Big hospital vs small hospital

[schwasted589]

Hi there,

So I'm an OM2 about to fill out the rotations rank list and I needed input. What is better: big hospital setting where you're with residents/teaching faculty or a smaller hospital where you're 1st assist and it's just you and the attending.

I do better in smaller settings where I'm not around overly aggressive med students but I'm worried about the lack of clinical exposure/pathology. Also, I've heard that the point of 3rd/4th year ISN'T to do procedures and that I should focus on going somewhere where I'll see the most complicated/cool stuff.

Any feedback? I'm interested in so many things (so that wont really narrow anything down) but specifically something like EM or OBGYN

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[animando]

Go for small hospital. You are just a shadow in a big setting.

 

[Petypet]

I share the feeling of go to a large hospital. The goal of 3rd year is to learn what you want to do and what setting you want to practice. Its cool getting first dibs on a line or intubation, for sure, but there are many more downsides to going to a small hospital. Large places have more pathology, more exposure (especially to subspecialties), and more structured learning opportunities. At my institution the students that goto the small community hospital, on surgery, work 8-5, 5 days a week. They also see the bread and butter stuff, but not necessarily the complicated and more elaborate stuff. Sure, I work 30 hours per week more, but I see a ton more. I learn that surgery lifestyle is rough, whereas my colleagues think its cush.

Also, being at a big house , it isn't all shadowing. You get out of what you put in. At my level 1 trauma center, they NEED hands. There is always work to be done and the more facetime you put in, the more you will get opportunities.

 

[DO1987]

I prefer the smaller (300 bed) community hospital I am at. There is a great possibility that I will be working in a similar setting so its great to see what surgery is like there. If I were at a level 1 academic center I wouldnt get to see what life will be like after residency. I have no desire to go into academics or be at a trauma center. These are things I will be looking for in a residency program, however. Plus, you get to do a ton, at least where I am. As a third year, Ive closed every surgery I have been in, done a BKA, CSection, and set screws in a hip with my attendings-and Im only on my fourth rotation.

 

[schwasted589]

Go for small hospital. You are just a shadow in a big setting.

That's what I've heard. That there's so many residents/med students/faculty/people in general that you're fighting to get a look at the patient or sit in on a cool case. Shadowing is boring to me and I feel like I'll mentally check out if I'm surrounded by throngs of gunner med students. Which I don't want, obviously.

I share the feeling of go to a large hospital. The goal of 3rd year is to learn what you want to do and what setting you want to practice. Its cool getting first dibs on a line or intubation, for sure, but there are many more downsides to going to a small hospital. Large places have more pathology, more exposure (especially to subspecialties), and more structured learning opportunities. At my institution the students that goto the small community hospital, on surgery, work 8-5, 5 days a week. They also see the bread and butter stuff, but not necessarily the complicated and more elaborate stuff. Sure, I work 30 hours per week more, but I see a ton more. I learn that surgery lifestyle is rough, whereas my colleagues think its cush.

Also, being at a big house , it isn't all shadowing. You get out of what you put in. At my level 1 trauma center, they NEED hands. There is always work to be done and the more facetime you put in, the more you will get opportunities.

THIS is my biggest concern. My friends that are at small community hospitals get to do stuff, but they end up having fairly cushy schedules--which is nice, don't get me wrong but not so close to the truth from what I hear. My friend on her OBGYN rotation told me she was at the office from 9-9:30am until 1-2pm usually. That's it. Her physician never had her come when she was on call. My friend loved it because she could do whatever the heck she wanted, but...(at the risk of sounding like a do-gooder), I don't know how much she got out of it.

I haven't been on rotations yet, obviously but I've worked at a bigger hospital and a smaller hospital and both had perks. I just don't know which is better for med students in terms of training: more pathology but less hands on OR one on one interaction with run of the mill cases. I'm not interested in academia necessarily but I'm more concerned because I'm interested in working at a Trauma facility if I end up going into EM.

 

[group_theory]

If you do the majority or all of your rotations in small hospitals without residents, then how would you know the roles/expectations of interns (and subI/AI) when you do an audition rotation at a large university center (as a 4th year) or when you become an intern (usually at a large academic center)? Plan to learn on the fly come July intern year?

 

[Petypet]

THIS is my biggest concern. My friends that are at small community hospitals get to do stuff, but they end up having fairly cushy schedules--which is nice, don't get me wrong but not so close to the truth from what I hear. My friend on her OBGYN rotation told me she was at the office from 9-9:30am until 1-2pm usually. That's it. Her physician never had her come when she was on call. My friend loved it because she could do whatever the heck she wanted, but...(at the risk of sounding like a do-gooder), I don't know how much she got out of it.

I haven't been on rotations yet, obviously but I've worked at a bigger hospital and a smaller hospital and both had perks. I just don't know which is better for med students in terms of training: more pathology but less hands on OR one on one interaction with run of the mill cases. I'm not interested in academia necessarily but I'm more concerned because I'm interested in working at a Trauma facility if I end up going into EM.

Spot on.

I think there is a huge misconception that going to a large hospital equaling less opportunities. My personal experience, opportunities is up to the quality of resident or attending. I have had my share of BS shadowing even at a primary care doc's office, when I was exclusively 1 on 1. In comparison, while at our 1000 bed big hospital, I have gotten my fair share hands on experience. Just because a hospital is big, has residents, has students, doesn't mean that opportunities can't be had. Certainly gunners will gun, but I am not a gunner (just average run of the mill decent student) and if you are willing to work people are willing to give you opportunities to learn.

Go big or go home. Pun intended.

 

[schwasted589]

Spot on.

I think there is a huge misconception that going to a large hospital equaling less opportunities. My personal experience, opportunities is up to the quality of resident or attending. I have had my share of BS shadowing even at a primary care doc's office, when I was exclusively 1 on 1. In comparison, while at our 1000 bed big hospital, I have gotten my fair share hands on experience. Just because a hospital is big, has residents, has students, doesn't mean that opportunities can't be had. Certainly gunners will gun, but I am not a gunner (just average run of the mill decent student) and if you are willing to work people are willing to give you opportunities to learn.

Go big or go home. Pun intended.

this makes me feel much better. I feel like most people at our school choose to go to smaller setting, partly because they're told that "small hospital = hands on = more learning" so I thought I was crazy for wanting to go to a larger hospital.

And like the user above you said, I really want to know what I'm doing for audition rotations so whatever will help me prepare for that is the route I'd like to go. there's so much discrepancy and I don't actually know what we're expected to get out of 3rd/4th year (see cool stuff/be able to identify it vs know how to deliver a baby/suture since you did it 10x in your small hospital rotation) that it's hard deciding what to do. And yes, gunners. They scare me. I'm not shy by any stretch of the imagination but I generally won't shove/push/brown nose into getting to do stuff so the idea that I may have to do that at a bigger hospital is kind of frightening.

 

[Doctor Bob]

I think it depends on the kind of learner you are.
If you learn best by reading, then go to a small center; you'll have more time for self-directed study.
If you learn best by doing, then go a large center; you'll work more but you'll see a wider range of pathology.

Not to say that small places don't see pathology... but bigger places are going to see more of it.

 

[schwasted589]

I think it depends on the kind of learner you are.
If you learn best by reading, then go to a small center; you'll have more time for self-directed study.
If you learn best by doing, then go a large center; you'll work more but you'll see a wider range of pathology.

Not to say that small places don't see pathology... but bigger places are going to see more of it.

hmm that's an interesting take. I definitely learn more by "doing" which is why I was debating going to a SMALL hospital so I could DO more stuff...but by "do'" more, you mean get to see more pathology?

 

[SurgeDO]

the obvious answer here is to go to a medium sized hospital.

also, i personally think it is a disservice to look down on a hospital that has a lot of residents/interns out of fear of missing out on opportunities. yea, the resident will always have priority over you in the eyes of the attending, but you are going to do most of your learning from residents and interns. attendings do not have the time to explain everything to a medical student. why should they? most/all of them are not being paid to teach you. residents and interns are at least always at the hospital and will always have something for you to do.

 

[SouthernSurgeon]

the obvious answer here is to go to a medium sized hospital.

The obvious answer is to go to a school that doesn't force you to make such ridiculous blind decisions, and instead affords you consistently strong clinical rotations.

But that's obviously out of the question here.

 

[schwasted589]

the obvious answer here is to go to a medium sized hospital.

also, i personally think it is a disservice to look down on a hospital that has a lot of residents/interns out of fear of missing out on opportunities. yea, the resident will always have priority over you in the eyes of the attending, but you are going to do most of your learning from residents and interns. attendings do not have the time to explain everything to a medical student. why should they? most/all of them are not being paid to teach you. residents and interns are at least always at the hospital and will always have something for you to do.

That's definitely a view I haven't heard but you make a good point, so thank you!

The obvious answer is to go to a school that doesn't force you to make such ridiculous blind decisions, and instead affords you consistently strong clinical rotations.

But that's obviously out of the question here.

if only...