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Best SUNY Med school?

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tkhan180

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Hey out of the 4 SUNY med schools, Stonybrook, Upstate, Downstate, and Buffalo, which one do you think is the best/competitive? I like all of them and am trying to see what makes them different from each other.
 

flatearth22

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Stony Brook > Downstate >> Buffalo = Upstate
 
K

kpcrew

according to the numbers, it looks like it's stony brook, buffalo, upstate, downstate but they're subjective. the best thing to do is to go see what it's like when you interview at them and see which one you fit best at. upstate has had some accreditation problems recently and downstate is apparently messing around with its curriculum but it's something you should determine for yourself. if you have the opportunity to choose between acceptances, i would try to talk to current medical students, not premeds.
 

flatearth22

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How did you figure out that ranking?

Stony Brook is clearly the best and most desirable state school in NY.

Downstate has the advantage of being in Brooklyn and getting to seeing a high volume of diverse clinical cases.

Buffalo and Upstate are meh.
 

ghostman

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according to the numbers, it looks like it's stony brook, buffalo, upstate, downstate but they're subjective. the best thing to do is to go see what it's like when you interview at them and see which one you fit best at. upstate has had some accreditation problems recently and downstate is apparently messing around with its curriculum but it's something you should determine for yourself. if you have the opportunity to choose between acceptances, i would try to talk to current medical students, not premeds.

What "numbers" are you referring to? MCAT score averages? USNews Research/Primary Care (downstate is not ranked... not sure why)? A combination of that?
 

FIREitUP

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Upstate is low ranked, Downstate is unranked, Buffalo is ranked near Stony Brook. This is all US News so basically research $$. Clinicals might be a different story. Buffalo has 7 (or 8) hospitals to rotate at but no university hospital. Downstate has UHB as well as Kings County (but our preclinicals are terrible, and getting worse). Stony Brook has a university hospital that's a level one trauma center, but they don't see much action over there. Upstate has about the same problem but there is a degree of impoverished people so you'll probably see more than at Stony Brook.
 

flatearth22

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Upstate is low ranked, Downstate is unranked, Buffalo is ranked near Stony Brook. This is all US News so basically research $$. Clinicals might be a different story. Buffalo has 7 (or 8) hospitals to rotate at but no university hospital. Downstate has UHB as well as Kings County (but our preclinicals are terrible, and getting worse). Stony Brook has a university hospital that's a level one trauma center, but they don't see much action over there. Upstate has about the same problem but there is a degree of impoverished people so you'll probably see more than at Stony Brook.

Could you elaborate please?
 

sector9

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Downstate is "Unranked" on US News, which means that Downstate didn't provide US News with the necessary information. If it said "Rank not published" then that would mean that Downstate was lower than the top 100 med schools, since US News only publishes the rankings for the top 100 and marks the rest of the schools as "Rank not published"

Basically, you can't use US News rankings when you're comparing Downstate to the others.
 

anbuitachi

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Downstate and Stony are top 2, followed by Buffalo , and Upstate. (Buffalo seems to be improving under its new dean... while upstate is under probation lol..)

Downstate research is ranked #2 this year out of the 4 behind Stony, but if you look at it, Stony is a much bigger university than Downstate so it makes sense. Downstate does extremely well for its size. Downstate's average GPA and MCAT was same as Stony's I believe... 32, 3.7... Downstate is known for better clinical experience.

Lot of people choose Stonybrook over Downstate and vice versa. Most choose these 2 over other 2.
 

flatearth22

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Downstate and Stony are top 2, followed by Buffalo , and Upstate. (Buffalo seems to be improving under its new dean... while upstate is under probation lol..)

Downstate research is ranked #2 this year out of the 4 behind Stony, but if you look at it, Stony is a much bigger university than Downstate so it makes sense. Downstate does extremely well for its size. Downstate's average GPA and MCAT was same as Stony's I believe... 32, 3.7... Downstate is known for better clinical experience.

Lot of people choose Stonybrook over Downstate and vice versa. Most choose these 2 over other 2.

Is your MDApps profile for real? 9 (10?) interviews and no acceptances?
 
K

kpcrew

oh i was just looking at usnews but i guess downstate is a lot better than i thought, my mistake

also i came across this:
Is the scholarship guaranteed for 4 yrs? If not, go to downstate, the instate tuition is not going to suddenly jump up 20k. Even if it is, downstate is a better school in my opinion

i was wondering whose fault it was
 
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MedicJosh

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regarding the stony brook vs downstate debate, one thing to consider is the grading system in the pre clinical years. As far as I know (please correct me if I'm wrong) they both use a pass, high pass, honors grading system, the difference being stony brook grades on a curve whereas downstate doesn't. as a result I've heard that it fosters a bit more of a competitive environment as stony brook. can any current students comment?
 

LizzyM

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Never mind the schools: look at the geography. It couldn't be more different: suburban, urban, rural, decaying rustbelt. Where do med students hang out/celebrate after an exam? Where do you go for a night on the town? Do you like spectator sports? -- very different offerings across the 4 locations. Outdoor activities: Ocean, Sound, Lake or Mountains? Proximity to Canada or to NYC?
 

EK601

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I think they're all pretty different and the small differences in ranking / prestige are not worth making the decision over. I had interviewed at 3 of the 4 and my (humble) opinion

Buffalo

- city location, much, much more happening than Upstate's area.
- Dingy facilities, I was actually very disappointed by the overall campus.

Stony Brook

- students seemed happy but more competitive
- very well known for research
- location can be a problem for many. Close the train stop but it's still 2hrs+ into NYC.

Upstate

- Nice campus and facilities.
- I wasn't too impressed by the curriculum
- Really disliked the city. This alone would probably pull me away from Upstate.

I have not interviewed at downstate but have visited it. I really dislike the surrounding area but proximity to the city and clinical experience opportunities are unbeatable.

For a research-focused student I would rank Stony > Downstate > UB > Upstate. If clinical experience was a priority I would rank Downstate >> UB > Upstate=Stony
 

wanderer

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You really have no way of evaluating the clinicals at this point (though people tend to say downstate is the best). I had the choice of the 3 SUNYs other than Stony and picked Downstate because of its location in NYC and proximity to home. If you're from a big city then the choice should be clear (there's not much to do in Buffalo, Syracuse or Stony Brook). Downstate might not be in the most bustling part of NYC but it's within 30 minutes of most of the exciting parts of the city.
 
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235009

I'm currently a 3rd year at stony brook. when applying i interviewed at all 4 sunys and chose stony brook over the other 3 (accepted at upstate and withdrew from waitlist at the other two). Here is a thread with my impression of all four schools when I interviewed: http://forums.studentdoctor.net/showthread.php?p=7636494#post7636494.

However as you all know upstate was recently put on probation so i just want to say that i would not recommend going to a school that is having accreditation problems. med school is a very expensive investment and you shouldn't take even the smallest risk. That said stony brook had a LCME visit this year and passed with flying colors.

Stony Brook has a university hospital that's a level one trauma center, but they don't see much action over there.

this was a misconception that i had as well before coming here. stony brook is the biggest and most respected hospital in suffolk county (population 1.5 million) ...there are all kinds of people and all kinds of cases ...every service is always busy and there are plenty of rare interesting cases

Downstate's average GPA and MCAT was same as Stony's I believe... 32, 3.7

if i'm not mistaken in the last MSAR stony brook's median MCAT of 33 was higher than all other SUNYs

regarding the stony brook vs downstate debate, one thing to consider is the grading system in the pre clinical years. As far as I know (please correct me if I'm wrong) they both use a pass, high pass, honors grading system, the difference being stony brook grades on a curve whereas downstate doesn't. as a result I've heard that it fosters a bit more of a competitive environment as stony brook. can any current students comment?

stony brook uses a F/LP/P/HP/H system but only reports F/P/H on your transcript for the first two years, LP and HP are only used internally. in the clinical years grades are reported F/LP/P/HP/H. only second year is graded on a curve however almost all systems now use shelf exams for the final which is an excellent preparation for the boards. Remember though that pre-clinical grades don't matter...what does matter is step 1 and stony brook prepares you really well! (see below)


before i get into more specifics about stony brook (specifically why it's a great choice) i will start with a general comment. your choice of SUNY should take into account regional bias. If you want to do residency in upstate NY go to buffalo or upstate. if you want to do residency in NYC and the surrounding regions go to stony brook or downstate. if you want to do residency outside of NY then stony brook is probably your best bet as it is (from what i've seen) the most highly regarded SUNY outside of NY.

on to stony brook...

Pros (in no particular order):
1. Value - I think stony brook is the best value out of all the SUNYs. though all 4 schools charge the exact same tuition you get private school quality. in anatomy lab you have 4 per cadaver as opposed to 6-8 at the other schools. classrooms and lecture halls are decked out with modern equipment.
2. Administration - extremely responsive to student feedback. they have made very significant changes in the last few years that have greatly benefited students
3. Curriculum - a hybrid with traditional curriculum first year and systems based curriculum second year which i thought was excellent because it really reinforces the material. final exams for systems have almost all been converted to shelf exams so you don't have to waste time memorizing silly minutiae off of powerpoint slides and try to decipher poorly written questions.
4. Pre-clinical professors - almost all are excellent and really care about the students
5. Step 1 - as of last year (class of 2013) shelf exams throughout most of second year (i keep repeating this because it's so crucial) and 6 weeks to study (up from 4). In addition there are several opportunities to get tutoring from upperclassmen. The results have been fantastic: stony's average this year was 8 points above the national average and an 11 point improvement over the previous year. I would bet that the step 1 average is easily the highest among the SUNYs.
6. Clinical education - i've really enjoyed clinicals so far ....residents and attendings are motivated to teach and scut work has been minimal. stony has 2 clinical campuses and a bunch of clinical sites scattered throughout long island and one in queens.

Cons:
1. Location - its pretty boring out here but its not prohibitively far from NYC. unlike downstate though the neighborhood is safe and you can live close to school without fearing for your life/property (a bit hyperbolic i know but you know what i mean). Cost of living is also surprisingly high given the location.
2. Parking - there is a huge problem with rationing of parking passes this year that has not been addressed very well yet


....i'm going to stop there for now. feel free to ask questions. i'm sure there are plenty of things i missed.
 
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235009

You really have no way of evaluating the clinicals at this point (though people tend to say downstate is the best). I had the choice of the 3 SUNYs other than Stony and picked Downstate because of its location in NYC and proximity to home. If you're from a big city then the choice should be clear (there's not much to do in Buffalo, Syracuse or Stony Brook). Downstate might not be in the most bustling part of NYC but it's within 30 minutes of most of the exciting parts of the city.

i was born in NYC and spent 24 years there before med school and still chose stony brook over downstate.
 

MedicJosh

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In regard to the clinical experience at stony brook vs downstate... it seems like the consensus on downstate is that it's superior due multiple reasons: patient population is generally lower in the socioeconomic scale and as such are more receptive to having students work on them, there are just too many patients relative to staff and as such the medical students will have more procedural opportunities than at a less busy clinical setting where the hospital staff will have more time per patient and often have done the procedure before the med student has the opportunity to do it. a current downstate student compared kings county hospital to a clinical experience in a third world country where the staff are just happy to have the help and let the med students have a lot of freedom with the patients. just looking at the #'s, KCH has about 145,000 ED visits annually with an additional 60,000 at downstate whereas Stony Brook ED sees about 60,000 and if you include the other clinical site, peconic bay ED sees an additional 30,000.

I did most of my hospital based rotations in paramedic school at Stony Brook and overall I'd have to agree with skinMD in that it's definitely the premier center in Suffolk and most services are usually pretty busy. My rotation through OB/GYN was a little slow, but that could have been an anomaly.

I wish there was some way to objectively compare clinical experience. The argument in favor of downstate as far as clinical experience goes seems to makes sense but does more patients necessarily mean more/better experience?
 
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235009

In regard to the clinical experience at stony brook vs downstate... it seems like the consensus on downstate is that it's superior due multiple reasons: patient population is generally lower in the socioeconomic scale and as such are more receptive to having students work on them, there are just too many patients relative to staff and as such the medical students will have more procedural opportunities than at a less busy clinical setting where the hospital staff will have more time per patient and often have done the procedure before the med student has the opportunity to do it. a current downstate student compared kings county hospital to a clinical experience in a third world country where the staff are just happy to have the help and let the med students have a lot of freedom with the patients. just looking at the #'s, KCH has about 145,000 ED visits annually with an additional 60,000 at downstate whereas Stony Brook ED sees about 60,000 and if you include the other clinical site, peconic bay ED sees an additional 30,000.

I did most of my hospital based rotations in paramedic school at Stony Brook and overall I'd have to agree with skinMD in that it's definitely the premier center in Suffolk and most services are usually pretty busy. My rotation through OB/GYN was a little slow, but that could have been an anomaly.

I wish there was some way to objectively compare clinical experience. The argument in favor of downstate as far as clinical experience goes seems to makes sense but does more patients necessarily mean more/better experience?

from my experience fewer patients = more time to teach. as a med student you are looking to go in depth into a small number of cases per day not see lots of volume. also as a med student you shouldn't be searching for "freedom" during the clinical years...in fact quite the opposite...the way i see it is that its much better to have a nurse/resident/attending who has time to show me how to do a procedure properly rather than having me go and figure it out myself because the hospital is so miserably understaffed.
 

FIREitUP

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I'm currently a 3rd year at stony brook. when applying i interviewed at all 4 sunys and chose stony brook over the other 3 (accepted at upstate and withdrew from waitlist at the other two). Here is a thread with my impression of all four schools when I interviewed: http://forums.studentdoctor.net/showthread.php?p=7636494#post7636494.

However as you all know upstate was recently put on probation so i just want to say that i would not recommend going to a school that is having accreditation problems. med school is a very expensive investment and you shouldn't take even the smallest risk. That said stony brook had a LCME visit this year and passed with flying colors.



this was a misconception that i had as well before coming here. stony brook is the biggest and most respected hospital in suffolk county (population 1.5 million) ...there are all kinds of people and all kinds of cases ...every service is always busy and there are plenty of rare interesting cases



if i'm not mistaken in the last MSAR stony brook's median MCAT of 33 was higher than all other SUNYs



stony brook uses a F/LP/P/HP/H system but only reports F/P/H on your transcript for the first two years, LP and HP are only used internally. in the clinical years grades are reported F/LP/P/HP/H. only second year is graded on a curve however almost all systems now use shelf exams for the final which is an excellent preparation for the boards. Remember though that pre-clinical grades don't matter...what does matter is step 1 and stony brook prepares you really well! (see below)


before i get into more specifics about stony brook (specifically why it's a great choice) i will start with a general comment. your choice of SUNY should take into account regional bias. If you want to do residency in upstate NY go to buffalo or upstate. if you want to do residency in NYC and the surrounding regions go to stony brook or downstate. if you want to do residency outside of NY then stony brook is probably your best bet as it is (from what i've seen) the most highly regarded SUNY outside of NY.

on to stony brook...

Pros (in no particular order):
1. Value - I think stony brook is the best value out of all the SUNYs. though all 4 schools charge the exact same tuition you get private school quality. in anatomy lab you have 4 per cadaver as opposed to 6-8 at the other schools. classrooms and lecture halls are decked out with modern equipment.
2. Administration - extremely responsive to student feedback. they have made very significant changes in the last few years that have greatly benefited students
3. Curriculum - a hybrid with traditional curriculum first year and systems based curriculum second year which i thought was excellent because it really reinforces the material. final exams for systems have almost all been converted to shelf exams so you don't have to waste time memorizing silly minutiae off of powerpoint slides and try to decipher poorly written questions.
4. Pre-clinical professors - almost all are excellent and really care about the students
5. Step 1 - as of last year (class of 2013) shelf exams throughout most of second year (i keep repeating this because it's so crucial) and 6 weeks to study (up from 4). In addition there are several opportunities to get tutoring from upperclassmen. The results have been fantastic: stony's average this year was 8 points above the national average and an 11 point improvement over the previous year. I would bet that the step 1 average is easily the highest among the SUNYs.
6. Clinical education - i've really enjoyed clinicals so far ....residents and attendings are motivated to teach and scut work has been minimal. stony has 2 clinical campuses and a bunch of clinical sites scattered throughout long island and one in queens.

Cons:
1. Location - its pretty boring out here but its not prohibitively far from NYC. unlike downstate though the neighborhood is safe and you can live close to school without fearing for your life/property (a bit hyperbolic i know but you know what i mean). Cost of living is also surprisingly high given the location.
2. Parking - there is a huge problem with rationing of parking passes this year that has not been addressed very well yet


....i'm going to stop there for now. feel free to ask questions. i'm sure there are plenty of things i missed.

That's really impressive. It looks like stony brook is headed in the right direction with regards to preclinical education while Downstate is going backwards. NBME's are definitely the way to go.
 

rhcp90

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A student from stony advocating for stony? nuts.

Well I interviewed at all of them, and I personally feel that upstate is the best. Yes they were recommended to be put on probation... but I highly doubt that they will be... especially seeing all the changes they have made. My ranking based on my experiences and talking to students is as follows...

upstate > stony> buffalo > downstate.

Was not a fan of downstate at all.
 

EK601

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A student from stony advocating for stony? nuts.

I was surprised at how many people I have talked to that wish they had instead gone to another school because they don't like the one they're at.
 

iniquus

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I was surprised at how many people I have talked to that wish they had instead gone to another school because they don't like the one they're at.

Yeah, if you're lucky enough to have multiple acceptances to schools, then you'll occasionally wonder "what if?"

I interviewed at all the SUNYs except Upstate and with all things considered, I personally ranked it Stony > Downstate >= Buffalo.
 

ghostman

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I've been accepted to all the SUNYs and I'm currently in the process of deciding between them. Downstate is the closest - within 20 minutes by car, 30 minutes by subway/bike - so that I can live from home and save about $10K/year. But I wonder if that is recommended. What's the parking situation for MS1's at Downstate? Is there a safe, private, indoor parking lot at Downstate (and if so, how much does it cost)? During my interview at Downstate, I walked down a street with shattered glass lining the entire length of the block, so I probably wouldn't park outdoors.

As for Stony Brook, the parking situation seems problematic. I heard most people live off-campus and I imagine many of them drive in. Can anyone elaborate on the parking pass rationing problem?
 

iniquus

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I've been accepted to all the SUNYs and I'm currently in the process of deciding between them. Downstate is the closest - within 20 minutes by car, 30 minutes by subway/bike - so that I can live from home and save about $10K/year. But I wonder if that is recommended. What's the parking situation for MS1's at Downstate? Is there a safe, private, indoor parking lot at Downstate (and if so, how much does it cost)? During my interview at Downstate, I walked down a street with shattered glass lining the entire length of the block, so I probably wouldn't park outdoors.

As for Stony Brook, the parking situation seems problematic. I heard most people live off-campus and I imagine many of them drive in. Can anyone elaborate on the parking pass rationing problem?

Most people do live off-campus, so the majority of us drive in. Because of hospital expansion and parking lot "non-expansion," parking can be extremely crowded in the morning. The school's solution has been to issue carpool passes. It hasn't been problematic for my household because there's already 4 of us living under one roof, but I can see it potentially being a problem if you live alone far away from other classmates. Although to be fair, the school makes exceptions to these isolated students and really most of us live within 10-15 minutes of school.

It also helps that our schedules are essentially the same, so carpooling isn't a problem 95% of the time. This isn't undergrad where everyone's taking different classes and involved in different activities. The administration has been very receptive to our concerns and found a way to issue a parking pass to every student for the month of January. They are currently exploring a more permanent solution and it's a high priority for them.

I was accepted to all the SUNYs (except for Upstate) and I'd pick Stony Brook over Downstate. I think Downstate's clinical education is overrated--you aren't only going to see white people and colds at Stony and only the rarest Caribbean diseases at Downstate.
 

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Thanks for the feedback. Anyone know the various step 1 scores for the SUNY's? skinMD mentioned 8 points above the national average. Is the national average 221? The only other info I could find was in the Step 1 score compilation thread that said Upstate had 222 in 2008.
 

wanderer

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Thanks for the feedback. Anyone know the various step 1 scores for the SUNY's? skinMD mentioned 8 points above the national average. Is the national average 221? The only other info I could find was in the Step 1 score compilation thread that said Upstate had 222 in 2008.
That information is hard to come by and pretty much irrelevant.
 
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Thanks for the feedback. Anyone know the various step 1 scores for the SUNY's? skinMD mentioned 8 points above the national average. Is the national average 221? The only other info I could find was in the Step 1 score compilation thread that said Upstate had 222 in 2008.

national mean this year was 225 with SD of 22, for the last 4 years it had been 221-222
 

anbuitachi

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when i was applying last year, i was also trying to figure out stony or downstate if accepted. Then a residency director told me that of the applicants that she interviews everywhere, downstate students on average definitely seemed clincally more experienced than stonybrook students. and that put downstate over stony for me.
 

penguins15

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I know someone mentioned Downstate tuition increasing... but Buffalos is too. They have a "UB 2020" mission where they want to expand their campus at the expense of student tuition... projected to have 10% increase (per year supposedly) in tuition over next ten years (was a proposal).... tuition can add up.
 

Asyouwereatrio

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they all cost the same

ALL SUNY Med schools are on the same 10% per year increase for OOS and 9% increase for IS students (OOS=Out of State, IS=In State).

Part of Governor Cuomo's plan to get SUNY system back on track and become financially sustainable.
 

royalmarquis

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when i was applying last year, i was also trying to figure out stony or downstate if accepted. Then a residency director told me that of the applicants that she interviews everywhere, downstate students on average definitely seemed clincally more experienced than stonybrook students. and that put downstate over stony for me.

which kind of residency director?
 

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For someone who eventually wants to specialize in some kind of surgery and work in a teaching hospital, which is better--Downstate or Stony Brook?

Also, current students, what's your opinion of the faculty at both these schools? Are they grouchy and buried in work/research? Or are they approachable and inspiring?
 

powerincarnate

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I went to Buffalo as an undergrad, I interviewed at upstate and downstate, and will interview at Stony Brook Tomorrow.


With that said Buffalo is THE State University of New York. It is clearly the most comprehensive, biggest of the State University Centers. It has Med, Law, Dental, Nursing, PT, Architecture schools. However, someone above mentioned the facilities weren't so great. Reality is, Buffalo's South Campus, which is located on the upper tip of the Buffalo near Amherst, is the little Brother to the Main North Campus, located 3 miles away in Amherst. It is clear the Amherst campus is the beauty and where all the main stuff is located. The Health Science Library on South Campus is Beautiful though. Buffalo as a city has been decaying for a long time, and I don't know if I could handle the cold and snow for 4 more years to be honest.

Syracuse Actually averages more snow than Buffalo, and temperature is about the same. It is a smaller city with less things to do. It isn't even close to Canada (niagara falls or toronto) like Buffalo is, so if cold and decaying city is a deal breaker for Buffalo, then look away from Upstate as well. I thought the facilties at Upstate were better than the facilites at Buffalo. Unfortunately, Upstate is on Probation so they are going to be scrambling with discrepancies between the two campuses (binghamton vs. syracuse), the whole cheating issue, the curriculum and so forth. The people were nice and honest though and I had a positive interview and a generally positive feel to the school.

Downstate is in Brooklyn, so If access to the city is key to you, then it wins. It is in the city, and close to Manhattan. The facilties were less than stellar, but not as Bad as some people characterize them to be. Area isn't the greatest. Buffalo isn't in the best area as well, but it is on the border with Amherst, the safest place in America so, finding a nice quite place to live in Buffalo would be a lot easier than Downstate. Buffalo has enough action, and enough poverty, where you will see a lot. Brooklyn though is immensely diverse, so you may have tropical diseases, and other cool clinical finding. Clinically, you probably can't beat Downstate compared to the other three schools.

Stony Brook?? Well I had a family member go to the Undergrad there, but I haven't been to the interview yet. Ranking wise, it is number 1 and I think it will ALWAYS be number 1. High Quality Researchers who want to be in NYC will go to Sinai, NYU, cornel, Columbia, or Einstein. Downstate will not compete against these other City Schools. Researchers who want a smaller place, is probably not going to go to Buffalo or Syracuse. Buff and Syracuse has the decaying, snow filled perception to deal with. Being in a less populated area means they could easily build a major research building, the Price Building Einstein opened in 2008, without worrying about space, like Downstate would. Also Despite Buffalo Med School being around since 1846 and Stony Brooks has been around in the 70s, Their incoming class generally has a higher GPA, higher MCAT score, higher average board score, and higher US news ranking. Stony Brook has their sights set on being a consistent top 50 NIH funded research University and I believe them.

So with that said, my ranking would be

1. Stony Brook, 2. Buffalo, 3. Usually Upstate followed by Downstate, but with recent issues at Upstate, I'm inclinded to say the NYC experience and better clinicals will put Downstate above Upstate. But honestly, 2, 3 or 4 can be switched depending on your preferences, but I think the consensus is Stony Brook is 1.
 

uclabruins2011

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almost everyone ive asked has said that downstate will get you a better residency than the rest because of the clinical training
 
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