ACGME Merger and USMLE/COMLEX

[ToKingdomCome]

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210, 215, 220 are not competitive at all albeit you can still match if you apply broadly. Lots of places will throw your applications out if you have only COMLEX scores.

So it's better to have a score in that lower range above for those specialties than to have just an above average COMLEX score?

 

[kenjixshadow]

So it's better to have a score in that lower range above for those specialties than to have just an above average COMLEX score?

Yes, idk anesthesia all that well, but in EM, USMLE scores are definitely required. The PD from Northwestern said that EM PDs want to compare apple with apple. They're not going to sit there and figure out how to interpret COMLEX scores. To them, a 700 on the COMLEX is equivalent to 400. Caveat is that many programs also have a score cutoff, so try to do well.

 

[deleted564680]

Yes, idk anesthesia all that well, but in EM, USMLE scores are definitely required. The PD from Northwestern said that EM PDs want to compare apple with apple. They're not going to sit there and figure out how to interpret COMLEX scores. To them, a 700 on the COMLEX is equivalent to 400. Caveat is that many programs also have a score cutoff, so try to do well.

This is very true and I dislike that the AOA still puts out "programs will accept COMLEX" nonsense. Yeah, they accept it...but if you look at FREIDA and talk to PDs then you'll see to apply they have minimums like 215 USMLE (25th percentile) and 550 COMLEX (66th percentile). I've even seen 210 USMLE and 600 COMLEX in some cases. The ACGME people can only use COMLEX to compare DO to DO and they know that higher scores are better, hah. They can't compare MD to DO with just COMLEX.

 

[IslandStyle808]

This is very true and I dislike that the AOA still puts out "programs will accept COMLEX" nonsense. Yeah, they accept it...but if you look at FREIDA and talk to PDs then you'll see to apply they have minimums like 215 USMLE (25th percentile) and 550 COMLEX (66th percentile). I've even seen 210 USMLE and 600 COMLEX in some cases. The ACGME people can only use COMLEX to compare DO to DO and they know that higher scores are better, hah. They can't compare MD to DO with just COMLEX.

In most cases, do DOs have to surpass both bare minimums or does a DO have to surpass just the USMLE threshold?

 

[deleted564680]

In most cases, do DOs have to surpass both bare minimums or does a DO have to surpass just the USMLE threshold?

Good question. I would assume USMLE would take precedent but I'm not sure.

 

[Drrrrrr. Celty]

This is very true and I dislike that the AOA still puts out "programs will accept COMLEX" nonsense. Yeah, they accept it...but if you look at FREIDA and talk to PDs then you'll see to apply they have minimums like 215 USMLE (25th percentile) and 550 COMLEX (66th percentile). I've even seen 210 USMLE and 600 COMLEX in some cases. The ACGME people can only use COMLEX to compare DO to DO and they know that higher scores are better, hah. They can't compare MD to DO with just COMLEX.

They need to claim that or else they would have no reason to retain it. The reality is that the COMLEX like the Step 2 PE ( For non-FMGs) needs to go.

 

[NurWollen]

Yes, idk anesthesia all that well, but in EM, USMLE scores are definitely required. The PD from Northwestern said that EM PDs want to compare apple with apple. They're not going to sit there and figure out how to interpret COMLEX scores. To them, a 700 on the COMLEX is equivalent to 400. Caveat is that many programs also have a score cutoff, so try to do well.

You're talking specifically about EM right? Because if you're talking about all specialties it might be a generalization but for EM specifically it's probably pretty true.

This is very true and I dislike that the AOA still puts out "programs will accept COMLEX" nonsense. Yeah, they accept it...but if you look at FREIDA and talk to PDs then you'll see to apply they have minimums like 215 USMLE (25th percentile) and 550 COMLEX (66th percentile). I've even seen 210 USMLE and 600 COMLEX in some cases. The ACGME people can only use COMLEX to compare DO to DO and they know that higher scores are better, hah. They can't compare MD to DO with just COMLEX.

Yeah so true.

 

[kenjixshadow]

In most cases, do DOs have to surpass both bare minimums or does a DO have to surpass just the USMLE threshold?

Ironically, I asked this question before. I can relay the answer from that resident. This is definitely program dependent -- a dual program is usually more lenient and don't screen you out as long you have one above the cut off score whereas the traditional ACGME programs favor USMLE scores since they can collate you with MD students. Hence, ppl tell you to do well on the USMLE and don't fret about the COMLEX scores as long you pass.

You're talking specifically about EM right? Because if you're talking about all specialties it might be a generalization but for EM specifically it's probably pretty true.

Yes

 

[IslandStyle808]

Ironically, I asked this question before. I can relay the answer from that resident. This is definitely program dependent -- a dual program is usually more lenient and don't screen you out as long you have one above the cut off score whereas the traditional ACGME programs favor USMLE scores since they can collate you with MD students. Hence, ppl tell you to do well on the USMLE and don't fret about the COMLEX scores as long you pass.


Yes

Thanks for the reply. My concern is if the program sets a ridiculously high COMLEX percentile as the cut off. If one does rather well on the USLME like say around 240, but only hits a 550 COMLEX when the cut off is 600, would they still be passed up? It sounds pretty ludicrous if this is true.

 

[deleted564680]

Thanks for the reply. My concern is if the program sets a ridiculously high COMLEX percentile as the cut off. If one does rather well on the USLME like say around 240, but only hits a 550 COMLEX when the cut off is 600, would they still be passed up? It sounds pretty ludicrous if this is true.

I doubt that would happen. That USMLE would probably get you in the door. Also, most students perform better on the COMLEX in relation to the USMLE anyway. The only ones who don't are the ones that totally blow off OMM or just dislike it so much they can't learn it well.

I mean the reality is that there's like 6000 DO students now with a pre-med average MCAT of 27ish and there's about 20000 MD students with a pre-med average MCAT of 31ish including the top 20 schools which have an MCAT average of like 34-35. If you scoop up only about the top half of DO students (3185 took the USMLE step 1 in 2015) and add them with the MDs (20213 took Step 1 in 2015), you can see why it's harder to score a higher percentile on the USMLE than COMLEX. Really the only saving grace there is all those carib. people getting 200s and whatnot (not sure how many of them there are but there was 15030 non US/Canadian takers of Step 1 in 2015). http://www.usmle.org/performance-data/default.aspx#2015_step-1

If you're a DO scoring 255+ (91st percentile+ http://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf), then that means you'd have been in the top 3787 students (42082 overall) and in the top 2190 students if you only consider US MD and DOs (2106 if considering only 1st time takers). The top 10 (US NEWS&WORLD REPORT) MD schools have about 1700 students per year in total with an average incoming MCAT of 36 and average incoming gpa of 3.85. The reality is that it's much harder as a DO to compete with and beat those students (and the rest of the US MDs) than it is to compete with and beat the DO students. Thus, usually a DO student has a higher percentile on COMLEX than USMLE. You can see why it's impressive when DOs score 255-260+ and even if a PD doesn't want a DO in their program, they usually will say complimentary things like "you really scored well and you should be proud. We would love to see that score from our own students. Sorry we can't take DOs."

As far as EM goes, it's the most notable specialty for this thread and discussion about COMLEX/USMLE scores because right now it's in that spot of moderately competitive for both MDs and DOs, average USMLE (230), above average COMLEX (~550-575), most programs will take/interview DOs, and many programs will look at people who have just COMLEX.

 

[hallowmann]

What is the absolute mimimum USMLE STEP 1 score that a DO should shoot for the be competitive at moderately competitive specialities like gas, EM, etc? 210, 215,220? And if a student were to go into those specialties with just a COMLEX score would that be doable going the acgme route?

Most people I know have said the cutoff is 215-220 depending on the specialty. It may even be as low as 210 for some of the least competitive fields. Really though, you shouldn't be planning to take the USMLE unless you're scoring above or close to the 220s on NBMEs. I would not apply Anesthesia or EM without a USMLE, unless as I said you will not get a 215 minimum. Cutoffs I've seen are all around 210/220. Some are as low as 200, but that basically means they just want you to have passed.

210, 215, 220 are not competitive at all albeit you can still match if you apply broadly. Lots of places will throw your applications out if you have only COMLEX scores.

I've seen plenty of "USMLE only" programs with cutoffs in the 210-220 range. getting in the range is probably the minimum that would be worth getting on the USMLE.

In most cases, do DOs have to surpass both bare minimums or does a DO have to surpass just the USMLE threshold?

This varies by program. In most cases the USMLE threshold is more important (if they only hold you to one, it'll be that one), but many programs might use a high COMLEX cutoff to exclude a lot of DOs from interviewing.

Thanks for the reply. My concern is if the program sets a ridiculously high COMLEX percentile as the cut off. If one does rather well on the USLME like say around 240, but only hits a 550 COMLEX when the cut off is 600, would they still be passed up? It sounds pretty ludicrous if this is true.

Most programs will look at the 240. I would imagine only the ones that want an excuse to not interview DOs would exclude an applicant like that. That said, short of being terrible at OMM and not studying it, I can't see how someone would get a 240+ and not a 600. I guess it could happen, but I wouldn't worry about that and focus on trying to get that 240+.

 

[NurWollen]

Most people I know have said the cutoff is 215-220 depending on the specialty. It may even be as low as 210 for some of the least competitive fields. Really though, you shouldn't be planning to take the USMLE unless you're scoring above or close to the 220s on NBMEs. I would not apply Anesthesia or EM without a USMLE, unless as I said you will not get a 215 minimum. Cutoffs I've seen are all around 210/220. Some are as low as 200, but that basically means they just want you to have passed.



I've seen plenty of "USMLE only" programs with cutoffs in the 210-220 range. getting in the range is probably the minimum that would be worth getting on the USMLE.



This varies by program. In most cases the USMLE threshold is more important (if they only hold you to one, it'll be that one), but many programs might use a high COMLEX cutoff to exclude a lot of DOs from interviewing.



Most programs will look at the 240. I would imagine only the ones that want an excuse to not interview DOs would exclude an applicant like that. That said, short of being terrible at OMM and not studying it, I can't see how someone would get a 240+ and not a 600. I guess it could happen, but I wouldn't worry about that and focus on trying to get that 240+.

Honestly I've seen places with cutoffs of 200 and 500. Or even 200 and 550. There certainly are programs with higher cutoffs, even in FM. But I don't think it's most. In more competitive specialties, then yes.

Also we all need to keep in mind that being over a cutoff doesn't necessarily make you competitive for a program. It can keep the door open if say you don't do so hot on step I but then rock step II, but don't expect simply being over the cutoff to take you very far.

 

[hallowmann]

Honestly I've seen places with cutoffs of 200 and 500. Or even 200 and 550. There certainly are programs with higher cutoffs, even in FM. But I don't think it's most. In more competitive specialties, then yes.

Also we all need to keep in mind that being over a cutoff doesn't necessarily make you competitive for a program. It can keep the door open if say you don't do so hot on step I but then rock step II, but don't expect simply being over the cutoff to take you very far.

The highest FM cutoff I've seen is 220. That said some of the surgical subspecialties have cutoffs like 235. The lowest I've seen is 192 (i.e. passing). I've seen places with no cutoffs, but they might just have hidden ones that change year to year.

 

[deleted564680]

Honestly I've seen places with cutoffs of 200 and 500. Or even 200 and 550. There certainly are programs with higher cutoffs, even in FM. But I don't think it's most. In more competitive specialties, then yes.

Also we all need to keep in mind that being over a cutoff doesn't necessarily make you competitive for a program. It can keep the door open if say you don't do so hot on step I but then rock step II, but don't expect simply being over the cutoff to take you very far.

I liken it to when you apply to medical school and all their websites state "minimum gpa 3.0, minimum MCAT 25" and we ALL know that you need to have higher stats than that to have a good chance.

 

[235009]

This focus on Step 1 cutoffs totally misses the point of how applicants are evaluated for residency. There are plenty of other factors that modify how your objective data is evaluated, not least of which is whether you are a US MD and which school you go to.


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[deleted564680]

This focus on Step 1 cutoffs totally misses the point of how applicants are evaluated for residency. There are plenty of other factors that modify how your objective data is evaluated, not least of which is whether you are a US MD and which school you go to.


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You slow played it this time lol (slow clap)

 

[IslandStyle808]

This focus on Step 1 cutoffs totally misses the point of how applicants are evaluated for residency. There are plenty of other factors that modify how your objective data is evaluated, not least of which is whether you are a US MD and which school you go to.


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We are just asking about a particular point of the residency process, not so much brushing off how dynamic it can be. Residents have stated in the past that programs can set the filter to a higher level cut off score, but PDs can take off the filter just to see if they are missing a diamond in the rough. The same could be said about taking off the non-LCME filter and then setting the board cut offs high to get a select few DO students (after all MDs are selected).

The question pertains to how the reality of the cut off is done by PDs, looking specifically at that aspect. Is this truly an apples to apples comparison (looking only at the USMLE and not caring about the COMLEX cutoff)? Or is this an indirect DO filter that could screw DO student with USLME high scores over? I want to know collective take on how PDs use the COMLEX cut off along with the USMLE?

 

[acapnial]

I doubt that would happen. That USMLE would probably get you in the door. Also, most students perform better on the COMLEX in relation to the USMLE anyway. The only ones who don't are the ones that totally blow off OMM or just dislike it so much they can't learn it well.

I mean the reality is that there's like 6000 DO students now with a pre-med average MCAT of 27ish and there's about 20000 MD students with a pre-med average MCAT of 31ish including the top 20 schools which have an MCAT average of like 34-35. If you scoop up only about the top half of DO students (3185 took the USMLE step 1 in 2015) and add them with the MDs (20213 took Step 1 in 2015), you can see why it's harder to score a higher percentile on the USMLE than COMLEX. Really the only saving grace there is all those carib. people getting 200s and whatnot (not sure how many of them there are but there was 15030 non US/Canadian takers of Step 1 in 2015). http://www.usmle.org/performance-data/default.aspx#2015_step-1

If you're a DO scoring 255+ (91st percentile+ http://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf), then that means you'd have been in the top 3787 students (42082 overall) and in the top 2190 students if you only consider US MD and DOs (2106 if considering only 1st time takers). The top 10 (US NEWS&WORLD REPORT) MD schools have about 1700 students per year in total with an average incoming MCAT of 36 and average incoming gpa of 3.85. The reality is that it's much harder as a DO to compete with and beat those students (and the rest of the US MDs) than it is to compete with and beat the DO students. Thus, usually a DO student has a higher percentile on COMLEX than USMLE. You can see why it's impressive when DOs score 255-260+ and even if a PD doesn't want a DO in their program, they usually will say complimentary things like "you really scored well and you should be proud. We would love to see that score from our own students. Sorry we can't take DOs."

As far as EM goes, it's the most notable specialty for this thread and discussion about COMLEX/USMLE scores because right now it's in that spot of moderately competitive for both MDs and DOs, average USMLE (230), above average COMLEX (~550-575), most programs will take/interview DOs, and many programs will look at people who have just COMLEX.

The USMLE percentiles are actually based only on US MD and Canadian students. Data from DO, FMG, and IMG students aren't included. All the 200's that pull down the average are from our own homegrown MD students. A USMLE of >230 means you've outperformed most of the MD students who have taken the test.

 

[deleted564680]

The USMLE percentiles are actually based only on US MD and Canadian students. Data from DO, FMG, and IMG students aren't included. All the 200's that pull down the average are from our own homegrown MD students. A USMLE of >230 means you've outperformed most of the MD students who have taken the test.

Good to know. Then just forget about the numbers I mentioned with the FMG/IMGs added. Everything else still applies.

 

[235009]

You slow played it this time lol (slow clap)

I'm sorry that reality hurts your feelings

We are just asking about a particular point of the residency process, not so much brushing off how dynamic it can be. Residents have stated in the past that programs can set the filter to a higher level cut off score, but PDs can take off the filter just to see if they are missing a diamond in the rough. The same could be said about taking off the non-LCME filter and then setting the board cut offs high to get a select few DO students (after all MDs are selected).

The question pertains to how the reality of the cut off is done by PDs, looking specifically at that aspect. Is this truly an apples to apples comparison (looking only at the USMLE and not caring about the COMLEX cutoff)? Or is this an indirect DO filter that could screw DO student with USLME high scores over? I want to know collective take on how PDs use the COMLEX cut off along with the USMLE?

The residency application process is extremely opaque. Those step 1 cutoffs listed in FRIEDA are completely meaningless, filled out by some random program coordinator who sends in the survey. It does not reflect reality. You will not be able to know how programs evaluate applicants beforehand. There is no MSAR and a multitude of data tables posted online like there was for the med school application process. Med students tend to put a disproportionate amount of weight on step 1 scores because it's one of the few tangible things available to them and they feel like it's something that was in their control. I've seen posts claiming that as a DO if you get anywhere from 5-15 points higher on step 1 than an MD then you will "overcome the bias" and other silliness like that. It's not that simple and people simply refuse to acknowledge that there are factors like which school they go to which play a very important role in how your application is perceived that cannot be numerically quantified.

 

[IslandStyle808]

Honestly I've seen places with cutoffs of 200 and 500. Or even 200 and 550. There certainly are programs with higher cutoffs, even in FM. But I don't think it's most. In more competitive specialties, then yes.

Also we all need to keep in mind that being over a cutoff doesn't necessarily make you competitive for a program. It can keep the door open if say you don't do so hot on step I but then rock step II, but don't expect simply being over the cutoff to take you very far.

Well it not really that clear cut. As I have read more and more resident accounts, I found that these numbers are not really hard cut offs. There have been instances of people receiving interviews by simply emailing the program coordinators if they didn't meet the USMLE cut off (i.e. express interest in the program). The process is so dynamic that even if one meets the cut off, they could still have a decent shot because they have research, are from the area, or other factors that make the candidate look more attractive. Some places don't have cut offs at all simply because they don't want to miss a student that could be great in other parts of their application. It surprises me how much other aspects of the application can pull up a student.

 

[NurWollen]

This focus on Step 1 cutoffs totally misses the point of how applicants are evaluated for residency. There are plenty of other factors that modify how your objective data is evaluated, not least of which is whether you are a US MD and which school you go to.


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Wait, wait. Hold on. You mean to tell me that DOs face disadvantages? Thank you. I don't think anyone on this thread knew that.

 

[IslandStyle808]

I'm sorry that reality hurts your feelings

The residency application process is extremely opaque. Those step 1 cutoffs listed in FRIEDA are completely meaningless, filled out by some random program coordinator who sends in the survey. It does not reflect reality. You will not be able to know how programs evaluate applicants beforehand. There is no MSAR and a multitude of data tables posted online like there was for the med school application process. Med students tend to put a disproportionate amount of weight on step 1 scores because it's one of the few tangible things available to them and they feel like it's something that was in their control. I've seen posts claiming that as a DO if you get anywhere from 5-15 points higher on step 1 than an MD then you will "overcome the bias" and other silliness like that. It's not that simple and people simply refuse to acknowledge that there are factors like which school they go to which play a very important role in how your application is perceived that cannot be numerically quantified.

My questions was more of the context of could not meeting the cutoff score for the COMLEX pull them down more than they are already pulled down. However, based on the responses it seem like if one does well on the USMLE then one will do even better on the COMLEX. Even if the score cut off is higher for the COMLEX, there is still a good chance one will do better on the COMLEX than the USMLE (if they go beyond the USMLE cut off that is). So it becomes a moot point in the grand scheme of things. I definitely acknowledge your point in that there are a lot of factors that make the selection process not transparent, so it is mainly a matter of doing the best you can. Thank you for your response.

 

[cbrons]

I don't mean to say all far away sites are poor. However, if there is a malignant site or an issue that has been persistent with multiple student it cannot be addressed by the clinical director who is most likely at the main school. Ensuring students are learning a equally as possible is much easier if rotations are closer.

I also agree with the below paragraph as well. In general, if the school is providing a service to the community it should get more funding. KCU is also doing a good job with research funding, I totally agree. However, in general most schools don't push faculty to do research and thus limits funding (it is part of the reason why tuition is high).

Any school that doesnt have all of their core hospital rotation sites within 45 min driving distance should be shut down.

It also should absolutely be against accreditation standards to have volunteer faculty as the day to day teachers.

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[cbrons]

In either case I'm waiting for the LCME to take over and for the same thing as the merger to happen. I.e Where DOs still get to maintain the OMM and the philosophy and everyone is happy.

What philosophy, m8? There isnt a separate fricken philosophy. That is just what those idiots at the AOA tell you to make you feel good about spending 60k per year on your M3 (osteopathic) medicine clerkship which consists of shadowing volunteer faculty and NPs five states away from campus.

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[cbrons]

What can a DO student do so that they can make sure they are certainly meeting the criteria necessary to begin functioning near an intern level by 4th year?

Nothing really. At least in terms of the exam skills. That is mostly depedent on your school and rotation and instructor quality.

Btw there MD schools with complete GARBAGE for M3 clerkships, so dont feel like its just a DO thing. Trust me, it not.

The AAMC runs just as much of a racket as the AOA, only on a much bigger and more criminal scale. Theyre still making out like bandits with the multiple scams they have going (AMCAS, VSAS, ERAS, etc.). VERY very profitable operations for them, and thats where their focus lays. (On how they can squeeze more money from students with some asinine fee for emailing a residency app to another program or apply for an away rotation).

They would get to improving clinical education but why bother? Not much money in that. In fact, its a money losing proposition for them since it means theyll have to start forcing schools to spend money on paying actual clinical faculty instead of a new "administrative specialist" who is about as useful to a student's clinical skills development as a dumpster.

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[cbrons]

I'm about to tell you something crazy. Whenever his preceptors let him leave early or during his days off, this 3rd year student drive 40 mins - 1 hr away to a hospital with residents, so that he can shadow them. Don't feel bad for him. He is at least learning.

Why would they do that? Are they intellectually disabled? Shadowing is of no actua value.

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[cbrons]

I disagree with you. I have received a better clinical education than most MD students. I have especially received a better education than MD students who intentionally made an effort not to get. I'd speculate that a large portion of DO students feel the same about their education.

This struck me as fairly comical. So you know enough about the clinical experience of every MD student to boldly make the claim that yours was definitively better?

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[Drrrrrr. Celty]

What philosophy, m8? There isnt a separate fricken philosophy. That is just what those idiots at the AOA tell you to make you feel good about spending 60k per year on your M3 (osteopathic) medicine clerkship which consists of shadowing volunteer faculty and NPs five states away from campus.

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'perceived' philosophy.

 

[uworldrelay]

'perceived' philosophy.

yaaaaaaa shadow-fest. ~sitting behind hospitalist doing computer stuff for hours~ "Can I go see some patients? A: No" "Can I go home and read? A: sure~~reports me and kicks off of rotation"

 

[hallowmann]

How many people are really having a shadowing only experience? I have quite literally never had an experience like this in any of my rotations. The most I've ever spent not seeing patients by myself when I start a new rotation is 4 days, and that only happened once. Usually its 1 hour (i.e. I watch the attending/resident see 1 patient, then I see the next one). That said, I heard from a student from another school that they basically shadowed for almost their entire FM rotation, which sounded terrible to me. I've also never worked under a non-physician preceptor, but have heard (on SDN) that others have.

 

[GUH]

How many people are really having a shadowing only experience? I have quite literally never had an experience like this in any of my rotations. The most I've ever spent not seeing patients by myself when I start a new rotation is 4 days, and that only happened once. Usually its 1 hour (i.e. I watch the attending/resident see 1 patient, then I see the next one). That said, I heard from a student from another school that they basically shadowed for almost their entire FM rotation, which sounded terrible to me. I've also never worked under a non-physician preceptor, but have heard (on SDN) that others have.

I haven't had any myself but have heard of exactly one outpatient psychiatry and one OMM preceptor who did not allow students to have meaningful patient interaction, and one of those is no longer accepted as a core rotation. It happens but isn't common from what I've seen. However, it would be interesting to know whether it's more common at other (perhaps larger new) schools.

 

[cbrons]

Fair points.

I would counter by saying undergraduate medical education is extremely archaic, and medical students are entering intern year with little clinical competence. IM rounds - for example - has ballooned into this overly long drawn out process which feels more like a group of actors practicing their monologues with a few critiques at the end. There simply isn't enough real clinical training for medical students in a setting where you round all day with 12 other people - most of whom are senior to you. Ask any old time doc and they will tell you clinical competence is at an all time low - and the problem starts in undergraduate medical education. There have been plenty of articles written about this problem, so it's not a new revelation.

While a strictly preceptor-based education may leave some holes in a students education, I applaud any university or medical center for trying to cut out the fat in undergraduate and graduate medical education in order to get to the real learning. The academic model has taught physicians for decades, but it has grown too cumbersome and leaves a lot to be desired.

Let me explain something to you.
The "Preceptor" model will be just as worthless.

Reason being - while there might be no residents and you work 1-on-1 with attending, the fact is that your school is not paying that person (its volunteer work). Hence you get volunteer quality. How this plays out in the real world - your IM clerkship is essentially you and 2 other people with a hospitalist you follow around writing notes all day. Maybe he has you see 1 patient per day and you present them in a very brief interval, but overall 98% of your day is spent shadowing and you only pick things up which you could have very easily learned from a textbook.

Now yes I agree if your preceptor model involves actually paying the teaching faculty and mandating that its 1 on 1 time rather than a hospitalist group taking turns being dragged down with the med students for the week, then maybe it will be useful.

Most M.D. schools are far more interested in raising tuition dollars to pay huge salaries to administrators who do absolutely no teaching or really anything of value as opposed to the physicians doing the actual teaching.

 

[cbrons]

I haven't had any myself but have heard of exactly one outpatient psychiatry and one OMM preceptor who did not allow students to have meaningful patient interaction

Oh it is very very common at certain state MD schools to have no meaningful patient interaction.

 

[deleted564680]

Oh it is very very common at certain state MD schools to have no meaningful patient interaction.

Yeah, clinical rotations are a problem for ALL medical schools - MD and DO. The difference is that at the end of the day the MD students can say they at least were "around" learning and physically present in an academic center where most DOs don't even get to "see" anything like that. The MDs typically don't have to travel far for rotations. Those two things help the MD side get away with it more easily.

 

[Drrrrrr. Celty]

Oh it is very very common at certain state MD schools to have no meaningful patient interaction.

One of my friends says that at Loyola Chicago many students basically just shadow.

 

[NurWollen]

How many people are really having a shadowing only experience? I have quite literally never had an experience like this in any of my rotations. The most I've ever spent not seeing patients by myself when I start a new rotation is 4 days, and that only happened once. Usually its 1 hour (i.e. I watch the attending/resident see 1 patient, then I see the next one). That said, I heard from a student from another school that they basically shadowed for almost their entire FM rotation, which sounded terrible to me. I've also never worked under a non-physician preceptor, but have heard (on SDN) that others have.

Not me. I've been required to see patients independently and write notes on every single rotation with one exception. And even on the exception, I actively participated in taking H&Ps.

Yeah, clinical rotations are a problem for ALL medical schools - MD and DO. The difference is that at the end of the day the MD students can say they at least were "around" learning and physically present in an academic center where most DOs don't even get to "see" anything like that. The MDs typically don't have to travel far for rotations. Those two things help the MD side get away with it more easily.

In other words, MD schools can ride on their reputation and on the perception that a rotation at X University Medical Center must be good.

 

[IslandStyle808]

In other words, MD schools can ride on their reputation and on the perception that a rotation at X University Medical Center must be good.

Best part is that a DO can train at X University Medical Center for their audition rotations or even core rotations and it still wouldn't matter....

 

[hallowmann]

Let me explain something to you.
The "Preceptor" model will be just as worthless.

Reason being - while there might be no residents and you work 1-on-1 with attending, the fact is that your school is not paying that person (its volunteer work). Hence you get volunteer quality. How this plays out in the real world - your IM clerkship is essentially you and 2 other people with a hospitalist you follow around writing notes all day. Maybe he has you see 1 patient per day and you present them in a very brief interval, but overall 98% of your day is spent shadowing and you only pick things up which you could have very easily learned from a textbook.

Now yes I agree if your preceptor model involves actually paying the teaching faculty and mandating that its 1 on 1 time rather than a hospitalist group taking turns being dragged down with the med students for the week, then maybe it will be useful.

Most M.D. schools are far more interested in raising tuition dollars to pay huge salaries to administrators who do absolutely no teaching or really anything of value as opposed to the physicians doing the actual teaching.

You're making a lot of assumptions here though that seem to be based on bad experiences you may have had with unpaid volunteers.

My school doesn't pay preceptors and two of the best rotations I've had were subspecialty rotations where I was one on one with a preceptor. In one of those, I saw a ton of patients by myself daily and even helped with some procedures. I was expected to act like a fellow, round on patients by myself, present them all to the preceptor, round with the preceptor after procedures, present one topic daily (which the preceptor would then expand upon), then write notes into the EMR by myself. I learned a ton on that rotation, and the preceptor was clearly actively trying to teach. Now they were also a former PD, so that may have played into it.

In the other one, I came in in the morning during which my preceptor reviewed ECGs, Caths, Nuclear stress tests, and Echos with me in a he'll do one then I'll do one fashion. I'd then see his patients in clinic, write notes, then we'd round at the hospital, and he'd give me either an assignment or talk about a pertinent topic, then we'd return for more clinic or procedures. This guy was never in a teaching setting, but he's been taking students for the past 4-5 yrs.

My point is that these were two rotations I had where I learned more than even some of my wards rotations because of how involved my preceptors were, and none of them were paid. I'm sure some preceptors view it as a waste of time, and as a result put in limited effort, but word gets around fast, and a lot of times you can set it up so you have better preceptors on your rotations. That is if you want to. I've met a couple people that basically want to do nothing on a rotation and then go home early. Those people sought out the bad preceptors.

 

[deleted564680]

You're making a lot of assumptions here though that seem to be based on bad experiences you may have had with unpaid volunteers.

My school doesn't pay preceptors and two of the best rotations I've had were subspecialty rotations where I was one on one with a preceptor. In one of those, I saw a ton of patients by myself daily and even helped with some procedures. I was expected to act like a fellow, round on patients by myself, present them all to the preceptor, round with the preceptor after procedures, present one topic daily (which the preceptor would then expand upon), then write notes into the EMR by myself. I learned a ton on that rotation, and the preceptor was clearly actively trying to teach. Now they were also a former PD, so that may have played into it.

In the other one, I came in in the morning during which my preceptor reviewed ECGs, Caths, Nuclear stress tests, and Echos with me in a he'll do one then I'll do one fashion. I'd then see his patients in clinic, write notes, then we'd round at the hospital, and he'd give me either an assignment or talk about a pertinent topic, then we'd return for more clinic or procedures. This guy was never in a teaching setting, but he's been taking students for the past 4-5 yrs.

My point is that these were two rotations I had where I learned more than even some of my wards rotations because of how involved my preceptors were, and none of them were paid. I'm sure some preceptors view it as a waste of time, and as a result put in limited effort, but word gets around fast, and a lot of times you can set it up so you have better preceptors on your rotations. That is if you want to. I've met a couple people that basically want to do nothing on a rotation and then go home early. Those people sought out the bad preceptors.

Unfortunately, most unpaid preceptors aren't as good as you describe. However, I will say that a lot of it depends on the work ethic and interest of the student too.

A big problem that is not always mentioned is how lazy and uninterested a lot of medical students act these days. I've seen it over and over and heard it from attendings commonly.

 

[hallowmann]

Unfortunately, most unpaid preceptors aren't as good as you describe. However, I will say that a lot of it depends on the work ethic and interest of the student too.

A big problem that is not always mentioned is how lazy and uninterested a lot of medical students act these days. I've seen it over and over and heard it from attendings commonly.

Yeah, I agree. At my school if you want to do barely anything its very possible that you could get through like that. You shouldn't obviously, because you only do yourself a disservice, but I could definitely think of a few sites and preceptors that wouldn't care if you don't.

I don't know a ton of people that would do that for all of their rotations, but some of them sure.

 

[ButterButter]

My school DOES pay preceptors and there's still no shortage of subpar experiences. That being said, they don't pay them enough to actually divert a substantial amount of attention away from their practice to help a limping med student. So while pay may be part of the issue, the other issue is the fact that a lot of docs are struggling to give their patients a decent experience in a ~15 minute (mostly less) visit regardless of the med student that's following them around.

 

[cbrons]

My school DOES pay preceptors and there's still no shortage of subpar experiences. That being said, they don't pay them enough to actually divert a substantial amount of attention away from their practice to help a limping med student. So while pay may be part of the issue, the other issue is the fact that a lot of docs are struggling to give their patients a decent experience in a ~15 minute (mostly less) visit regardless of the med student that's following them around.

The med student shouldnt be "following them around." They should be seeing the patient by themselves and then presenting. If that takes too much time, the attending can just see a patient himself while the student sees one that is waiting.

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[Petypet]

how lazy and uninterested a lot of medical students act these days

 

[kenjixshadow]

The med student shouldnt be "following them around." They should be seeing the patient by themselves and then presenting. If that takes too much time, the attending can just see a patient himself while the student sees one that is waiting.

This x1000!!!

Why would they do that? Are they intellectually disabled? Shadowing is of no actua value.

I wasn't clear in the other message. This "shadow" rotation doctors actually let him see pts and present to them like he was rotating with them. They have no problem with it since med students are always there & doing the same thing. Meanwhile, his main rotations don't teach him jacksh*t. They don't even let him see pts on his own.

The MDs typically don't have to travel far for rotations.

This too!!! FM clerkship is in rural area, which is 1 north hr drive away from main site. A month later, there is surgery rotation is at another community hospital which is 45 mins away south. After that, peds is in the city 30 mins west. Smh. Commuting is a b*tch. Even if you live out of suitcase and use airbnb, it'd still be annoying as hell.

 

[CopaceticOne]

Oh it is very very common at certain state MD schools to have no meaningful patient interaction.

Help out future students (current applicants) and post which schools you're referring to.

 

[hallowmann]

The med student shouldnt be "following them around." They should be seeing the patient by themselves and then presenting. If that takes too much time, the attending can just see a patient himself while the student sees one that is waiting.

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This is basically how it has gone for me on outpatient rotations. With some of the faster paced attendings seeing 2 patients while I saw 1 early in the year.

...This too!!! FM clerkship is in rural area, which is 1 north hr drive away from main site. A month later, there is surgery rotation is at another community hospital which is 45 mins away south. After that, peds is in the city 30 mins west. Smh. Commuting is a b*tch. Even if you live out of suitcase and use airbnb, it'd still be annoying as hell.

To be fair I know people at a top 20 MD school that have to commute 20-40min for some rotations. They have to go to some of the university affiliates for some rotations.

I've primarily had to commute by choice seeking out better rotations and electives that took me back home. Its painful though. I went through a 3 rotation streak where I did each rotation in a different city. Terrible. I learned more that way, but its terrible having to drive and move so much. It definitely hurt a couple shelf scores too, but I feel way more comfortable with certain types of rotations than people at my core site. That said, there are people at my core site that have done every rotation within a 30 min drive of there.

I hope that DO schools are focusing more on core clinical sites just to make things easier for students. I know my school shifted to doing that a couple years ago. Having to move after preclinicals isn't so bad, but having to move for every rotation is unbearable.

 

[Instatewaiter]

Oh it is very very common at certain state MD schools to have no meaningful patient interaction.

I have never, ever heard this from another person and realize I am much further in my training and have had a lot more exposure to people from different MD schools than you. This has NEVER once come up.

 

[cbrons]

I have never, ever heard this from another person and realize I am much further in my training and have had a lot more exposure to people from different MD schools than you. This has NEVER once come up.

Oh well i know the schools in my area and trust me theres a reason I used the word "certain."

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[NurWollen]

Looks like @Instatewaiter has had an incedible, vastly superior N=1 experience.

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