Any way to succeed in a poor quality rotation site?

[gmcguitar4]

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From what I have seen on these forums, quality rotation sites seems to be lacking with many DO schools. I was wondering if any 3rd or 4th years could chime in with advice on what a student can do if they get stuck at one of these sites. Say for example, nobody there is teaching anything or giving you guidance during the day, how do you ensure you are getting the most out of your rotation?

Any problems you faced during a rotation and how you overcame it would be great!

 

[cliquesh]

You just need to look at the patient's chart, see the patient, and come up with a plan. Then compare your plan to the attending's/fellow/resident. Then when you go home in the evening read about the patient's disease, diagnosis, and treatment.

My rotations, for the most part, were fine.

You can schedule your 4th year electives anywhere. If you feel like your clinical education during your 3rd year was bad, then you should schedule as many rotations at university hospitals as you can during your 4th year.

 

[sonofva]

yeah really i think you kind of just have to turn it into a game almost. at first read the orders/H+P/progress notes/differentials for each patient, for all consults and primary doctors. use this to try to formulate what things are done for each condition. as you feel more comfortable, make your own plans. then compare to the real thing.

and frankly, if you have free time, be thankful and make the most of it. plan on crushing step 2...

 

[thepoopologist]

You just need to look at the patient's chart, see the patient, and come up with a plan. Then compare your plan to the attending's/fellow/resident. Then when you go home in the evening read about the patient's disease, diagnosis, and treatment.

My rotations, for the most part, were fine.

You can schedule your 4th year electives anywhere. If you feel like your clinical education during your 3rd year was bad, then you should schedule as many rotations at university hospitals as you can during your 4th year.

This. And ask questions and see who responds. If they don't want to be bothered, **** them.

Even in the best circumstances, it won't make up for the rotation being absolute garbage. You're basically trying to turn chicken**** into chicken soup.

 

[HooliganSnail]

Often really bad "sites"will have some good rotations on them. Good "sites" will have bad rotations at them. In the end its all equalizes out. It also matters what you define as "bad". Some places will not supervise you very much and its up to you to see your patients, write some notes, and learn about the diseases and treatments and why the team is doing what they are doing. Other places will "hold your hand" and have lots and lots of didactics. Depending on how you learn either one could be amazing or a diseaster.

I was at one of my schools worst sites.,but at the end of the year I can look back and say that I learned a lot, and there were still some good rotations.

What determines the crappiness of a rotation has almost nothing to do with what kind of medicine it is, it has everything to do with who you are working with.

Example: Surgery at a huge level one trauma center lots of patients etc........may sound awesome, but if there is a lot of turnover of residents,interns, and students, then the attendings will not get to know anyone really well. If they dont know you, they dont trust you, and wont ask you to do things like suture and assist. It doesn't matter if its a crazy procedure that rarely happens if your standing in the corner.
A smaller hospital may give you a better surgical experience if you are working with a single attending, because then they get to know you and understand your skill level.

 

[Slane]

If you lack attendings that take the time to teach you, you have to take the initiative and study on your own. It's really as simple as that. Most schools won't allow you to change rotation sites, at least not without extremely pressing circumstances to do so. In all honesty though, you need to study on your own all of third year regardless. Very few hospitals will give you all the pathology you need to be competent to sit for your Level 2 boards.

 

[dozitgetchahi]

Often really bad "sites"will have some good rotations on them. Good "sites" will have bad rotations at them. In the end its all equalizes out. It also matters what you define as "bad". Some places will not supervise you very much and its up to you to see your patients, write some notes, and learn about the diseases and treatments and why the team is doing what they are doing. Other places will "hold your hand" and have lots and lots of didactics. Depending on how you learn either one could be amazing or a diseaster.

I was at one of my schools worst sites.,but at the end of the year I can look back and say that I learned a lot, and there were still some good rotations.

What determines the crappiness of a rotation has almost nothing to do with what kind of medicine it is, it has everything to do with who you are working with.

Example: Surgery at a huge level one trauma center lots of patients etc........may sound awesome, but if there is a lot of turnover of residents,interns, and students, then the attendings will not get to know anyone really well. If they dont know you, they dont trust you, and wont ask you to do things like suture and assist. It doesn't matter if its a crazy procedure that rarely happens if your standing in the corner.
A smaller hospital may give you a better surgical experience if you are working with a single attending, because then they get to know you and understand your skill level.

You're forgetting about the absolute worst type of rotations - the ones in which the attending barely lets you touch patients and your 'experience' amounts to shadowing at best. I had a few of these, and frankly you're left to do little other than read and learn on your own. These types of rotations are good in some ways - you'll be able to maximize the amount of time you spend studying for step 2 and shelfs - but you'll also be missing out on most of the practical experience and knowledge you need to function as a resident (how are you ever going to develop your physical exam skills if you never utilize them, etc).

 

[koojo]

Read every night. I did a lot of reading throughout 3rd year. A lot of people slacked off during that time, but it paid off for me. If you're doing OB, read everthing about OB that month. If you're doing surgery, read everything surgery. The main thing you are trying to build is your differential diagnosis list. You'd be surprised how many people do not read. This will make up some of what you're losing by being at a rotation where you're not getting much feedback. Also, you can learn a lot by actively listening and watching what your attendings/residents do.

 

[survivordo]

You have gotta be a sponge. Soak up whatever you can and then read about it. Question Why the attending/resident did what they did. If they aren't the teaching type then try to figure it out yourself (you'll probably remember it better anyway) and if you still have no idea then ask. You just gotta find a way to take SOMETHING from each rotation and read read read.

Survivor DO

 

[HooliganSnail]

You're forgetting about the absolute worst type of rotations - the ones in which the attending barely lets you touch patients and your 'experience' amounts to shadowing at best. I had a few of these, and frankly you're left to do little other than read and learn on your own. These types of rotations are good in some ways - you'll be able to maximize the amount of time you spend studying for step 2 and shelfs - but you'll also be missing out on most of the practical experience and knowledge you need to function as a resident (how are you ever going to develop your physical exam skills if you never utilize them, etc).

O Yeah! Those are absolutely the worst. Nothing is worse than the shadowing rotation. I find after the first week to be assertive and ask the attending if you can take a more active role in patient care. I've had to do that twice and so far it works well. You have to be careful how you say it though, you can not come off as whining, that never works. But if you act like you are generally interested, they will respond well.

A lot of those "shadowing" rotations are simply because they don't realize the student is capable and willing to do more. Sadly I went through three bad rotations as a timid third year before I grew a pair and spoke up.

If the attending still won't let you do anything then you accept your fate and buck up for the rest of the rotation. After it is over you let your DME know about it.