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Planning 3rd/4th year rotation sites...Is there a pro or con for rotating alongside residents? I'm nervous they may do all of the patient care but also I think it would be interesting to be working alongside people who were just medical students a few months ago. thoughts?
 

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Residents + attendings are usually better teachers, each will think of something different to highlight
 
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Rotations on teaching teams are what residency programs are looking for - your preceptor based rotations will hardly count as real in the eyes of future residency programs. Get as many residency program based rotations as is humanly possible - you'll thank me later. When I was in your shoes I had no idea how much it mattered.
 
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Clinical years are when you're preparing for residency by learning how to act like a resident. Can't do that without residents to teach you. It also helps you shine when it comes time for audition rotations.
 
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There's pros and cons to each. But personally, from a medical and practical learning standpoint, I found my rotations so far that did not have residents to be much more enjoyable and allowed me to build a better relationship with the attending and patients. Not to mention having a greater role in patient care and being able to do a lot of procedures yourself or being first assist in procedures.

Some residents can be real dicks surprisingly (maybe just my experience). But some can be very nice too, so it varies.
 
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FutureDoctor5000

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Rotations on teaching teams are what residency programs are looking for - your preceptor based rotations will hardly count as real in the eyes of future residency programs. Get as many residency program based rotations as is humanly possible - you'll thank me later. When I was in your shoes I had no idea how much it mattered.
residencies wont know if they were preceptor or wards based though, I would say go for a mix of both, preceptor rotations are really chill and relaxed .. I would def do a resideceny wards based one in my field of interest though, other than that most wards based rotations are just med students standing behind the resident doing absolutely nothing, and writing a few notes, and if the resident sucks at teaching they aren't learning either.
 
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FutureDoctor5000

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Clinical years are when you're preparing for residency by learning how to act like a resident. Can't do that without residents to teach you. It also helps you shine when it comes time for audition rotations.
you cant literally "learn how to act" like a resident in one rotation... also many residents suck at teaching.
 
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you cant literally "learn how to act" like a resident in one rotation... also many residents suck at teaching.
I mean it really isn't THAT hard to ACT like a resident. If you've been in any sort of team environment before, halfway socialble, and work hard *with requisite knowledge* you'll fit right in. The people who have trouble fitting in are missing one or more of those things.

Its very much overblown on here to have 'resident' rotations. If you're doing things and not just shadowing its arguably better rotation. Dont get me wrong you need to have at least a couple resident rotations but honestly the vast majority I've been in haven't been any different than my sole preceptor rotations.
 
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residencies wont know if they were preceptor or wards based though, I would say go for a mix of both, preceptor rotations are really chill and relaxed .. I would def do a resideceny wards based one in my field of interest though, other than that most wards based rotations are just med students standing behind the resident doing absolutely nothing, and writing a few notes, and if the resident sucks at teaching they aren't learning either.
I have definitely been asked about my core and sub-I rotations on interviews, and have likewise had comments about being impressed by my experiences mentioned in my LORs. As in having evidence right there with a letter from an aPD describing *what* I did was super important to them even more so than how well I did those things or my personal attributes.
 
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residencies wont know if they were preceptor or wards based though, I would say go for a mix of both, preceptor rotations are really chill and relaxed .. I would def do a resideceny wards based one in my field of interest though, other than that most wards based rotations are just med students standing behind the resident doing absolutely nothing, and writing a few notes, and if the resident sucks at teaching they aren't learning either.
They ask in some IM interviews. You can lie and get away with it but it's a good idea to work with residents and learn how to work as part of that team.
 
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Please don't listen to the posts I've disliked above. They are doing you a disservice. Try your best to do as many rotations in academia or community with strong residency programs as you can. Your future self will be thanking you, I promise.
 
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There's pros and cons to each. But personally, from a medical and practical learning standpoint, I found my rotations so far that did not have residents to be much more enjoyable and allowed me to build a better relationship with the attending and patients. Not to mention having a greater role in patient care and being able to do a lot of procedures yourself or being first assist in procedures.

Some residents can be real dicks surprisingly (maybe just my experience). But some can be very nice too, so it varies.
lmao. You forgot "/s" at the end there.
 
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Here is the expectation by the third month of your intern year in an academic setting:

Be ready to admit 4-5 people on your shift, med recs, put in all the orders, present to your attending in a concise manner with your A/P, and manage another 4-5 people already on your census with minimal supervision from your senior, especially when that person has to see 14-17 new pts for that shift.

Be prepared to get torn if you aren’t at this level by Thanksgiving of your intern year.
 
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DrStephenStrange

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Here is the expectation by the third month of your intern year in an academic setting:

Be ready to admit 4-5 people on your shift, med recs, put in all the orders, present to your attending in a concise manner with your A/P, and manage another 4-5 people already on your census with minimal supervision from your senior, especially when that person has to see 14-17 new pts for that shift.

Be prepared to get torn if you aren’t at this level by Thanksgiving of your intern year.
Damn, What specialty is that? Is that in a big city?
 

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This answer is very speciality specific I think. But I think for a general rule of thumb, you want a teaching service with residents for the speciality you plan to apply to.

For something like IM, much more team-based focused, rounding the hospital, you definitely want that with a resident team. If you do inpatient IM with just a preceptor, odds are the day-to-day schedule would be chill for you (that's nice) but it's going to be "go at the docs pace" and you'll spend a month or whatever doing it their way. If however you do it with the teaching service (residents and attending), you'll get a much better idea of how you're supposed to act, function, and your true expectations in a year or two as an intern. I'm applying IM so I feel confident discussing this more than other specialities.

If you're planning a non-surgical speciality, then you don't necessarily need or even want a teaching service for your gen surg rotation, that would be miserable, just rotate with a surgeon and try to go home early lol.

Also, I think with rotations that are with preceptors and no residents or trainees, it's a coinflip if that preceptor is a good teacher, or even going to teach much at all. Looking back on my third year rotations, some of the rotations in specialities I'm not currently applying to were comical in how little these old docs taught. They've been out of real teaching for so long, they just wanted to chit chat with a younger kid about politics or whatever. It was a true waste of time. Compare that to an attending who works with residents daily, they more often than not are in a constant state of throwing out teaching points and pearls during rounds, at the computer stations, in the hallway walking towards lunch. Their main focus is to consistently teach residents because its the residents that are doing all the patient care for the attendings patient list. It's really a night and day difference.

TLDR: preceptors for specialties you're not applying to, resident/teaching teams for the speciality you are applying to.
 
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Residents are better.

Not only for the educational purposes listed above, but also for learning what residency is like in a specific field.

I’m on a preceptor-based IM rotation right now. There’s still plenty to learn. But if this was my only exposure to IM in third year, I would be thinking the field is super chill and may have considered it for a career.

But on my third year rotations at a residency program, I was counting down the seconds until I could escape the torture at morning report.
 
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DO2015CA

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Residents are better.

Not only for the educational purposes listed above, but also for learning what residency is like in a specific field.

I’m on a preceptor-based IM rotation right now. There’s still plenty to learn. But if this was my only exposure to IM in third year, I would be thinking the field is super chill and may have considered it for a career.

But on my third year rotations at a residency program, I was counting down the seconds until I could escape the torture at morning report.

Hospitalist gig is pretty chill once you finish residency, especially at a community hospital. Don’t let a residency dictate your life it’s only a few short years
 
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Damn, What specialty is that? Is that in a big city?

This is IM Ward. What I described will probably be one of those bad days during your intern year when you’re behind a note or two by the end of your shift, with the nurses paging you every couple of mins bc you just admitted some liver cirrhosis decimpensatinf pt or a somebody on Afib and they’re freaking out.
 
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They've been out of real teaching for so long, they just wanted to chit chat with a younger kid about politics or whatever. It was a true waste of time.

That resonates so much with one of my rotations. My preceptor just complained and grumbled about everything unrelated to medicine for a month. We would literally spend hours just sitting in his office discussing how much millennials suck, how lazy they are, Biden being the devil, democrats ruining our country, you name it. I just sat there agreeing with him for the month and he gave me a great eval for that in spite of knowing very little about OB.
 
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That resonates so much with one of my rotations. My preceptor just complained and grumbled about everything unrelated to medicine for a month. We would literally spend hours just sitting in his office discussing how much millennials suck, how lazy they are, Biden being the devil, democrats ruining our country, you name it. I just sat there agreeing with him for the month and he gave me a great eval for that in spite of knowing very little about OB.
100% Same thing happened to me with my 3rd year surg rotation. surgeon was maybe 70 year old chick who just went on and on about reagannomics and trickle down and how the people at the bottom don't want to pull themselves up.

On the plus side, she did let me do a lot of stuff in the OR, that was neat. But if I was going into surgery it would have been a pointless rotation because come audition time, I wouldn't have a clue how to operate as an intern managing the floor and rounding on patients.
 
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Chibucks15

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Please don't listen to the posts I've disliked above. They are doing you a disservice. Try your best to do as many rotations in academia or community with strong residency programs as you can. Your future self will be thanking you, I promise.
Eh say whatever you want but it’s overblown on here. May be true for surgery or whatever but there hasn’t been a huge difference at least in my rotations. I got to do more and be more involved without just doing phone calls and annoying patients by being like the fourth person to wake them up to ask them the same questions that they’ve heard 4 times.

there is value to them and yes try to get enough experience with it, but don’t tell me I’m doing a disservice when I’m talking of my experience. Maybe I’ve gotten lucky with my smaller rotations but I’ve barely noticed a difference. My point is to not freak out if you have some preceptor based. The full year of them is bad but it isn’t the end of the world if you have them
 
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Eh say whatever you want but it’s overblown on here. May be true for surgery or whatever but there hasn’t been a huge difference at least in my rotations. I got to do more and be more involved without just doing phone calls and annoying patients by being like the fourth person to wake them up to ask them the same questions that they’ve heard 4 times.

there is value to them and yes try to get enough experience with it, but don’t tell me I’m doing a disservice when I’m talking of my experience. Maybe I’ve gotten lucky with my smaller rotations but I’ve barely noticed a difference. My point is to not freak out if you have some preceptor based. The full year of them is bad but it isn’t the end of the world if you have them
I really do think it's speciality-dependent and also dependent on what you plan to apply/go into
 
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Eh say whatever you want but it’s overblown on here. May be true for surgery or whatever but there hasn’t been a huge difference at least in my rotations. I got to do more and be more involved without just doing phone calls and annoying patients by being like the fourth person to wake them up to ask them the same questions that they’ve heard 4 times.

there is value to them and yes try to get enough experience with it, but don’t tell me I’m doing a disservice when I’m talking of my experience. Maybe I’ve gotten lucky with my smaller rotations but I’ve barely noticed a difference. My point is to not freak out if you have some preceptor based. The full year of them is bad but it isn’t the end of the world if you have them


I had your experience without residents in what I felt was great working preceptorships. I was writing notes, seeing patients, presenting them to the attending, first assist in all surgeries but once I started residency I learned that it was not all that great. Those students that work with residents are so much more advantaged. Attendings mentally skip stuff because they know what is happening. The farther away from residency they are, the less helpful they are. Residents you will not only see what the right management is but you will see WHY which is so much more important. Then you also see how residencies function.
 
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I've been asked at all 3 of my interviews so far about my surgery rotations. They specifically wanted to know if I had worked with residents on all of them.
 
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Surgery is it’s own animal. Neuro there really hasn’t been a huge difference. As I said it’s very specialty dependent, and it depends if you’re trying to go to the ivory tower or not.

I seem to be one of the few on here just trying to chill and get out to the community haha
 
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residencies wont know if they were preceptor or wards based though, I would say go for a mix of both, preceptor rotations are really chill and relaxed .. I would def do a resideceny wards based one in my field of interest though, other than that most wards based rotations are just med students standing behind the resident doing absolutely nothing, and writing a few notes, and if the resident sucks at teaching they aren't learning either.

As a resident who went through 12 interviews and the match and now as a faculty attending who interviews for a mid size internal medicine residency I can tell you this is 100% false
 
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Just to re-iterate. I’ve seen 4th years medical students who did preceptor based medicine for 3rd year and it was scary how little they knew. May just be my personal experience, but I strongly recommend against the preceptor based teaching. Attendings who want to teach have residents. The programs are set up to have some educations with rounds, grand rounds, M&M etc.
 
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Surgery is it’s own animal. Neuro there really hasn’t been a huge difference. As I said it’s very specialty dependent, and it depends if you’re trying to go to the ivory tower or not.

I seem to be one of the few on here just trying to chill and get out to the community haha

wrong especially if you’re doing Neuro. Your intern year will be much heavier than the typical IM intern yr in term of inpatient months.

be prepared for the above mentioned on a regular basis. It also only gets worse in term of the hrs through your training years. There is no such thing as 4th yr senioritis in Neuro.
 
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wrong especially if you’re doing Neuro. Your intern year will be much heavier than the typical IM intern yr in term of inpatient months.

be prepared for the above mentioned on a regular basis. It also only gets worse in term of the hrs through your training years. There is no such thing as 4th yr senioritis in Neuro.
Hahahaha what the hell are you talking about? If it’s 4th year med school senioritis I’m 100% already in it so “no such thing” isn’t true. I’m livin the dream right now no need to burn myself out before I even get there. I seem to have gotten good evals even though I’m “slacking” by SDN standards.

If you’re talking about residency every neuro program I’ve interviewed at front loads so 4th year you’re barely taking call and you’re mostly electives. You seem to have no clue what you’re talking about
 
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Surgery is it’s own animal. Neuro there really hasn’t been a huge difference. As I said it’s very specialty dependent, and it depends if you’re trying to go to the ivory tower or not.

I seem to be one of the few on here just trying to chill and get out to the community haha


I can not speak to neurology. I was just referring to core education
 
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As a resident who went through 12 interviews and the match and now as a faculty attending who interviews for a mid size internal medicine residency I can tell you this is 100% false

Absolutely. We can 100% tell for auditioning fourth years then especially so for starting interns. They tend to be behind and have to catch up which sometimes can be hard.
 
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I also will strait up ask in interviews how many rotations were wards based, and reading comments in the MSPE is often a big clue as well. It helps me gauge how prepared a future intern is going to be on day 1. Don't get me wrong, I will happily recommend ranking to match people with mostly preceptor based rotations but they better have great MSPE comments and come off like someone who can think on their feet and appear competent in their interview.
 
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As someone applying to an advanced program, I was asked this on every prelim/ty interview I have gone to. Specifically on how my IM rotation was structured. OP I would choose rotations with more resident affiliations, I think it will only benefit you in the long run.
 
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I also will strait up ask in interviews how many rotations were wards based, and reading comments in the MSPE is often a big clue as well. It helps me gauge how prepared a future intern is going to be on day 1. Don't get me wrong, I will happily recommend ranking to match people with mostly preceptor based rotations but they better have great MSPE comments and come off like someone who can think on their feet and appear competent in their interview.

As someone applying to an advanced program, I was asked this on everyone prelim/ty interview I have gone to. Specifically on how my IM rotation was structured. OP I would choose rotations with more resident affiliations, I think it will only benefit you in the long run.


I had similar questions in peds interviews. I wanted an inpatient heavy peds residency so it makes sense why
 
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I mean nobody is arguing it’s good to have academic rotations, especially in IM and surgery. My point is you won’t be incompetent and the world won’t end if you have a few preceptor based ones. Having all preceptor based obviously isn’t ideal
 
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Hahahaha what the hell are you talking about? If it’s 4th year med school senioritis I’m 100% already in it so “no such thing” isn’t true. I’m livin the dream right now no need to burn myself out before I even get there. I seem to have gotten good evals even though I’m “slacking” by SDN standards.

If you’re talking about residency every neuro program I’ve interviewed at front loads so 4th year you’re barely taking call and you’re mostly electives. You seem to have no clue what you’re talking about

lol ohhh boyyy. I’ll just let life gives you some humble pies in the next couple of years.
 
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Chibucks15

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lol ohhh boyyy. I’ll just let life gives you some humble pies in the next couple of years.
Oh I’m fully ready to get my ass kicked in residency. But speaking directly to residents they’ve said there really isn’t anything much you can do to prep. It’s gonna kick your ass regardless. So my mindset is enjoy life while I can. Apologies to you and the SDN try hards who are astonished I don’t want to be working 60+ hours a week as an M4 in application season when it will make a marginal difference if any at all

Logistically though none of what you said has been my direct experience in terms of hours and the like. But thanks anyway!
 
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As a resident who went through 12 interviews and the match and now as a faculty attending who interviews for a mid size internal medicine residency I can tell you this is 100% false
So you ask them if every single rotation they ever did is wards vs. preceptor? I strongly recommend doing a wards based in your specialty of interest in 3rd and 4th year . Also there’s the entire 4th year and the ability do to everything wards based even in fields you have no interest in like surgery etc.. via elective rotations. I just don’t see what the issue is here at all.. I can’t imagine someone making it through all 4 years of any Med school in the us with strictly all preceptor based rotations. My school has several sites with mostly wards and others more preceptor based but no one will strictly do all preceptor only. It’s all a requirement at my school to have atleast one THIRD year wards based rotation with residents, I am sure most other schools do this as well. There’s good preceptor based rotations and there’s bad wards based rotation where you learn absolutely nothing cause the resident won’t teach you and you can’t even write notes since you don’t have access to the emr, you go to didactic and morning report but that’s about it.
 
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Oh I’m fully ready to get my ass kicked in residency. But speaking directly to residents they’ve said there really isn’t anything much you can do to prep. It’s gonna kick your ass regardless. So my mindset is enjoy life while I can. Apologies to you and the SDN try hards who are astonished I don’t want to be working 60+ hours a week as an M4 in application season when it will make a marginal difference if any at all

Logistically though none of what you said has been my direct experience in terms of hours and the like. But thanks anyway!

I agree with everything on this post, but disagree with 90% of your other posts on this thread. Considering that I make the schedule for Neurology residents, I think I have an idea of your potential hours and clinical exp in the next couple of years. Thanks for the lols
 
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Chibucks15

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I agree with everything on this post, but disagree with 90% of your other posts on this thread. Considering that I make the schedule for Neurology residents, I think I have an idea of your potential hours and clinical exp in the next couple of years. Thanks for the lols
No problem glad I could help. Maybe at your program they like to kick the residents ass but everyone I’ve rotated at that isn’t the case. I’m guessing you’re at a coastal big wig place. Glad I ain’t heading out that way for sure
 

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So you ask them if every single rotation they ever did is wards vs. preceptor? I strongly recommend doing a wards based in your specialty of interest in 3rd and 4th year . Also there’s the entire 4th year and the ability do to everything wards based even in fields you have no interest in like surgery etc.. via elective rotations. I just don’t see what the issue is here at all.. I can’t imagine someone making it through all 4 years of any Med school in the us with strictly all preceptor based rotations. My school has several sites with mostly wards and others more preceptor based but no one will strictly do all preceptor only. It’s all a requirement at my school to have atleast one THIRD year wards based rotation with residents, I am sure most other schools do this as well. There’s good preceptor based rotations and there’s bad wards based rotation where you learn absolutely nothing cause the resident won’t teach you and you can’t even write notes since you don’t have access to the emr, you go to didactic and morning report but that’s about it.

The 1 third year rotation being with residents rule was adopted when the merger happened. The first class where COCA required it was for 2020. For my class it was not. I had zero rotations with residents until my auditions which were not required by my school. I went to ACOM, so a relatively new school but not one that is constantly dragged on sdn for the despicable rotations. Now if that happened where I was, then imagine schools where people do drag those schools.
 
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Hospitalist gig is pretty chill once you finish residency, especially at a community hospital. Don’t let a residency dictate your life it’s only a few short years
I should clarify. I would have had no clue what goes into that chill gig. I.e., the thought process, decision-making, etc.
 
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FutureDoctor5000

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The 1 third year rotation being with residents rule was adopted when the merger happened. The first class where COCA required it was for 2020. For my class it was not. I had zero rotations with residents until my auditions which were not required by my school. I went to ACOM, so a relatively new school but not one that is constantly dragged on sdn for the despicable rotations. Now if that happened where I was, then imagine schools where people do drag those schools.
Hmm yea idk, I guess it could be hard for schools where they don’t have affiliations with hospitals with residency programs to get their students into more traditional wards based rotations. I thought ACOM had southeastern health which has a few residencies and many students rotate there but that might be new and after you graduated.
 

Osteosaur

I eat the whole patient
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Its weird.

When I did a preceptor based FM rotation they were pretty good about teaching. Would let me see the patient, present, critique A&P and write the note. This was like 6-8 patients each day. I mean I felt like i was getting a good experience on the day to day. Like is this a "normal" preceptor-based rotation, or a good one and most are worse?

In IM I maybe saw and 1-3 each day. I got to present and do a note, but I definitely "felt" like I was doing less. Then again I guess I am also unconciously picking up what residents are meant to be doing.
 
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Chibucks15

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Its weird.

When I did a preceptor based FM rotation they were pretty good about teaching. Would let me see the patient, present, critique A&P and write the note. This was like 6-8 patients each day. I mean I felt like i was getting a good experience on the day to day. Like is this a "normal" preceptor-based rotation, or a good one and most are worse?

In IM I maybe saw and 1-3 each day. I got to present and do a note, but I definitely "felt" like I was doing less. Then again I guess I am also unconciously picking up what residents are meant to be doing.
This is my experience as well to a T. Which is why my mindset is as above. Apparently those are good ones that we’ve had
 

FutureDoctor5000

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I agree with everything on this post, but disagree with 90% of your other posts on this thread. Considering that I make the schedule for Neurology residents, I think I have an idea of your potential hours and clinical exp in the next couple of years. Thanks for the lols
Yea but you do it at ONE neurology residency, and there’s plenty to *****y ones, you very well might be at one Chibucks15 is also speaking from is real experience at other neuro residencies...
 
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fldoctorgirl

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I think about this all the time. I want to do IM and I'll have one outpatient month and one month with a hospitalist. Apparently the hospitalist rotation is the one you want to have if you want to do IM-- supposedly you practically run his service, round on the patients, write all the notes and come up with your own plan and he will sign off or amend it. Butttttt, I don't believe either of these will have residents. So I'm super excited for the rotation and think I will learn a lot, but every time I read SDN it makes me nervous that I'll look like an idiot come sub-Is/intern year.

I've been with residents for a couple of other rotations. I agree with others that I have noticed the attendings are far better teachers than when I've been preceptor-based. It was also definitely nice to see the role of the resident. However, and this is probably just because I haven't rotated at a big academic center?, I haven't noticed much of a difference besides that. Don't know why.

Regardless, I'm planning on doing several months of sub-Is in IM, so I hope that will fix any deficiencies. Does anyone have any other tips for bridging the gap you claim to see? I've worked with residents who graduated from my school and haven't noticed them seeing more or less proficient than their co-residents, but I don't know. I tried really hard to get an IM rotation with residents (my school has one at a big academic center), but my clinical coordinator told me they didn't care and couldn't take requests lol. Makes no sense to me but just another example of schools trying to sabotage us :rolleyes:
 
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sunshinefl

All Gold Everything
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I think about this all the time. I want to do IM and I'll have one outpatient month and one month with a hospitalist. Apparently the hospitalist rotation is the one you want to have if you want to do IM-- supposedly you practically run his service, round on the patients, write all the notes and come up with your own plan and he will sign off or amend it. Butttttt, I don't believe either of these will have residents. So I'm super excited for the rotation and think I will learn a lot, but every time I read SDN it makes me nervous that I'll look like an idiot come sub-Is/intern year.

I've been with residents for a couple of other rotations. I agree with others that I have noticed the attendings are far better teachers than when I've been preceptor-based. It was also definitely nice to see the role of the resident. However, and this is probably just because I haven't rotated at a big academic center?, I haven't noticed much of a difference besides that. Don't know why.

Regardless, I'm planning on doing several months of sub-Is in IM, so I hope that will fix any deficiencies. Does anyone have any other tips for bridging the gap you claim to see? I've worked with residents who graduated from my school and haven't noticed them seeing more or less proficient than their co-residents, but I don't know. I tried really hard to get an IM rotation with residents (my school has one at a big academic center), but my clinical coordinator told me they didn't care and couldn't take requests lol. Makes no sense to me but just another example of schools trying to sabotage us :rolleyes:
Do what you’re already planning to do. That’s what I advise the M3s at my school who got Core sites without residents—— do as many electives, aways, and sub-Is at residency-based clerkships that you can during 3rd and 4th year, especially in your field, but also at least 1 IM if you’re going into anything possibly related or with any IM wards in intern year.
 
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