Are Ward-type rotations always better than Preceptor-based?

[sdominator21]

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So I am currently at a medical school where we have a mix of rotations. I know that the traditional ones have residents and attendings. But our place seems to be heavy on preceptor-based teaching more which is centered in Community Hospitals generally. I was told that Preceptor based is better because you get to “Do more”, instead of scut work. But I’m not sure if this is really better than a rotation that has Residents In it.

Is it generally better for me to choose Ward-based areas for a Core site? We have a lottery during 2nd year.

I am starting to feel that the Clinical years are a weakness of a lot of DO programs

 

[deleted898021]

It depends. You should do atleast one core rotation 3rd year especially in the specialty your interested in at a residency program or where there are residents and you can get to interact with program director so you get the experience of what an academic program is like. Other than that for the other specialties it is better to do preceptor especially if the preceptor is willing to teach since you will do so much more and actually get to run patient care. Coca now requires that you do atleast one 3rd year rotation with residents anyway.

 

[Goro]

A number of OMSIIIs and IVs have commented that preceptorships at rural community hospitals are actually great teaching opportunities, because you actually get to do a lot more stuff.

Key word there is "do". A preceptorship where you're doing no more than glorified shadowing is a bane on the profession.

Sometimes ward-based venues can backfire. One of our major rotation sites is a large and good community hospital. Students get to do things there, but those students who would rather just hug the wall and blend into shadows get lost there. In that setting, attendings or residents might think, "oh, you don't want to learn this and just stand there? Fine. I'll teach these guys instead".

As such, we've learned not to send certain students there.

OP, strongly suggest you seek out your senior students and ask them what they consider the best sites are. And complain often, loud and strenuously to your Clinical Deans about bads sites! My students were able to get a Clinical Dean fired over something like this!

 

[Dr. Death]

Ward based. As a third and fourth year you need to learn to be a resident. The best way to do that is working with residents. "Getting to do stuff" does not correlate with quality of training

 

[sab3156]

Wards. You have to be an intern during your first year of residency, and delivering babies with Dr. DO-never-taught-a-resident-before-in-his-life does NOT prepare you for this. There is a reason the top medical schools in the country use this model. Let’s not pretend the DO schools are mainly doing preceptor based rotations because they are “better”... the sad reality is that they are doing mainly preceptor based because they can’t provide you with anything better.

I am starting to feel that the Clinical years are a weakness of a lot of DO programs

This is one thing, yes... among many other things.

 

[BorntobeDO?]

Ideally you would get to do both. Being on a preceptor based rotation where they have you do everything is a good experience. Working with residents is also a great experience where you present and learn a lot. Shadowing is not so good no matter which one it’s with.

 

[hallowmann]

Leave wards based for cores and you can do subspecialties/electives with preceptors. The experiences can be crappy in either setting, but you're more likely to learn how to function on a clinical team in the wards based rotations even if they aren't that great.

 

[Dr.Bruh]

Ward based experience is important for your auditions so you don’t look totally clueless. But those community experience are going to be much more valuable when you match and you’re more competent as an intern bc you’ve gotten more experience clinically and more charting etc.

On my rural ER rotation I’ve been able to place central lines solo, do pelvic exams, suture, intubate etc. that’s not gunna really matter for my Sub-I but will help me feel more comfortable come intern year. So both are valuable.

 

[Chibucks15]

Mixture is best. You don’t need 7 wards rotations to learn how to function in a resident team unless you’re socially inept

 

[Dr.Bruh]

Mixture is best. You don’t need 7 wards rotations to learn how to function in a resident team unless you’re socially inept

I would die if I had that many ward rotations. They’re so boring. You do less and stay longer.

 

[sab3156]

Mixture is best. You don’t need 7 wards rotations to learn how to function in a resident team unless you’re socially inept

I would die if I had that many ward rotations. They’re so boring. You do less and stay longer.

I guess all the top medical schools that are known for their clinical education are doing things differently than Rural Community Hospital XYZ because the students at these medical schools are socially inept and cannot scrape by without having tons of wards based rotations at teaching hospitals? You should know that learning to function in a resident team is far from the only reason why MD schools do things differently from the DO schools. The list is exhausting to discuss. There are many reasons why ACGME faculty in a lot of specialties have a tough time taking these rotations seriously.

Like I said before, let's not pretend DO schools are doing any favors for their students - the fact remains that they cannot provide you with enough wards based rotations, and that's what it really comes down to. It's fine to have an option for people to go out to random hospitals and knock themselves out delivering babies and whatever else they want to do with Dr. DO-Never-Taught-A-Resident-Before, but to make that your main model of clinical education is simply reflective of the inadequacy of the osteopathic resources.

 

[Chibucks15]

I guess all the top medical schools that are known for their clinical education are doing things differently than Rural Community Hospital XYZ because the students at these medical schools are socially inept and cannot scrape by without having tons of wards based rotations at teaching hospitals? You should know that learning to function in a resident team is far from the only reason why MD schools do things differently from the DO schools. The list is exhausting to discuss. There are many reasons why ACGME faculty in a lot of specialties have a tough time taking these rotations seriously.

Like I said before, let's not pretend DO schools are doing any favors for their students - the fact remains that they cannot provide you with enough wards based rotations, and that's what it really comes down to. It's fine to have an option for people to go out to random hospitals and knock themselves out delivering babies and whatever else they want to do with Dr. DO-Never-Taught-A-Resident-Before, but to make that your main model of clinical education is simply reflective of the inadequacy of the osteopathic resources.

Man it must be exhausting to be you. You’re pretty insufferable on here. Like usual when you quote me, Many of those things I never said, and I personally could give two ****s about “top medical school” curriculum. Basically only said a mixture wont hurt you.

 

[sab3156]

Man it must be exhausting to be you. You’re pretty insufferable on here. Like usual when you quote me, Many of those things I never said, and I personally could give two ****s about “top medical school” curriculum. Basically only said a mixture wont hurt you.

I was being facetious, but it's inappropriate and inaccurate for people to keep implying that the wards based rotations only teach you how to be an intern and that there is a huge advantage in learning how to do random things by yourself that you probably will never be doing in residency depending on your specialty. The aim of my post was to highlight that there are actually way more advantages to having wards based rotations other than simply learning how to be an intern.

And I think we can have a discussion without the constant emotional backlash. Let's keep the insults to a minimum.

Another advantage that can be highlighted here is - wards based rotations give you a thicker skin. (Note: this is a joke)

 

[deleted898021]

I guess all the top medical schools that are known for their clinical education are doing things differently than Rural Community Hospital XYZ because the students at these medical schools are socially inept and cannot scrape by without having tons of wards based rotations at teaching hospitals? You should know that learning to function in a resident team is far from the only reason why MD schools do things differently from the DO schools. The list is exhausting to discuss. There are many reasons why ACGME faculty in a lot of specialties have a tough time taking these rotations seriously.

Like I said before, let's not pretend DO schools are doing any favors for their students - the fact remains that they cannot provide you with enough wards based rotations, and that's what it really comes down to. It's fine to have an option for people to go out to random hospitals and knock themselves out delivering babies and whatever else they want to do with Dr. DO-Never-Taught-A-Resident-Before, but to make that your main model of clinical education is simply reflective of the inadequacy of the osteopathic resources.

Bruh chill, theres MD schools where the students have a few rotations that are one one one with preceptors and they basically shadow, its more common then you think, then there's sites at DO school(like mine) where all we do is wards based in every single specialty and have didactics, so the point here is that it varies at almost every school from specialty to specialty and you should get a mixture of both, COCA shockingly now requires that every student have atleast one wards based rotation so thats a positive thing. Also IDK if you know this but residency PD's don't get to see what kind of rotation it was and will only see your grade in the rotation, when asked about it on interviews it will look good on your part if you did some roatations(especially in the field your applying for) where you worked with a team of residents, thats all we are trying to tell OP. This whole thing about "top medical school" is just nonsense, most people in this world don't give a damn about residency prestige, they just want to get into the residency of their choice in the location of their choice,"There are many reasons why ACGME faculty in a lot of specialties have a tough time taking these rotations seriously" haha ok, its incredibly funny because a lot of our attendings actually also work with and teach the state MD school students so yea I am sure they think that all of our rotations are crap ya know, and can't take them seriously LOL when some of MD students are rotation with the same people . Also when the random DO who is in the residency at a traditional MD programs actually knows how to not only work as a part of a resident team(that he learned in his wards base rotations in 3rd and 4th year) but ALSO knows how to put in central lines and you know actually do stuff cause he learned it in 3rd year, will definetly bring into question his 3rd and 4th year clinical education, competency is competency, theres competent DO's who learned in medical school during 3rd and 4th year and theres incompetent MD's who just stood there behind the residents and didn't do anything on their "vastly superior MD taught rotation at a teaching hospital".

 

[Ho0v-man]

I guess all the top medical schools that are known for their clinical education are doing things differently than Rural Community Hospital XYZ because the students at these medical schools are socially inept and cannot scrape by without having tons of wards based rotations at teaching hospitals? You should know that learning to function in a resident team is far from the only reason why MD schools do things differently from the DO schools. The list is exhausting to discuss. There are many reasons why ACGME faculty in a lot of specialties have a tough time taking these rotations seriously.

Like I said before, let's not pretend DO schools are doing any favors for their students - the fact remains that they cannot provide you with enough wards based rotations, and that's what it really comes down to. It's fine to have an option for people to go out to random hospitals and knock themselves out delivering babies and whatever else they want to do with Dr. DO-Never-Taught-A-Resident-Before, but to make that your main model of clinical education is simply reflective of the inadequacy of the osteopathic resources.

Bruh. I’ll happily join you in ****ting on DO schools and their haphazard clinical rotations. But most MD schools don’t provide wards based rotations for all of third year. I know that you know this.

I agree with the rest of your points about the lies our schools tell us about how preceptor based rotations are so much better because you get to do stuff that won’t help you match into your desired field, etc.

 

[sab3156]

Bruh chill, theres MD schools where the students have a few rotations that are one one one with preceptors and they basically shadow, its more common then you think

That's exactly why I said it's OK to have opportunities like that, but it's not their main model of clinical education. Like you said, it is common, and I know of many MD schools that offer preceptor based opportunities, in the form of electives. Some even have one or more core rotations as such.

Also IDK if you know this but residency PD's don't get to see what kind of rotation it was

This is true. However, IM applicants and other applicants have repeatedly stated that it was common for PDs to ask them about their clinical education - they wanted at least some wards based rotations so that they could be sure that the person received some form of education during their clinical years.

Bruh. I’ll happily join you in ****ting on DO schools and their haphazard clinical rotations. But most MD schools don’t provide wards based rotations for all of third year. I know that you know this.

This is definitely true. But I would say that it's not that common for schools to have core rotations at preceptor based community sites without residency programs. For the schools that do that, it may be a lack of resources (just like it is with DO schools) which causes this situation.

 

[zero0]

I am starting to feel that the Clinical years are a weakness of a lot of DO programs

If that's not the understatement of the century...

Tbh it depends on the quality of the wards based rotation. For example, if it's particularly malignant then I'd do the preceptor based one. There's one FM residency in Danville, VA that I have no issues naming and shaming in particular because of how utterly malignant it is (they fill through the SOAP literally every year). I know I learned way more from my 2 other preceptor FM rotations than I ever did at that place.

 

[Mad Jack]

I had a mix and found it valuable. Outpatient is good as preceptor-based, inpatient is best as ward-based imo

 

[Angus Avagadro]

You will get more hands on experience with preceptors. Ward based rotations should have more time for academics. Noon conferences, journal clubs, bedside presentations by residents and attendings. You will also learn how to critically review journal articles, very important. A mix of both is best IMO.

 

[Drrrrrr. Celty]

Both have their utilities.
But here's the thing. Ward rotations are important because you're working with residents. You will be a resident soon. You need to learn how to be a resident before you learn how to be an attending. And part of that process also will help you learn how to work WITH residents and how to build connections.

Likewise in my opinion you gain a lot more learning from a resident or a fellow than an attending. They know how to do their job. A resident or fellow is always still learning and know what they needed to know last year and thus what ways to teach you expectations of what you need to know or value.

I will openly say that at my hospital the weakest residents and or the ones who are at risk of non-advancing in any of the programs here are those who had preceptor predominant 3rd and 4th years. They take too long to write notes, don't understand their limitations as well, and don't understand how a team based process a service is if it's run as a traditional senior intern dynamic.

You will learn to be a doctor in your residency. But now is the time to prepare to be a resident.

 

[hallowmann]

Both have their utilities.
But here's the thing. Ward rotations are important because you're working with residents. You will be a resident soon. You need to learn how to be a resident before you learn how to be an attending. And part of that process also will help you learn how to work WITH residents and how to build connections.

Likewise in my opinion you gain a lot more learning from a resident or a fellow than an attending. They know how to do their job. A resident or fellow is always still learning and know what they needed to know last year and thus what ways to teach you expectations of what you need to know or value.

I will openly say that at my hospital the weakest residents and or the ones who are at risk of non-advancing in any of the programs here are those who had preceptor predominant 3rd and 4th years. They take too long to write notes, don't understand their limitations as well, and don't understand how a team based process a service is if it's run as a traditional senior intern dynamic.

You will learn to be a doctor in your residency. But now is the time to prepare to be a resident.

I overall agree with the main points of this post, but I have not found the bolded to be true at my institution. Outside of the first few months of intern year (you usually can tell the difference depending ones school, but this quickly resolves for most), the differences in residents has been because they are simply not good at what they're doing, not because of what their 3rd and 4th year in med school consisted of.

Some people are just bad at those things. They struggle to adjust to different situations and it shows in a lot of what they do. My experience has simply been that some people simply struggle regardless of their 3rd and 4th year experiences. This includes plenty of MD students and residents I've seen that had mostly wards based rotations in a big academic institution.

 

[group_theory]

You don't want your audition rotation to be your first "ward-base" experience. Audition rotations should be your "A" game - whether because you're interested in the program, or you want a strong LOR from an academic attending in the field. Shouldn't be the time to learn how to function on inpatient rotations.

Had a few students where the rotation was their first inpatient rotations (with students, residents, fellows) ... and it was painfully obvious. Didn't know how to present on rounds, thought process was disorganized, plan was basically verbatim of previous day's plan, would immediately come to me with questions/issues (and bypassing the intern and senior residents assigned to them). If you're a 4th year medical student functioning at a level of a beginning 3rd year medical student, on a sub-I/AI rotation, you're in trouble. And if you were hoping to impress the residents, or fellows/attendings - you're in trouble. You're playing catch-up.

And if you're an intern with little experience on wards, your intern year will be off to a rough start - you don't want the glaring eyes of the attendings, chief residents, assistant program director or program director looking at you and determining that you need "special" attention.

 

[Dr.Bruh]

You don't want your audition rotation to be your first "ward-base" experience. Audition rotations should be your "A" game - whether because you're interested in the program, or you want a strong LOR from an academic attending in the field. Shouldn't be the time to learn how to function on inpatient rotations.

Had a few students where the rotation was their first inpatient rotations (with students, residents, fellows) ... and it was painfully obvious. Didn't know how to present on rounds, thought process was disorganized, plan was basically verbatim of previous day's plan, would immediately come to me with questions/issues (and bypassing the intern and senior residents assigned to them). If you're a 4th year medical student functioning at a level of a beginning 3rd year medical student, on a sub-I/AI rotation, you're in trouble. And if you were hoping to impress the residents, or fellows/attendings - you're in trouble. You're playing catch-up.

And if you're an intern with little experience on wards, your intern year will be off to a rough start - you don't want the glaring eyes of the attendings, chief residents, assistant program director or program director looking at you and determining that you need "special" attention.

This makes 100% sense but I'm always perplexed by, for example, KCU's match list. The vast majority of us will have no IM wards experience, and none of us will have EM experience wards experience (meaning our first wards experience is a Sub-I). But the majority of our IM/EM matches are at university programs. So often does showing up with no wards experience really translate to being "obvious" or at least so obvious you need "special attention"? Must not be that much.

 

[deleted898021]

This makes 100% sense but I'm always perplexed by, for example, KCU's match list. The vast majority of us will have no IM wards experience, and none of us will have EM experience wards experience (meaning our first wards experience is a Sub-I). But the majority of our IM/EM matches are at university programs. So often does showing up with no wards experience really translate to being "obvious" or at least so obvious you need "special attention"? Must not be that much.

I was under the the impression that having any wards experience regardless of specialty i.e.. say wards experience at a family med or gen surgery program would help for any Sub/I since its the experience in working with residents, presenting patients and operating as a team in the hospital that mattered, and not the specialty it was in?

 

[Dr.Bruh]

I was under the the impression that having any wards experience regardless of specialty i.e.. say wards experience at a family med or gen surgery program would help for any Sub/I since its the experience in working with residents, presenting patients and operating as a team in the hospital that mattered, and not the specialty it was in?

Idk bc my surgery rotation was at a residency, with residents, rounding etc and I doubt it would help at all for for IM subI. I didn't type a single note, didn't have to present, they didn't even make us round everyday. We had weekly didactics which was pointless and we just sat there. We scrubbed in every case and was first assist, closed every non-complicated incision which was awesome but not useful for Sub Is in other specialties. Suprisingly, my rotations that have been preceptor base I've had to type all the notes, presents all pts and come up with the assessment and plan etc.

 

[AlteredScale]

Idk bc my surgery rotation was at a residency, with residents, rounding etc and I doubt it would help at all for for IM subI. I didn't type a single note, didn't have to present, they didn't even make us round everyday. We had weekly didactics which was pointless and we just sat there. We scrubbed in every case and was first assist, closed every non-complicated incision which was awesome but not useful for Sub Is in other specialties. Suprisingly, my rotations that have been preceptor base I've had to type all the notes, presents all pts and come up with the assessment and plan etc.

Glad you got that exposure but IMO I think the issue is that your experience is not the same as the other KCU students rotating in KC with different preceptors for the same rotation. This is not true of MD students (specifically at KU) with mainly ward-based/resident-based who have a set expectation to write notes and formally present patients through each of their rotations. It is consistent amongst every student and every rotation.

Preceptors can be hit or miss regarding the expectations about presentations. So when you get to your sub-I and choose to do the style you've learned based on what a preceptor taught you, it may or may not be the correct format and in that instance you've potentially already set yourself back with the attending. This is why there is utility to rotating at an academic hospital to learn this sort of universal style of presenting, especially if going into IM (EM not so much).

I will say without a doubt that on my first IM rotation, the MD students were running circles around me with regards to how well their presentations were and it took 2-3 weeks to really get that organized. My sub-I at a hospital here in KC required carrying 6 patients on the floors, notes in before rounds with a new A&P, along with all the other intricacies of being sub-intern.

Your experience with that surgical residency (not doing literally anything but first assist) is honestly an outlier.

 

[Leo260]

Glad you got that exposure but IMO I think the issue is that your experience is not the same as the other KCU students rotating in KC with different preceptors for the same rotation. This is not true of MD students (specifically at KU) with mainly ward-based/resident-based who have a set expectation to write notes and formally present patients through each of their rotations. It is consistent amongst every student and every rotation.

Preceptors can be hit or miss regarding the expectations about presentations. So when you get to your sub-I and choose to do the style you've learned based on what a preceptor taught you, it may or may not be the correct format and in that instance you've potentially already set yourself back with the attending. This is why there is utility to rotating at an academic hospital to learn this sort of universal style of presenting, especially if going into IM (EM not so much).

I will say without a doubt that on my first IM rotation, the MD students were running circles around me with regards to how well their presentations were and it took 2-3 weeks to really get that organized. My sub-I at a hospital here in KC required carrying 6 patients on the floors, notes in before rounds with a new A&P, along with all the other intricacies of being sub-intern.

Your experience with that surgical residency (not doing literally anything but first assist) is honestly an outlier.

Sorry to derail a bit, but do KCU students rotating in KC have any opportunity to fulfill a wards-based IM rotation? Are there any sites that seem to offer this? Or do you just sort of have to bite the bullet and wait until M4

 

[sab3156]

This makes 100% sense but I'm always perplexed by, for example, KCU's match list. The vast majority of us will have no IM wards experience, and none of us will have EM experience wards experience (meaning our first wards experience is a Sub-I). But the majority of our IM/EM matches are at university programs. So often does showing up with no wards experience really translate to being "obvious" or at least so obvious you need "special attention"? Must not be that much.

Your point is a valid one. However, I would argue that KCU's match list with regard to EM and IM is typically multiple tiers beneath even lower tier MD schools (just look at the match lists of UMKC or Albany Medical College, which are lower tier MD schools). KCU, even with its massive class size, tends not to have the quality of IM and EM matches even against a lower tier MD school with a much smaller class size. From what I can see, the IM matches that have been made over the past few years have typically been, for the most part, lower tier academic hospitals, community hospitals, and a very small smattering of strong matches. The lower tier academic hospitals aren't exactly attracting the cream of the crop IM applicants - therefore, I don't think that simply matching into academic programs is an indicator that preceptor based rotations are strong.

The counter-argument to what I just said is likely to be: "Well, there is a bias against the DO schools, therefore the match lists aren't as good."

That's a valid critique. There are lots of confounding variables here, and the match lists differ so drastically in terms of quality of matches between DO schools and low tier MD schools that we really cannot draw any conclusions about whether or not clinical rotations were problematic enough to negatively effect KCU students during the match, on the basis of the match list alone.

 

[AlteredScale]

Sorry to derail a bit, but do KCU students rotating in KC have any opportunity to fulfill a wards-based IM rotation? Are there any sites that seem to offer this? Or do you just sort of have to bite the bullet and wait until M4

If you are lucky, one of your core rotations will be at the VA which is with KUMC's IM program, if you're really lucky you'll get the KC VA (the Leavenworth VA is super small and you don't see as much pathology).

I am not sure if you can request it. But I would reach out to your clerkship coordinator as soon as you know who it is in second year.

The next thing you can do is use all of your elective time to rotate at UMKC/St Luke's, I suggest doing at least 1 in general medicine, 1 in a subspecialty, and then 1 in the ICU. The school will let you know when you can request to sign up for St Luke electives. Make sure to respond fast because I believe in some way it's first-come first-serve.

 

[AlteredScale]

, I don't think that simply matching into academic programs is an indicator that preceptor based rotations are strong.

Yep. Matching into academic uni programs is not based only on your experience in third year rotation, but without a doubt having largely varied, potentially useless/pointless preceptor rotations will be a negative in your performance as a Sub-I which means a weak or no letter and a waste of a very important month in fourth year before application season opens.

 

[Drrrrrr. Celty]

This makes 100% sense but I'm always perplexed by, for example, KCU's match list. The vast majority of us will have no IM wards experience, and none of us will have EM experience wards experience (meaning our first wards experience is a Sub-I). But the majority of our IM/EM matches are at university programs. So often does showing up with no wards experience really translate to being "obvious" or at least so obvious you need "special attention"? Must not be that much.

Probably more than half of KC's students do predominately wards based rotations with residents. I did.

 

[bogle8]

Your point is a valid one. However, I would argue that KCU's match list with regard to EM and IM is typically multiple tiers beneath even lower tier MD schools (just look at the match lists of UMKC or Albany Medical College, which are lower tier MD schools). KCU, even with its massive class size, tends not to have the quality of IM and EM matches even against a lower tier MD school with a much smaller class size. From what I can see, the IM matches that have been made over the past few years have typically been, for the most part, lower tier academic hospitals, community hospitals, and a very small smattering of strong matches. The lower tier academic hospitals aren't exactly attracting the cream of the crop IM applicants - therefore, I don't think that simply matching into academic programs is an indicator that preceptor based rotations are strong.

The counter-argument to what I just said is likely to be: "Well, there is a bias against the DO schools, therefore the match lists aren't as good."

That's a valid critique. There are lots of confounding variables here, and the match lists differ so drastically in terms of quality of matches between DO schools and low tier MD schools that we really cannot draw any conclusions about whether or not clinical rotations were problematic enough to negatively effect KCU students during the match, on the basis of the match list alone.

Is it just me or is this guy/gal picking up where MeatTornado left off?

 

[sab3156]

Is it just me or is this guy/gal picking up where MeatTornado left off?

Nah, man. He was a legend.

 

[sab3156]

The “proper way to present a patient” argument is such a red herring. Literally every attending wants residents/ students to present differently and literally every attending thinks their way is the correct way.

It’s a nonsensical argumen

I think what people mean by that isn't necessarily something like "oh this physician only wants you to give him such-and-such information" - but rather, developing an organized assessment and plan, being able to systematically approach a clinical problem, and being able to demonstrate your clinical reasoning to your team. At teaching hospitals which truly put an emphasis on these things from an academic standpoint, your education will be far more streamlined in this respect. The didactics are leagues above what a preceptor rotation can usually offer. The goal of all these educational resources is that you would be able to focus on the important aspects of learning to think like a clinician and learning to work as an intern in a structured, hierarchical team. Presenting a patient in a didactics-driven environment like this is much different than at a preceptor based rotation, and this is simply a fact. I've seen many people rotate through the department where I'm doing research at, and it is very obvious sometimes which students have achieved a certain skillset in this regard, and which ones haven't.

So no, it's not a red herring if you think of "presenting a patient" as a much broader term.

 

[67552931811]

I think what people mean by that isn't necessarily something like "oh this physician only wants you to give him such-and-such information" - but rather, developing an organized assessment and plan, being able to systematically approach a clinical problem, and being able to demonstrate your clinical reasoning to your team. At teaching hospitals which truly put an emphasis on these things from an academic standpoint, your education will be far more streamlined in this respect. The didactics are leagues above what a preceptor rotation can usually offer. The goal of all these educational resources is that you would be able to focus on the important aspects of learning to think like a clinician and learning to work as an intern in a structured, hierarchical team. Presenting a patient in a didactics-driven environment like this is much different than at a preceptor based rotation, and this is simply a fact. I've seen many people rotate through the department where I'm doing research at, and it is very obvious sometimes which students have achieved a certain skillset in this regard, and which ones haven't.

So no, it's not a red herring if you think of "presenting a patient" as a much broader term.

No need to try and “explain” anything to me my dude. I ran my med school race. My statement still stands, broader use notwithstanding

 

[Drrrrrr. Celty]

Is it just me or is this guy/gal picking up where MeatTornado left off?

I think it's stupid to pretend that it's not true though. A lot of our class that match well will also do so through good connections as well. As a DO you're very much DNR for a lot of fellowships and residencies.

 

[deleted898021]

I think it's stupid to pretend that it's not true though. A lot of our class that match well will also do so through good connections as well. As a DO you're very much DNR for a lot of fellowships and residencies.

I wouldn’t say “a lot” prbly the upper echelons of academic programs in every specialty, however a few DO’s do match at these programs anyway, the vast majority of mid tier and lower tier MD programs do have at least 1 DO tho, for fellowships I haven’t heard the DO stigma carry over as much and really just depends on your residency training, most fellowships at most programs are open to taking DO’s barring a few of the very top ones.

 

[NurWollen]

Idk bc my surgery rotation was at a residency, with residents, rounding etc and I doubt it would help at all for for IM subI. I didn't type a single note, didn't have to present, they didn't even make us round everyday. We had weekly didactics which was pointless and we just sat there. We scrubbed in every case and was first assist, closed every non-complicated incision which was awesome but not useful for Sub Is in other specialties. Suprisingly, my rotations that have been preceptor base I've had to type all the notes, presents all pts and come up with the assessment and plan etc.

On the other hand, my surgery rotation was at a residency, with residents as well. I did progress notes, presented on, and wrote up to 10 notes a day. It was perfect preparation for my residency-based IM and peds rotations.

Sent from my SM-G930V using SDN mobile

 

[bogle8]

I think it's stupid to pretend that it's not true though. A lot of our class that match well will also do so through good connections as well. As a DO you're very much DNR for a lot of fellowships and residencies.

I never said I wholly disagreed with anything he said. It was just his tone mostly.

 

[You shall know the Truth]

There are good and bad for both. I like having the rotations I don’t want to be at preceptor bases because they let you do things and it makes the time go by quickly.

 

[deleted407021]

Is it just me or is this guy/gal picking up where MeatTornado left off?

Oh yeah, I forgot hamtornado rage quit the forum

 

[fldoctorgirl]

I am not sure if you can request it. But I would reach out to your clerkship coordinator as soon as you know who it is in second year.

The next thing you can do is use all of your elective time to rotate at UMKC/St Luke's, I suggest doing at least 1 in general medicine, 1 in a subspecialty, and then 1 in the ICU. The school will let you know when you can request to sign up for St Luke electives. Make sure to respond fast because I believe in some way it's first-come first-serve.

Wanted to PM you about this but it won't let me, so here goes the thread derail.

When you mention reaching out to the clerkship coordinator, how do you recommend going about that? Just sending them an email like, "hey, I'm pretty sure I want to go into IM and would love the opportunity to rotate at one of these 2 sites for xyz reasons"? They keep telling us not to reach out to our sites yet, so I'm not sure if this goes in the same vein as that.

Also, did they have the honors tracks for your class? I'm kind of suspicious that all of these "better" IM rotations will go to those in the IM honors track, as well as the electives (since they have some of theirs pre-chosen for them from what I understand).

 

[AlteredScale]

When you mention reaching out to the clerkship coordinator, how do you recommend going about that? Just sending them an email like, "hey, I'm pretty sure I want to go into IM and would love the opportunity to rotate at one of these 2 sites for xyz reasons"? They keep telling us not to reach out to our sites yet, so I'm not sure if this goes in the same vein as that.

Also, did they have the honors tracks for your class? I'm kind of suspicious that all of these "better" IM rotations will go to those in the IM honors track, as well as the electives (since they have some of theirs pre-chosen for them from what I understand).

I just asked if I could rotate at the VA in KC for one of my IM rotations with the reason that I was interested in IM. Kept it very simple.

Yeah we had the honors IM tracks. I think the only thing that happens with the IM track is that you get an additional IM sub specialty elective and do didactics with the IM faculty. It doesn't change much but it does allow you to have the deans letter state you were in the honors track which idk how much that helps in the long run TBH (in comparison to clinical grades and stuff).

 

[fldoctorgirl]

I just asked if I could rotate at the VA in KC for one of my IM rotations with the reason that I was interested in IM. Kept it very simple.

Yeah we had the honors IM tracks. I think the only thing that happens with the IM track is that you get an additional IM sub specialty elective and do didactics with the IM faculty. It doesn't change much but it does allow you to have the deans letter state you were in the honors track which idk how much that helps in the long run TBH (in comparison to clinical grades and stuff).

Do you think it's too early to do that if they've told us not to reach out to our sites? I'm not sure if this counts as reaching out to the site or not, since I think the clerkship coordinators are just KCU employees? Sorry for all the questions, they aren't super transparent about all of this stuff haha

 

[group_theory]

With the USMLE Step 1 now going P/F, likely where and how you spend your 3rd year rotations will get a lot more scrutiny

And getting that ward-base rotations beginning of 4th year will get a lot harder now since everyone in the country will be trying to do just that.

A lot of DO schools will now have to revamp their clinical curriculum, and just can't solely depend on preceptor-based rotation sites to predominantly support their 3rd/4th year curricula.

Some residencies may be OK with preceptor based rotations and LORs - mainly those that are outpatient focused.

 

[Dr.Bruh]

With the USMLE Step 1 now going P/F, likely where and how you spend your 3rd year rotations will get a lot more scrutiny

And getting that ward-base rotations beginning of 4th year will get a lot harder now since everyone in the country will be trying to do just that.

A lot of DO schools will now have to revamp their clinical curriculum, and just can't solely depend on preceptor-based rotation sites to predominantly support their 3rd/4th year curricula.

Some residencies may be OK with preceptor based rotations and LORs - mainly those that are outpatient focused.

Wonder if that may just be a silver lining in all of this. If large numbers of DOs go unmatched due to P/F step it may force the hand of COCA to raise clinical standards significantly.

 

[group_theory]

Difficult to predict how residencies adjust to this new environment. Waiting to see what my own program does.

But absent a key discriminating factor, other factors take on more weight - the letter of recommendations, maybe who writes it - an academic attending (or division chief of a university hospital) vs private practice independent surgeon. "This is the best student I have ever encountered" takes on different meaning depending on who writes it.

Up until now I've only glanced at the rotation sites when I review the files, but maybe there will be more scrutiny? (maybe? - pure speculation)

Something will fill the void. How will a program decide who to invite for interview? Maybe the shelf exams score will take on significantly more importance.

DO schools will have to allow for more "electives" towards beginning of their 4th year to allow students to have rotations and "face-time" with potential programs.

The visiting student "electives" will suddenly be a lot more sought after, I suspect, esp from July-January.

 

[MedicineZ0Z]

Preceptorship tends to be high risk high reward. You can end up somewhere where you mostly shadow or you can be very actively involved. I'd try and find out what the specific attending you work with does.
Ideally, you'd do both. A mixture of autonomous preceptorship rotations and ward based academic center type rotations with residents.