Benefit to Rotating with Residents?

[sunshinefl]

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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.

My mandatory core outpatient rotations were without residents, but all my inpatient/IM/surgery/psych/EM were with residents. I always felt like I learned much more with residency based rotations, and even preferred the IM team with the interns over the one with the seniors only. In private practice outpatient, I was either made to act like an MA or a PA, not in between. Like I wasn’t treated and respected as a medical student *learner*, I was free labor either being tasked over my head to be almost completely independent, or rooming patients and getting vitals.

 

[Espressso]

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.

Your experience isn't necessarily rare. I've had preceptor rotations as a third year where the preceptor was just an incredible teacher and enjoyed teaching the single student he had in his office. But my feeling is that with preceptors it's a bit more of a toss up. I think many students can have preceptor rotations and feel like they've learned a lot. But I know for me, there were a handful of preceptor rotations in which the preceptor just kinda, sucked, really.

All in all though, the difference is what you mention in the end of your comment: with the resident teams, you end the rotation having a much better grasp with what you're supposed to be doing, as a resident. And that I think helps a lot for auditions in early fourth year, and really sets you up well for intern year. This doesn't equate to "if you don't work with residents you'll suck as a resident!". What I'm trying to say is that it helps a lot.

Again, I think this discussion is very dependent on which speciality you plan on going into. Me doing my OB rotation with a bunch of really solid residents was great, but I'm not applying OB and learning how to be an OB resident wasn't really going to come into play much for me as an IM intern. But if I was applying OB, man, that rotation would have helped me alot come audition time.

 

[FrechToastFries]

lmao. You forgot "/s" at the end there.

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.

What a pretentious reply. I'm literally just sharing my experience and how I felt about my rotation. I'm not saying that's the case for everyone. I just enjoyed my preceptor based rotations a lot more.

 

[ortnakas]

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?

What @CocoMelon0531 described as a bad day sounds pretty normal to me. Except for we usually run at 8-10 ongoing patients for interns, and it’s not uncommon to cap out on new patients.

Preceptors can teach a lot one on one. Some are great. But as a rule, they won’t teach you residency workflow or how to function as an intern.

I don’t think you’re doomed if you don’t have wards based rotations, but getting as many as you can will help you
—adjust to the workload
—understand the hierarchy and how to work as a team (I have co-residents who never did before and while they’re great now, they uniformly had a pretty awkward first July)
—see if the training is for you/something you’re willing to do (you won’t be a resident forever, but it’s 3-5 years, and if you only see, for example, community subspecialty life and not surgery resident life, you’re gonna have a bad time)

 

[ciestar]

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.

Yikes. Im on our FM service this month and my day never looks this bad lol
But im also at a community hospital and many days we wont get 5 admissions in a day let alone a shift. Either way, im capped at 6 patients and i mostly can handle it.

 

[hallowmann]

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.

You're exaggerating a bit here. I was on-board with your description until the bolded. Unless your definition of "seeing" is laying eyes on 15 new pts because you have 3 juniors under you, but no way is the senior doing 14-17 admissions/new consults by themselves for the shift. Most hospitalists don't do that in a day (again unless you're including rounding on already admitted patients).

4-5 admits for the junior during the shift seems reasonable, busy, but within the realm of expectations. Good seniors will help taking 1-2, but if it's busy they might not. The interns are carrying up to 7-8 patients by this time, so if they're only rounding on 3-4 in the AM, they have room for 4-5 admits.

 

[CocoMelon0531]

You're exaggerating a bit here. I was on-board with your description until the bolded. Unless your definition of "seeing" is laying eyes on 15 new pts because you have 3 juniors under you, but no way is the senior doing 14-17 admissions/new consults by themselves for the shift. Most hospitalists don't do that in a day (again unless you're including rounding on already admitted patients).

4-5 admits for the junior during the shift seems reasonable, busy, but within the realm of expectations. Good seniors will help taking 1-2, but if it's busy they might not. The interns are carrying up to 7-8 patients by this time, so if they're only rounding on 3-4 in the AM, they have room for 4-5 admits.

Coverage is by 1 senior and four interns for Team 1/2/3/4 for a total of 14- 18 admissions throughout the day. Each team max cap is 12. Depending on the ED, the late intern who is in charge of admits throughout the day, can be in charge of 5-8 pts already on the census on top of the 4-5 admits. Those things happened quite frequently to me.

 

[hallowmann]

Coverage is by 1 senior and four interns for Team 1/2/3/4 for a total of 14- 18 admissions throughout the day. Each team max cap is 12. Depending on the ED, the late intern who is in charge of admits throughout the day, can be in charge of 5-8 pts already on the census on top of the 4-5 admits. Those things happened quite frequently to me.

Yeah, so the senior has 4 interns. They're not doing 14-18 new admissions, they're laying eyes on the patients the interns are admitting.

Also, IM interns are limited to 10 patients per day. Unless the senior is carrying 2 patients from each team, I'm pretty sure that wouldn't fly. 10 patients a day, 4-5 old and 5 new is not unreasonable. If it's truly 12 per intern, I'd say that's borderline unsafe and not "how it is in academic medicine".

 

[CaffeineStat]

Wow- I step away for a few days to study for an exam and come back to so many good responses. Thankful for everyone that took the time to read and answer my question!!

 

[ortnakas]

Yeah, so the senior has 4 interns. They're not doing 14-18 new admissions, they're laying eyes on the patients the interns are admitting.

Also, IM interns are limited to 10 patients per day. Unless the senior is carrying 2 patients from each team, I'm pretty sure that wouldn't fly. 10 patients a day, 4-5 old and 5 new is not unreasonable. If it's truly 12 per intern, I'd say that's borderline unsafe and not "how it is in academic medicine".

Cap is ten per day ongoing- you can have 4-5 new on top of your ongoing (this is a combination of transfers/admits from a night team and new admissions).

 

[Mass Effect]

The biggest travesty of a DO education is preceptor-based rotations. Get on an academic team and don't look back. And I disagree with the advice to do core rotations without residents. You need residents on every rotation you can find them.

 

[Mass Effect]

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.

This. I'm psych and by Thanksgiving of intern year, I was on my second month of medicine wards and was admitting 3-4 patients a day and carrying a total of 10-12 patients with little supervision. I made a lot of mistakes (as everyone will) and my preceptor based med school IM rotation didn't even come close to preparing me.

 

[calivianya]

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.

Geez. Maybe I will just try to match at my core site (community IM).

The intern on my IM team was capped at 5 patients until right before I was off the rotation - he had started taking 6 then (October). That includes admits and current inpatients. The second and third years were capped at 10 patients each, and that includes the intern‘s patients that they were sharing plus the med students’ patients. A lot of days I was there, the 2nd/3rd years didn’t write any notes because all of their patients were covered by med students or interns. Once all the 2nd/3rd years across all teams had 10 patients, the attendings dropped in and took patients alone... so even as a third year, you’d never have more than 10 total including admits and current inpatients.

Obviously if you know you want a certain fellowship it’s advantageous to go to a program that has it, but otherwise it’s not the end of the world to go community IM in a smaller hospital. The only specialty it seems like my program has difficulty getting residents into is GI... they’ve matched some good programs for other specialties.

 

[deleted898021]

Geez. Maybe I will just try to match at my core site (community IM).

The intern on my IM team was capped at 5 patients until right before I was off the rotation - he had started taking 6 then (October). That includes admits and current inpatients. The second and third years were capped at 10 patients each, and that includes the intern‘s patients that they were sharing plus the med students’ patients. A lot of days I was there, the 2nd/3rd years didn’t write any notes because all of their patients were covered by med students or interns. Once all the 2nd/3rd years across all teams had 10 patients, the attendings dropped in and took patients alone... so even as a third year, you’d never have more than 10 total including admits and current inpatients.

Obviously if you know you want a certain fellowship it’s advantageous to go to a program that has it, but otherwise it’s not the end of the world to go community IM in a smaller hospital. The only specialty it seems like my program has difficulty getting residents into is GI... they’ve matched some good programs for other specialties.

What programs is this...?

 

[MLNS]

Geez. Maybe I will just try to match at my core site (community IM).

The intern on my IM team was capped at 5 patients until right before I was off the rotation - he had started taking 6 then (October). That includes admits and current inpatients. The second and third years were capped at 10 patients each, and that includes the intern‘s patients that they were sharing plus the med students’ patients. A lot of days I was there, the 2nd/3rd years didn’t write any notes because all of their patients were covered by med students or interns. Once all the 2nd/3rd years across all teams had 10 patients, the attendings dropped in and took patients alone... so even as a third year, you’d never have more than 10 total including admits and current inpatients.

Obviously if you know you want a certain fellowship it’s advantageous to go to a program that has it, but otherwise it’s not the end of the world to go community IM in a smaller hospital. The only specialty it seems like my program has difficulty getting residents into is GI... they’ve matched some good programs for other specialties.

You become a better doctor by seeing more patients and seeing more pathology. What you described sounds like a place I wouldn’t even apply to.

 

[calivianya]

You become a better doctor by seeing more patients and seeing more pathology. What you described sounds like a place I wouldn’t even apply to.

To each his own, for sure.

I don’t feel like there’s a significant skill difference between the attendings I work with here and the attendings I used to work with in my previous life at a 900+ bed tertiary referral center, and many of the attendings here did residency locally. I’d trust either set with myself or my family (so far - haven’t worked with everyone here yet). Granted, I can’t compare the resident quality because I intentionally avoided working at teaching facilities before.

I suppose it depends on what your goals are. If you want to manage the unicorns for a living you need to go to a bigger center for sure because seeing all the stuff places like the one I’m at refer out is important, but you can learn to manage bread and butter DM, HF, pneumonia, COPD, etc. anywhere.

 

[hallowmann]

Cap is ten per day ongoing- you can have 4-5 new on top of your ongoing (this is a combination of transfers/admits from a night team and new admissions).

So in the scenario they were talking about the night team would have 12 patients per team (because of what happened during the day) that day, so unless they are discharging overnight, I don't see how you don't end up having >10 carrying over for the next day. The only scenario where I could see this working out is if each day you were DCing at least two in addition to getting the 4-5 admits, which again, I guess that would work. That means at least a couple of those carry over patients were basically wrapped up, so you weren't managing >10 "acute" patients daily. That would be fine.

 

[Chibucks15]

The biggest travesty of a DO education is preceptor-based rotations. Get on an academic team and don't look back. And I disagree with the advice to do core rotations without residents. You need residents on every rotation you can find them.

Again, nobody is saying that you should shoot for preceptor based ones. All anyone has ever said is that if you happen to get a good chunk of them it won’t be the end of the world (specialty dependent). And again, nobody denied that you should at minimum get a rotation with a residency in your field of choice. It’s overblown on here that every single rotation needs to be with residents or you’re subpar. Sweeping generalized statements do not help people who just read these pages.

It really isn’t that hard to meld into a resident team and get the job done. If you’re in any way sociable, hardworking, and a team player it’s pretty damn easy. If I'm not going into OB there’s really no need for me to see how an OB resident works for example.

 

[thumbz]

I'll swoop back into this thread - about a page ago someone asked if I ask about every rotation when I interview. Thankfully I don't need to. Think about how you'll answer this question: "how many of your rotations were in a hospital where you worked directly with residents on a teaching team?". I always want the answer to be more than 1. And the more the better. Don't worry, I know everyone is going to do some preceptor based rotations. If your answer to that question is 1 (or zero, which I have had rarely happen) be prepared to explain how it prepared you to function as an intern, how you are at managing multiple patients and what you learned about work flow. And before I catch a bunch of grief - settle down everyone, I don't expect a med student to function as an intern. However, I also don't want to spend the first 3 months of intern year teaching someone how to function as an MS3 so they can then start functioning as an intern. It's a short path to ending up on remediation and extending your training.

Be careful going to a program that caps residents at low numbers. As a resident you'll love it and it'll seem totally worth it. When you finish, and decide you want to get a job as a hospitalist, you'll hate it. As a hospitalist you'll be carrying 15-20 patients and if you've never done it before it will be a steep learning curve. Part of residency is learning efficiency, and the other part is balancing teaching/education with volume.

Lastly - be careful who you listen to for advice and who you don't. Feel free to disregard my advice and take the advice of other posters in this thread. Here's me: I interview residents for IM and I'm a full time academic hospitalist. I don't know what the job titles of others are doling out advice for you.

 

[deleted898021]

Again, nobody is saying that you should shoot for preceptor based ones. All anyone has ever said is that if you happen to get a good chunk of them it won’t be the end of the world (specialty dependent). And again, nobody denied that you should at minimum get a rotation with a residency in your field of choice. It’s overblown on here that every single rotation needs to be with residents or you’re subpar. Sweeping generalized statements do not help people who just read these pages.

It really isn’t that hard to meld into a resident team and get the job done. If you’re in any way sociable, hardworking, and a team player it’s pretty damn easy. If I'm not going into OB there’s really no need for me to see how an OB resident works for example.

There’s also the whole 4th year(in a normal year without covid) where you can do all wards based electives and learn how a resident “functions”. I even fail to understand what the point is. If someone goes out of their way to only do preceptor based ones for all 4 years, they will reap what they sow...

 

[Mass Effect]

It really isn’t that hard to meld into a resident team and get the job done. If you’re in any way sociable, hardworking, and a team player it’s pretty damn easy. If I'm not going into OB there’s really no need for me to see how an OB resident works for example.

I'm confused on why you think that the reason you should be on an OB resident team is "to see how an OB resident works." That isn't even close to being the point.

 

[deleted898021]

I'll swoop back into this thread - about a page ago someone asked if I ask about every rotation when I interview. Thankfully I don't need to. Think about how you'll answer this question: "how many of your rotations were in a hospital where you worked directly with residents on a teaching team?". I always want the answer to be more than 1. And the more the better. Don't worry, I know everyone is going to do some preceptor based rotations. If your answer to that question is 1 (or zero, which I have had rarely happen) be prepared to explain how it prepared you to function as an intern, how you are at managing multiple patients and what you learned about work flow. And before I catch a bunch of grief - settle down everyone, I don't expect a med student to function as an intern. However, I also don't want to spend the first 3 months of intern year teaching someone how to function as an MS3 so they can then start functioning as an intern. It's a short path to ending up on remediation and extending your training.

Be careful going to a program that caps residents at low numbers. As a resident you'll love it and it'll seem totally worth it. When you finish, and decide you want to get a job as a hospitalist, you'll hate it. As a hospitalist you'll be carrying 15-20 patients and if you've never done it before it will be a steep learning curve. Part of residency is learning efficiency, and the other part is balancing teaching/education with volume.

Lastly - be careful who you listen to for advice and who you don't. Feel free to disregard my advice and take the advice of other posters in this thread. Here's me: I interview residents for IM and I'm a full time academic hospitalist. I don't know what the job titles of others are doling out advice for you.

I mean if anyone has ever done 4th year auditions and electives, that answer will undoubtedly be more then 1 even if they never did a single wards based one thier entire third year. I don’t know how many people never audtion anywhere and only do preceptor based rotations their entire 3rd and 4th year, it’s in the very very small minority of people...

 

[Ho0v-man]

Again, nobody is saying that you should shoot for preceptor based ones. All anyone has ever said is that if you happen to get a good chunk of them it won’t be the end of the world (specialty dependent). And again, nobody denied that you should at minimum get a rotation with a residency in your field of choice. It’s overblown on here that every single rotation needs to be with residents or you’re subpar. Sweeping generalized statements do not help people who just read these pages.

It really isn’t that hard to meld into a resident team and get the job done. If you’re in any way sociable, hardworking, and a team player it’s pretty damn easy. If I'm not going into OB there’s really no need for me to see how an OB resident works for example.

Yeah I agree to an extent. Get as much as you can of course. But most MD students aren’t with residents on every rotation. As long as you do a couple and still try to function that way when you’re with preceptors it’s all good.

 

[Chibucks15]

I'm confused on why you think that the reason you should be on an OB resident team is "to see how an OB resident works." That isn't even close to being the point.

That was a specific reason given from before. But I’ve done a few of both so in my experience there hasn’t been too much difficulty switching back and forth. It may make more a difference in different locations or specialty. Idk I’ve gotten good evals so it hasn’t seemed to affect me so far...

 

[CaffeineStat]

The biggest travesty of a DO education is preceptor-based rotations. Get on an academic team and don't look back. And I disagree with the advice to do core rotations without residents. You need residents on every rotation you can find them.

Do MD programs not have preceptor-based rotations?? That's news to me.

 

[Mass Effect]

That was a specific reason given from before. But I’ve done a few of both so in my experience there hasn’t been too much difficulty switching back and forth. It may make more a difference in different locations or specialty. Idk I’ve gotten good evals so it hasn’t seemed to affect me so far...

The point is to learn that specialty. When you're in a preceptor-based rotation, you learn what the preceptor teaches. When you're on a resident team at an academic hospital, you learn what there is to learn. Is that full proof? No, of course not. Some preceptors are excellent teachers and some residents suck, but the difference between a community hospital with a preceptor and an academic hospital with resident teams is, in many (most) cases, significant.

 

[Mass Effect]

Do MD programs not have preceptor-based rotations?? That's news to me.

Most MD schools have their students at academic hospitals and/or on resident teams for at least half their rotations whereas there are a number of DO schools that have their entirely 3rd year curriculum in community hospitals/on non-resident teaching teams.

 

[Chibucks15]

The point is to learn that specialty. When you're in a preceptor-based rotation, you learn what the preceptor teaches. When you're on a resident team at an academic hospital, you learn what there is to learn. Is that full proof? No, of course not. Some preceptors are excellent teachers and some residents suck, but the difference between a community hospital with a preceptor and an academic hospital with resident teams is, in many (most) cases, significant.

I have had a good mix of both. It may be regional but there really hasn’t been much different to me. But to each their own

 

[Mass Effect]

I have had a good mix of both. It may be regional but there really hasn’t been much different to me. But to each their own

Let's check back in when you're a resident.

 

[ciestar]

Do MD programs not have preceptor-based rotations?? That's news to me.

Of all of my rotations as a med student, i only had 2 preceptor based rotations...

 

[Chibucks15]

Let's check back in when you're a resident.

Sure. I’m gonna go ahead and doubt it’ll be much of a difference after speaking directly to residents. Residency sucks regardless. It may suck 5% more but I think ill be okay. I’m simply saying I didn’t notice a huge difference and I’ve had literally the same experience as MD students.

also I did my entire third year with residents, it’s been my fourth year I’ve had a mix of residents and preceptors. So using your logic, I should be just fine right? Appreciate the concern there bud

 

[Lexdiamondz]

Not a DO and not in IM (EM actually) but it's pretty telling when the vast majority of residents in a thread are in agreement that having more rotations on teaching services is important.

As someone who had to do 6 weeks of IM wards as resident, as well as 8 months of critical care and a month of general surgery - if I didn't have a strong IM and GS inpatient experience on a teaching service as an MS3 I would have been screwed.

Preceptor based rotations are fine as a 4th year - in fact I'd argue they're better as an MS4 because you'll have at least enough baseline knowledge to make use of them and can be useful for some electives- but they definitely shouldn't make up the majority of your MS3 year.

 

[Chibucks15]

Not a DO and not in IM (EM actually) but it's pretty telling when the vast majority of residents in a thread are in agreement that having more rotations on teaching services is important.

As someone who had to do 6 weeks of IM wards as resident, as well as 8 months of critical care and a month of general surgery - if I didn't have a strong IM and GS inpatient experience on a teaching service as an MS3 I would have been screwed.

Preceptor based rotations are fine as a 4th year - in fact I'd argue they're better as an MS4 because you'll have at least enough baseline knowledge to make use of them and can be useful for some electives- but they definitely shouldn't make up the majority of your MS3 year.

Completely agreed, which is what everyone’s been saying all along haha

 

[Lexdiamondz]

Completely agreed, which is what everyone’s been saying all along haha

There's quite a few people in this thread saying "it doesn't matter" or something to that effect. Nearly all of them are med students, who almost invariably don't have any real insight into whether or not it matters yet.

Geez. Maybe I will just try to match at my core site (community IM).

The intern on my IM team was capped at 5 patients until right before I was off the rotation - he had started taking 6 then (October). That includes admits and current inpatients. The second and third years were capped at 10 patients each, and that includes the intern‘s patients that they were sharing plus the med students’ patients. A lot of days I was there, the 2nd/3rd years didn’t write any notes because all of their patients were covered by med students or interns. Once all the 2nd/3rd years across all teams had 10 patients, the attendings dropped in and took patients alone... so even as a third year, you’d never have more than 10 total including admits and current inpatients.

Obviously if you know you want a certain fellowship it’s advantageous to go to a program that has it, but otherwise it’s not the end of the world to go community IM in a smaller hospital. The only specialty it seems like my program has difficulty getting residents into is GI... they’ve matched some good programs for other specialties.

This program sounds clinically pretty weak. As an intern on IM in September I was capped at 10 patients and a PGY3 should be more than capable of handling >10 patients. These grads would have some challenges managing a busy hospitalist service in any medium sized institution if they never get to manage more than 10 patients (including the intern's) and rarely wrote notes.

 

[Chibucks15]

There's quite a few people in this thread saying "it doesn't matter" or something to that effect. Nearly all of them are med students, who almost invariably don't have any real insight into whether or not it matters yet.

At least for me when I’m saying things along those lines, and I assume it’s the way that most people meant it, was that if you end up with a chunk of preceptor rotations in specialties that don’t matter to you, likely it really won’t make THAT much of a difference. Most people do a good amount of their 4th year like that unless they’re really busting their ass more than necessary (the SDN way).

also, for many of us (myself included) we’re gonna go chill outpatient and let other people take the 20 patient lists inpatient. I know there’s plenty of paperwork outpatient too, but it’s a whole different animal in terms of time and note requirements

 

[Ho0v-man]

Of all of my rotations as a med student, i only had 2 preceptor based rotations...

And that’s the big difference. In 3rd year I only had 4 rotations with residents and the rest are with preceptors. Could’ve done 5 but the scheduling didn’t work out. That’s actually pretty good for a DO school, sadly. Ever since Covid hit, it’s been all preceptors except my one allowed away rotation but that’s of course not normal.

The big problem is I actually had to try to get this much education. Despite it being a coca rule, there’s plenty of sites at my school that don’t offer any wards based rotations. They ask students to pick a rotation site in 4th semester before boards when everything is on fire. So of course the vast majority of students will pick the notoriously chill sites if they can.

 

[Lexdiamondz]

At least for me when I’m saying things along those lines, and I assume it’s the way that most people meant it, was that if you end up with a chunk of preceptor rotations in specialties that don’t matter to you, likely it really won’t make THAT much of a difference. Most people do a good amount of their 4th year like that unless they’re really busting their ass more than necessary (the SDN way).

also, for many of us (myself included) we’re gonna go chill outpatient and let other people take the 20 patient lists inpatient. I know there’s plenty of paperwork outpatient too, but it’s a whole different animal in terms of time and note requirements

I mean for most residents around 25-30% of your training is going to be on tangentially related specialties, whether that be a prelim or TY, or just in off-service rotations with other fields. I didn't give a **** about inpatient medicine but a third of my training ended up being on wards and ICU.

Again, it's not the end of the world, but this stuff *does* matter.

 

[Mass Effect]

I mean for most residents around 25-30% of your training is going to be on tangentially related specialties, whether that be a prelim or TY, or just in off-service rotations with other fields. I didn't give a **** about inpatient medicine but a third of my training ended up being on wards and ICU.

Again, it's not the end of the world, but this stuff *does* matter.

Not only does it matter for educational purposes, but the next time people are bitching about DO stigma, they should be reminded this is one reason why. In the real world, you will 100% hear TPTB at non-DO residencies wonder about a DO candidate's clinical acumen due to the difference in clerkships. This needs to change.

 

[deleted898021]

Not only does it matter for educational purposes, but the next time people are bitching about DO stigma, they should be reminded this is one reason why. In the real world, you will 100% hear TPTB at non-DO residencies wonder about a DO candidate's clinical acumen due to the difference in clerkships. This needs to change.

Ok DO education sucks, we get it, lets all move on now.. .. this still didn't prevent kids in prior classes from my school from matching at baller places and getting into the specialty they wanted. To OP, make what you want of this thread and get more wards based academic rotations if you want in your third and fourth year.

 

[thumbz]

Not only does it matter for educational purposes, but the next time people are bitching about DO stigma, they should be reminded this is one reason why. In the real world, you will 100% hear TPTB at non-DO residencies wonder about a DO candidate's clinical acumen due to the difference in clerkships. This needs to change.

Ok DO education sucks, we get it, lets all move on now.. .. this still didn't prevent kids in prior classes from my school from matching at baller places and getting into the specialty they wanted. To OP, make what you want of this thread and get more wards based academic rotations if you want in your third and fourth year.

I think what Mass Effect is truly getting at is DO schools need to step up, change their core curriculum requirements and have more rigor in 3rd and 4th year. I legit dream of a day when I don't need to ask DO students if they had any real clinical rotations or if they were all a glorified shadowing experience.

I personally think COCA should require all med schools have >3 wards based rotations for 3rd year clerkships per student. We are undoing the DO bias bit by bit every year, allowing some DO's to match at baller places. Now lets get it so all baller places will consider DO's because they get the same education.

 

[deleted898021]

I think what Mass Effect is truly getting at is DO schools need to step up, change their core curriculum requirements and have more rigor in 3rd and 4th year. I legit dream of a day when I don't need to ask DO students if they had any real clinical rotations or if they were all a glorified shadowing experience.

I personally think COCA should require all med schools have >3 wards based rotations for 3rd year clerkships per student. We are undoing the DO bias bit by bit every year, allowing some DO's to match at baller places. Now lets get it so all baller places will consider DO's because they get the same education.

I think theres already a requirement that at least 1 rotation has to be wards based with residents, most people at my school have several such rotations, and many have all wards based with residents. Stuff like FM will be preceptor based everywhere....

 

[DrStephenStrange]

I think what Mass Effect is truly getting at is DO schools need to step up, change their core curriculum requirements and have more rigor in 3rd and 4th year. I legit dream of a day when I don't need to ask DO students if they had any real clinical rotations or if they were all a glorified shadowing experience.

I personally think COCA should require all med schools have >3 wards based rotations for 3rd year clerkships per student. We are undoing the DO bias bit by bit every year, allowing some DO's to match at baller places. Now lets get it so all baller places will consider DO's because they get the same education.

It is a COCA accreditation requirement to have at least one rotation in 3rd year with residents. That added to the few away/audition rotations early 4th year, there is your 3+ ward base rotations right there.

 

[Mass Effect]

Stuff like FM will be preceptor based everywhere....

And you're getting that idea from where?

 

[deleted898021]

It is a COCA accreditation requirement to have at least one rotation in 3rd year with residents. That added to the few away/audition rotations early 4th year, there is your 3+ ward base rotations right there.

And to add on top of this, many people do their entire 4th year as wards based rotations as elective rotations even in fields they are not applying to. Even with covid my school has entire sites that are fully wards based for 4 th year students. This whole thread is a moot point, if you want wards based rotations you can get them in your 4th year....

 

[deleted898021]

And you're getting that idea from where?

I was talking about at my school specifically but I know many MD's students who rotate at the same clinics as we do for FM...
Well we also have an FM residency with an affiliated hospital where a few of the students can rotate at, almost no one wants to do that since your "stuck" behind the resident doing nothing, while with some preceptors you can run patient care and write notes and orders etc... for your FM rotation.

 

[Mass Effect]

In was talking about at my school but I know many MD's students who rotate at the same clinics as we do for FM...
Well we also have an FM residency with an affiliated hospital where a few of the students can rotate at, almost no one wants to do that since your "stuck" behind the resident doing nothing, while with some preceptors you can run patient care and write notes and orders etc... for your FM rotation.

Your experience is not universal.

The bottom line is that this thread was a question about whether or not it's beneficial to work with residents. The residents and attendings on this thread have all said YES, it's beneficial, both for learning and for matching. You should do as many rotations as possible both third and fourth year on a resident team at an academic center. A major weakness of DO schools is their clerkships. If you have the choice, change it. Don't defend it.

 

[deleted898021]

Your experience is not universal.

The bottom line is that this thread was a question about whether or not it's beneficial to work with residents. The residents and attendings on this thread have all said YES, it's beneficial, both for learning and for matching. You should do as many rotations as possible both third and fourth year on a resident team at an academic center. A major weakness of DO schools is their clerkships. If you have the choice, change it. Don't defend it.

Yes I should go take a $100 million loan and try to single handedly help my school build an academic center so we can have all 3rd year clerkships be wards based... got it... reality is that this whole thread is pointless, you cant change some things, there is plenty of opportunity to get a wards based rotation in your 3rd year(at least at my school) and during 4 th year so you dont look like an idiot during residency and so that you can answer XYZ person during your residency interview that you had X number of wards based rotations with residents and didn't just do pointless "shadowing" your entire 3rd and 4th year... to me, as big a problem people make it out to be on SDN it just really isn't.. the DO stigma has decreased signifiantly over the years although it still remains at places to some extent, but the quality of rotations have largely stayed the same at DO schools.

 

[Mass Effect]

Yes I should go take a $100 million loan and try to single handedly help my school build an academic center so we can have all 3rd year clerkships be wards based... got it...

That's exactly what I said.

reality is that this whole thread is pointless, you cant change some things, there is plenty of opportunity to get a wards based rotation in your 3rd year(at least at my school) and during 4 th year so you dont look like an idiot during residency and so that you can answer XYZ person during your residency interview that you had X number of wards based rotations with residents and didn't just do pointless "shadowing" your entire 3rd and 4th year...

Ok. Enjoy.

to me, as big a problem people make it out to be on SDN it just really isn't..

Ah, the view from the hallowed halls of med school.

 

[Lexdiamondz]

And to add on top of this, many people do their entire 4th year as wards based rotations as elective rotations even in fields they are not applying to. Even with covid my school has entire sites that are fully wards based for 4 th year students. This whole thread is a moot point, if you want wards based rotations you can get them in your 4th year....

You shoudn't have to wait until your fourth year to actually have experience on the wards though.

How the hell are you supposed to make an informed decision about what specialty you're going to go for in September of your MS4 year if you aren't really exposed to any residents in that specialty (or other specialties that you may be interested in) until June of your MS4 year?

Furthermore, how are you supposed to do well on your auditions as an MS4 and get good letters if you haven't worked on a team with residents before?

All of this sounds pretty dysfunctional and ass backwards. Its like they're deliberately setting you up to have worse outcomes.

 

[deleted898021]

That's exactly what I said.



Ok. Enjoy.



Ah, the view from the hallowed halls of You shoudn't have to wait until your fourth year to actually have experience on the wards though.l

How the hell are you supposed to make an informed decision about what specialty you're going to go for in September of your MS4 year if you aren't really exposed to any residents in that specialty (or other specialties that you may be interested in) until June of your MS4 year?

Furthermore, how are you supposed to do well on your auditions as an MS4 and get good letters if you haven't worked on a team with residents before?

All of this sounds pretty dysfunctional and ass backwards. Its like they're deliberately setting you up to have worse outcomes.

well according to coca everyone should already have 1 wards expirence with residents in their 3rd year ideally in the field they are interested in.. you do multiple auditions anyway, so you can fill in the gaps you may have during your first rotation which will be in June/July of 4th year, also this is assuming you have never worked with residents but that’s literally not allowed by coca anymore and you can def get several wards based rotations in your 3rd year at most DO schools. Many people at my school have all of theirs as wards based with residents and mine isn’t even a school that people would consider as a “top” DO school. Regarding how your supposed to decide your specialty, you don’t have to necessarily work with residents to decide, if you enjoy surgery you will know that even with just a preceptor rotation, you do know that residency will suck regardless of specialty and you can get to see how surgery residents function in your 4th year if you weren’t able to do a wards based one in your third year.. the same goes for every specialty. You don’t need to see what an intern does in a particular specialty to decide if that’s what you want to do haha..