Why are preceptor based rotations so bad? Is is because there is little to no consistency?
That's one. You have little to no control over the quality of your preceptor. Some can be great, and some are truly a joke. And if you do all your rotations with the preceptor model, you get to run this crapshoot every month. Sound fun?
Is it because residency programs don't recognize these rotations as adequate training?
That's two. Several hospitals in Arizona do not accept students for 4th year rotations unless previous core rotations were done on a ward based system. So good luck trying to get an audition rotation there, and kiss a chance of matching there goodbye.
I would like to hear this expounded on by someone that has experienced both kinds or clerkships.
Sure thing. Some other reasons why preceptors are a shady way to go: your school cannot ever hope to adequately ensure that each preceptor gives students a good experience. They don't have the manpower to ensure much of any quality control. Of course, this assumes that the school is as interested in your 3rd/4th year education as they are your tuition check.
A really big problem is that preceptor based rotations DO NOT prepare you to be a resident. There is a huge amount of knowledge gained by clerking in a hospital that cannot be learned but by experience. You can know all the books, but what does it gain you if you don't know how to get a stat CT done in the middle of the night? What happens in your internship when you've never been around the interventions needed for a hypotensive patient? It's not just about learning from an attending, you learn from the environment. If you don't get a good foundation as a student, you'll be behind as an intern. And nobody likes that intern.
Autonomy can be an issue too. At AZCOM, many of the preceptors are doctors first and teachers second. What I mean by this is that they have to sustain a practice, and paying the bills will come before teaching students. Just a fact of life. This isn't to say that you have to just shadow and be a fly on the wall, never seeing patients by yourself, but it tends to happen more with a preceptor.
You also need exposure to different attendings. being stuck with one guy for a month isn't ideal. Do two family practice rotations, and you'll see why. You've gotta get perspective on the many different ways to approach clinical problems as a student.
Also, the residents you associate with will supplement your education a lot. In many instances, they are more current and better read on subjects than the attendings, and they are more prone to teach because they are still in the academic soup. Also, they are a lot closer to your peer group, and can become very good and valuable friends, counselors, and advocates.
Another big reason is that ward based rotations make it much easier to make connections and get letters. This is crucial come residency application time.
You need structure a a 3rd/4th year. Ward based rotations usually have a good didactic schedule that are a boon to your personal reading.
Oh yeah, with preceptors, you'll be driving all over the Valley. that gets old. Of course, this can be true of ward based rotations as well.
These are just some of the reasons. There are certainly more. Don't believe the hype they give pre-meds about their preceptor based rotations. They were spewing that stuff long before I came, they still did it while I was there, and they'll keep spinning it. If you go to AZCOM, do your very best to get a majority of ward based rotations, supplemented by a few preceptors. I fully admit that preceptors can be great a s a supplement to round out your rotations. They just aren't a good idea when used as the base of your education. It's almost reminiscent of nurse practitioner training in a way. Not good.
As for the school, I actually liked it. Loved my classmates, and the school fit me well. Some really great individuals in the faculty and administration. Most importantly, I'm doing what I want to do now in residency. However, I am very wary of the new rule keeping 3rd years in AZ. Maybe some current students can comment on how that's working out.
