ToeJam,
I've got some questions. The first part is quick. The second might require some reflection.
If CCPM has lost practically all of the professors that were there during your tenure, how do you think the school has changed? Do you think their replacements are better or worse? Do you expect that any changes have been made in the clinical exposure?
How did your third and fourth year clinics work? For comparison, I'll give a synopsis of Des Moines' clinics.
During the summer between 2nd and 3rd years we each spend a month in "summer clinics", which was our "Intro to clinics". Fairly basic, but it got everyone accustomed to the clinic routine. See the patients, take a history, come up with a diagnosis (Or a differential list), and think about a plan of action. THis was presented before any patient care was allowed. As the year went on this changed a bit.
During the first semester of the second year, our time was split between classes and clinic. We had different clinic groups (attendings) and rotated every month. We generally had classes on Mondays and Fridays (typically in the mornings) and were in clinics the rest of the time. The hours varied by rotation.
By the second semester we were essentially done with classes (except ACLS). This time each rotation also include Problem Based Learning sessions. Each rotation had a different focus. We rotated through the same attendings again, changing every month. From summer clinics to the end of third year there was a significant change in expectations. By the end of the year, we had better have a plan of action to recommend when we presented the patient to the attending. If it was a simple case, (nail care, calluses, IPKs, wound care, etc) we might be expected to have completed this before presenting. The clinics varied. Some were very busy, others fairly light. With one clinician, we could expect to see approx 30+ patients in a morning or afternoon clinic. Some were all diabetic, others primarily biomechanic, others had a fair amount of surgical patients.
Our fourth year is variable. We are responsible for arranging our rotations. The basic guidelines we have: have to complete a "core" rotation. There are hospital based, generally 4 months, though a couple are 6 months. We have to have at least one month of "office based" practice. This can be done anywhere, (such as your hometown DPM), just needs to be arranged ahead of time, so the school can contact them to take care of liability, forward immunization records, etc. The focus of this rotation should be on practice management, office procedures, paperwork, etc. We can take 1 month of "vacation", but this is not required. The rest of the months are up to each individual. Typically the first months are spent rotating at places that one might consider applying for residency. The school also encourages "outside" rotations. I.e. Internal medicine, vascular, radiology, etc. Again, this is up to the individual and can be tailored according to whatever desires you might have. Some people have multiple months spent rotating in office based practices. Others spend most of their time with diabetic intense practices or surgical practices. For example, my first 4 months are being spent in large hospital practices, all of which I am seriously considering for residency. Each is very different in focus and patient base. The first was essentially a referal based practice, high volume. Generally 2 days/week in surgery, the rest in clinics. A typical clinic day might see ~60 patients. Some post-op, some pre-op, some new, some basic nails and calluses. During my current rotation we have typically had 4-7 inpatients (I have been told this is lower than normal). Clinics 2 mornings each week, the rest of the time in surgery with a large number of attendings. Rounding on inpatients mornings and afternoons. A fair amount of call. And we do get calls, a few for nails, but more for diabetic ulcers, fractures, etc. I have been putting in an average of over 12 hours/day.
After looking at what I've written it doesn't seem to bear any resemblance to what you have described from your experiences. To what extent do you think this might be a difference in the schools vs. the way our rotations were arranged? I do know that some of my classmates have 4+ months of "office based" practices arranged for their 4th year. I expect their experiences will be quite different from mine. I also think we might have different goals and expectations. I know that some of my classmates are not interested in having surgical based practices, or plan to limit their surgery to bunions and hammertoes. I thin there are others who plan to focus their practices on diabetic wound care, and others with a greater focus on biomechanical treatement.
I'd be interested in hearing your input.