few minutes to chat with the patient.

    To be completely honest, not too long ago (we're talking in the 90s) 3rd year med students used to do far more than that on their own. Its sad that his statements sound unbelievable, but its not surprising given the way things have changes.

    Personally, I don't necessarily think these experiences are particularly essential as a med student, although they can be reassuring and make intern year a bit easier. I know plenty of MD students at my current institution that don't do the majority of them. When you come in as an intern, everyone assumes that you have very little experience, because there is such a range of experience at different med schools. Intern year, the learning curve is steep, and you really do have to be ready to do a lot of things you have no experience with. You watch a Youtube video, ask for help/supervision if its available, and then you do it.
  27. SLC

    SLC Lock, Step, & Gone (Graduated!!!) Physician 7+ Year Member

    Mar 24, 2010
    The Empire

    I did 3rd and 4th year in 2013-2015; and I did a lot more than most all the students I come across in residency, especially more recent grads, even these past few years. But I also went to med school out west, and am in residency in the east where the practice environment is more litigious, so maybe that’s why most students and recent grads out here haven’t had my experiences?

    On surgery I closed the majority of the time, both sutures and staples, I even sutured an aortic valve in place (with supervision). As soon as the valve was secure and the patient was coming off bypass, the surgeon (who knew I’m an avid fly-fisherman) said “now we see if your knots are up to par”. He then had me grasp the aortic root between my fingers while his nurse played B.B. King’s “The thrill is gone” on the sound system. Corny joke, but I’ll always remember that.

    On plastics, I did a 7cm lipoma removal from start to finish, unassisted. The attending and his partner were doing a reduction mammaplasty on the patient at the same time so were in the immediate vicinity for questions and to look over my shoulder. But I made the incision, did the removal and closure all by myself.

    In ER, I sutured, put in a couple central lines, learned FAST exams, and participated in (not ran) codes.

    On outpatient blocks (FM and Peds, Specialty IM) it was normal for me to see the patients alone, precept with the attending, then go see the patient a second time with the attending.

    In Onc. I did all the follow-up breast cancer surveillance visits on my own; a quick ROS, screen for aromatase inhibitor adverse effects and a breast exam. The attending just came in at the end to say hi to the patient and ask if I had anything abnormal to report. I also did his email consults (it was a Kaiser permanente facility so PCP’s could email him about abnormal CBC’s etc and ask for advice). He obviously reviewed everything before it was sent back to the requesting provider.

    On OB, I did around 14 vaginal deliveries, and at least as many c-sections where I was scrubbed in, and holding retraction etc; first assisting when the attending’s partner wasn’t around. I also did all the office procedures and well woman exams at clinic, learned a little colposcopy etc.

    Interspersed with all these hands-on experiences was plenty of formal teaching. My OB Gyn preceptor took me to breakfast every morning at 5:30 and we discussed a topic until 6:30, and then had similar lectures over lunch. I even completed a couple of 24h calls with him; it was a great experience.

    I think I got most of this experience by asking for it, and having procedural skills and clinical instincts that made attendings feel comfortable continuing to allow me to do things. Many of my rotations (including all surgery months) were in the same hospital. During my surgery blocks I was told that I had a reputation in the OR there for being capable. I’m sure that’s why the CT surgeon let me sew, and the Plastics guy let me take the lipoma (he also let me try putting a pin in a carpal bone under fluoroscopy (I didn’t get it in), and do a number of other things both in the OR and in his clinic). I’ve recieved a lot of comments/compliments about these types of things (procedural aptitude, good instincts) in residency too.

    I think you have to ask for these types of opportunities, and then impress when you’re given them; and then they keep coming.

    Anyway, these are the types of things that make me feel like my rotations were not sub-par; despite having gone to a DO school.

    But like Hallowman said, I’m not certain most of that procedural stuff was 100% necessary for me to have felt like I got a quality education. Many of my co-residents didn’t get those types of experiences, and they did just fine in intern year, and are excellent doctors now.

    What it probably did do was make being a medical student less miserable than it seemed to be for a lot of other folks I speak with.
    Last edited: Jan 14, 2018
  28. Rekt

    Rekt 2+ Year Member

    May 29, 2015
    Absolutely full of ****
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  29. hallowmann

    hallowmann SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Mar 13, 2012
    I think what's most disturbing to me is how varied the experiences are.

    I felt like my experiences were solid, and thought it was basically representative of what many people at my school experienced, until I met up with my friends from different sites at the end of 3rd year, and then again at the end of 4th. The truth is it varies a lot. There are certainly some things in his and SLC's post that I couldn't see happening at my site or any site I rotated at, but I know some people that did have some of those experiences and I attribute the rest to changes in med student responsibilities over the last decade.

    I don't really find it that unbelievable, but I guess if your experience is such that all you did on rotations is shadow, then I guess it would be unbelievable.

    There's an intern at my program that went to an MD school where one of the hospitals they rotated in still had a mix of EMR and paper charts and no residents, and they were responsible for putting in orders on patients while the attending was at home sleeping. He'd roll in at 9 or 10, sign all the notes (written by the students), make sure people were alive, and then be gone by midday, and with no residents the student was the one asked all the questions by nurses for the rest of the day (but often the med student would ask nurses what to do). Sounds basically illegal to me, but I don't doubt it happened, and the story was corroborated by a couple other residents that went to his same med school. Compare that to the other MD students I rotated with that had a pretty standard and similar experience to mine (worked with residents, saw patients, then rounded on them with the team, wrote a note that was rarely used, maybe got to do or see something cool every once and a while, etc.).

    My point is, med student experiences really vary from place to place (and I suspect region to region). I honestly think its for that reason that they basically expect nothing but that you're teachable and willing to work during intern year.

    When I did my first paracentesis (2nd block of intern year - first inpatient block), I had never done one and honestly I couldn't remember seeing one before (in person at least). I was supervised, but basically I just needed to show up and know how to handle a needle. Even if I didn't know how to handle a needle, I would have quickly learned, because that's the expectation of interns. Some people have those experiences in med school, but many will at least have them in intern year.
  30. W19

    W19 SDN Gold Donor Gold Donor Classifieds Approved 2+ Year Member

    Sep 23, 2014
    Things aren't different in the MD world. Some rotations are good and others are glorified shadowing...

    6 wks inpatient where I see patients from 8am to 12noon/1pm and present them to the attending, go over labs/test etc... and treatment plans when he shows up around 1pm. No one wanted to work with that attending because he wanted med students to do most of his work as he has a ton of patients that he has to see everyday. He even made me go to the his clinic twice during that rotation to see more of his patients. I guess that's the only way he could continue to drive his 400k toy and his nice BENZ. That attending wrote me a nice LOR i was told...

    4wks IM subspecialty inpatient (cardio in my case): Attending is in clinic 3 days/wk (7:30am to 1pm). He made me see almost all of his patients and take care his consults at the hospital and let me write all the notes and twick them after we see the patients together. The other 2 days that he did not have clinic, we saw the patients together from 7:30am to 5/6pm.

    2 wks outpatient neuro which was glorified shadowing

    6 wks outpatient and attending usually come at 10 am. I started seeing patients at 8 am and by the time she got there, I already saw 3-4 patients, present them to her and we go over the plan and she then see them by herself. I continue to see more patients by myself until she catches up with me...

    3 wks inpatient at a malignant place where the residents did not let students do anything.
    3 wks outpatient where I saw some patients who did not mind having a male student to see them...

    6 wks of glorified shadowing. Other students at my school had great experience at other sites.

    6 wks inpatient/post-op... 3 days with a general surgeon and 2 days with surgical oncologist. My classmate and I took turns in scrubbing with the attendings. He was gung-ho about surgery and I was not and the attendings picked up on that. Needless to say he honored that horror of a rotation and I got a high pass.

    3 wks inpatient where I got my own 2-3 patients depending on the census. I got the attending at my finger tips and could text message her and she would answer in less than 10 minutes. I asked questions to residents from time to time if I did not feel like bothering the attending. I made round with her from 2-5pm.

    3 wks of glorified outpatient shadowing...

    Other students at my school have different experience... So much variation in clerkship even within schools...
    Last edited: Jan 14, 2018

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