Clerkships with greatest learning curve

[Yoyomama88]

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Which clerkships/shelf exams have the most amount of information that is "new" and fairly unrelated to information tested on Step 1???

After perusing review books, it seems that Internal Medicine, Family Medicine, Pediatrics, Psychiatry have information that were already well established in the pre-clinical years.


I feel as if OB/GYN and Surgery are the ones that will have the toughest learning curve and have the most "new " information.


Can anyone comment if this perspective seems accurate.

 

[VisionaryTics]

OB/Gyn. Completely different than every other rotation, all new terminology, tons of concepts you've never heard of before.

 

[link2swim06]

OB/Gyn. Completely different than every other rotation, all new terminology, tons of concepts you've never heard of before.

+1

I walked in the first day to labor and delivery and was told go see the "G8P1152 at +2 with pit". I was like wtf does that mean....is that even human?

However, you can truly master ob/gyn during the clerkship. It is a small knowledge base compared to something like medicine. At the end I felt very very knowledgable about the subject matter.

 

[Anastomoses]

OB/Gyn. Completely different than every other rotation, all new terminology, tons of concepts you've never heard of before.

Can anyone tell me why this is even one of the required rotations?

 

[Armadillos]

Can anyone tell me why this is even one of the required rotations?

I have less than zero interest in doing OB/GYN, but considering everyone is born and about half the population will be pregnant at some point, it seems like something doctors should have experience with. Also hormonal contraception and cervical cancer screening seem to be in the "all doctors should know something about this" category as well.

 

[tco]

I have less than zero interest in doing OB/GYN, but considering everyone is born and about half the population will be pregnant at some point, it seems like something doctors should have experience with.

Right. And yet OB/GYN still gets consulted any time there's a pregnant patient ANYWHERE in the hospital. Waste of time rotation.

Also hormonal contraception and cervical cancer screening seem to be in the "all doctors should know something about this" category as well.

Even the OB/GYNs don't understand the most recent cervical cancer screening guidelines yet. They change so frequently, it's literally impossible (and a total waste of time if you're not doing OB/GYN) to keep up with.

Basic hormonal contraception can be covered in family medicine.

This rotation was the bane of my existence. It provided zero intellectual stimulation, and the residents were some of the most miserable I've encountered. The only saving grace was that one of our patients ended up going to IR for embolization of the uterine artery. That exposure to IR lead to my ultimate career choice.

 

[thefritz]

I'm going to echo ob/gyn. By far the worst rotation. The specialty by its nature is malignant and unless you are a gung-ho female who wants to do ob/gyn, you're probably going to have a hard time. Do whatever you can to spend most of your time in the OR with gyn-onc. L&D sucks big time. Schedule ob/gyn last. I can't imagine starting 3rd year on this rotation.

Many faculty and residents seem to be aware that most med students hate the ob/gyn rotation and seem to have a chip on their shoulder about their specialty and make you feel like there is something wrong with you if you don't think it's the greatest thing on earth.

For the surgery shelf, it's basically a "what do you do next" kind of test instead of "what is this structure." Not too bad if you review cases and understand management of trauma patients and post-op patients.

 

[Yoyomama88]

So, it does sound like the consensus is surgery and obgyn as the two rotations that should be initially most foreign to a medical student?

 

[WaylonS]

So, it does sound like the consensus is surgery and obgyn as the two rotations that should be initially most foreign to a medical student?

What? No one said surgery was foreign. As a med student, you're responsibility is not to learn how to do surgery, it's how to recognize which patients need surgery and how to handle them post-operatively. It's really not that difficult

Re: OB/GYN, it's weird. On the one hand, as other have mentioned, initially there's a lot of lingo and concepts from basic science you have to remember, but after two days, it's not bad. OB/GYN isn't IM where you have hundreds of conditions you need to think about; ultimately, you just need to know how to manage vagina problem A, B, and C. At my school, we have to do 8 weeks of OB/GYN, which is unfortunate because I'm pretty sure you could have a worthwhile learning experience in 4 weeks.

 

[Yoyomama88]

Yea but I dont feel like that there are many "new concepts" in psych, im, fm, and peds. Just some additional info in management regarding medications/procedures you know about already from Step 1.

Where as Surgery, the management is completely out of the scope for Step 1 and for ObGyn Pregnancy is virtually not covered.

 

[WaylonS]

Yea but I dont feel like that there are many "new concepts" in psych, im, fm, and peds. Just some additional info in management regarding medications/procedures you know about already from Step 1.

Where as Surgery, the management is completely out of the scope for Step 1 and for ObGyn Pregnancy is virtually not covered.

Have you done your clerkships yet?

 

[Yoyomama88]

No, but I'm basing this off of the information that you are required to study for your Shelf Exams...nothing else.

 

[mvenus929]

At my school, we have to do 8 weeks of OB/GYN, which is unfortunate because I'm pretty sure you could have a worthwhile learning experience in 4 weeks.

We used to have 4 weeks of OB, then they redesigned the clerk ships to run on 12 week blocks instead, so peds got cut to 6 weeks and OB got those extra two weeks. Personally, I think peds is more important than knowing GYN Onc, but I may be biased since I'm going into peds...

 

[Perrotfish]

Can anyone tell me why this is even one of the required rotations?

Because when the national standards for medical education were created in the 1950s the guys who made the standards reached back to their early experiences as physicians (post WWI) when most new physicians finished an Intern year and then went to practice in a small town where there was no easy transfer to tertiary care centers. Medical education has then failed to adapt in any way to new developments in medicine.

So you're being trained to be a WWI era physician in a small town: ready to deliver a baby (OBGYN) amputate a leg (Surgery) or just treat a case of the measels (IM/PEDs). On the other hand your school can maintain acrrediation with little/no exposure to the branches of medicine that weren't around during WWI (path, rads, EM, anesthesia,)

 

[tco]

We used to have 4 weeks of OB, then they redesigned the clerk ships to run on 12 week blocks instead, so peds got cut to 6 weeks and OB got those extra two weeks. Personally, I think peds is more important than knowing GYN Onc, but I may be biased since I'm going into peds...

Both of them are equally unimportant to most physicians.

 

[VisionaryTics]

Yea but I dont feel like that there are many "new concepts" in psych, im, fm, and peds. Just some additional info in management regarding medications/procedures you know about already from Step 1.

Where as Surgery, the management is completely out of the scope for Step 1 and for ObGyn Pregnancy is virtually not covered.

It's painfully obvious that you have no idea what clinical medicine is like.

 

[235009]

Yea but I dont feel like that there are many "new concepts" in psych, im, fm, and peds. Just some additional info in management regarding medications/procedures you know about already from Step 1.

Where as Surgery, the management is completely out of the scope for Step 1 and for ObGyn Pregnancy is virtually not covered.

I'll agree with you regarding psych. For step 1 you're basically exposed to all the diagnoses from the DSM IV and a bunch of the meds that will come up during your rotation. So I think it's by far the one rotation you walk into where step 1 knowledge is paramount.

Regarding IM, FM and peds you are WAY off the mark. You'll find that the step 1 knowledge is such a small and rare subset of diseases and that you were not actually exposed to more common and/or less serious conditions. For example all those genetic conditions you memorized are quite useless for peds. You'll find you've learned nothing about reactive airway disease for instance. Can you come up with a broad differential for GI bleed and all the tests to do for it including how good they are and what order you should do them in then what the treatment is for each? Nope. What about abdominal pain?

As for surgery it's basically a subset of diseases from IM that may require surgical intervention. So depending on when you do it relative to medicine it may be a steep learning curve or a very smooth transition.

 

[Kal EI]

I'll agree with you regarding psych. For step 1 you're basically exposed to all the diagnoses from the DSM IV and a bunch of the meds that will come up during your rotation. So I think it's by far the one rotation you walk into where step 1 knowledge is paramount.

Regarding IM, FM and peds you are WAY off the mark. You'll find that the step 1 knowledge is such a small and rare subset of diseases and that you were not actually exposed to more common and/or less serious conditions. For example all those genetic conditions you memorized are quite useless for peds. You'll find you've learned nothing about reactive airway disease for instance. Can you come up with a broad differential for GI bleed and all the tests to do for it including how good they are and what order you should do them in then what the treatment is for each? Nope. What about abdominal pain?

As for surgery it's basically a subset of diseases from IM that may require surgical intervention. So depending on when you do it relative to medicine it may be a steep learning curve or a very smooth transition.

To be fair, most curriculums don't focus on coming up with broad differentials and the order to pursue treatment options.

 

[mvenus929]

Both of them are equally unimportant to most physicians.

I disagree. Sure, if you go into IM, you won't be exposed to peds patients ever again, but in pretty much every other specialty, you will at some point in your training. But even if you go into IM, you're going to have friends, family, or even yourself that have kids at some point. Knowing what a sick kid who needs to go to the hospital vs. a sick kid that can stay home is a useful skill. Plus, all those kids with congenital diseases that didnt used to live beyond childhood are now growing up... Having some background on what went on with them during childhood will likely help you treat them as adults.

So Peds... Pretty important.

OB, on the other hand... Most people will send the pregnant or newly postpartum lady to the OB, rather than attempting to treat her themselves, and the aspects that are important for everyone to know are gone over again in other specialties (cervical cancers screening, stds, abdominal pain that might or might not be pregnancy, etc).

Course, my advisor says that peds and OB are the two specialties that seem to surprise people... Most don't have that much exposure to them before med school.

 

[Yoyomama88]

I can probably do a good job on the differential for both a GI bleed and abdominal pain, but like I said, I wouldnt know all the best tests/steps to manage those conditions. But the conceptual understanding is done already with the completion of step 1.

I expect there to be here and there a few more diseases, but the bulk of learning will be management issues in fm, im, peds....I guess I could be wrong, we'll see.

 

[tco]

I disagree. Sure, if you go into IM, you won't be exposed to peds patients ever again, but in pretty much every other specialty, you will at some point in your training. But even if you go into IM, you're going to have friends, family, or even yourself that have kids at some point. Knowing what a sick kid who needs to go to the hospital vs. a sick kid that can stay home is a useful skill. Plus, all those kids with congenital diseases that didnt used to live beyond childhood are now growing up... Having some background on what went on with them during childhood will likely help you treat them as adults.

So Peds... Pretty important.

OB, on the other hand... Most people will send the pregnant or newly postpartum lady to the OB, rather than attempting to treat her themselves, and the aspects that are important for everyone to know are gone over again in other specialties (cervical cancers screening, stds, abdominal pain that might or might not be pregnancy, etc).

You literally used two completely different examples to try to further explain your point that, in fact, make my point more valid. So I need to be able to give advice about Joe Smith's sick kid, but Joe's wife who is pregnant is off limits? In fact, the sick kid is more in need of specialist care than the OB patient. The OB's in my hospital said, "I'd rather have a woman show up for her first OB visit, then not see her until the delivery than have her show up 8 months in and not before." Pregnancies typically ride perfectly fine, unless there's a major problem, which will take the patient to the hospital regardless. As far as giving pregnant patients medications, as long as it's not in the first trimester, they pretty much don't give a s***.

If you're not a pediatrician or FM doc, you're not going to be giving people advice about their kids. You're also not going to be treating pregnant patients if you're not an OB. It's a specialized world, and, like I said, most physicians don't need to know peds or OB/GYN. Believe and do what you want, but I'm going to be passing people off with "That's not my realm of knowledge. You should probably go to your pediatrician," every time someone asks. What if you give them bad advice and the kid has a poor outcome? Guess you should have picked up whatever was wrong with them from your 8 week pediatrics rotation during MSIII. You're not a bad doctor if you say, "I don't know. I'll find someone who does," but you are a bad one if you make something up that you don't know, or if you're ignorant and don't realize it. I can also tell you that I saw ONE adult patient with tetrology of Fallot. What other congenital diseases are you talking about? I saw very few weird things, and most of those don't make it to adulthood (Edwards syndrome, for example).

Our education system needs dramatically revamped. As perrotfish stated (he always pops up in these discussions), our education system is antiquated. Everything in medicine has moved on except for it...

 

[ECkayak]

I'd argue that OB/GYN is one of those specialties that require people-skills. You don't really get the day-to-day workings of OB/GYN without going through the rotation. I'd venture a guess that over half of the obs going into the profession (I am one of them) today would not have chosen it if they hadn't been forced to do a rotation in it.

It seems like you, tco, are mostly interested in the specialties with little-to-no patient interaction, and that's fine, it's just that you don't need to do a required rotation to be interested in them (interventional IR, surgical subspecialties, diagnostic rads, path, etc.)

This is why I think ob/gyn should be kept in the required rotation block.

 

[Armadillos]

I think peds is important for most folks because most residencies are going to have you doing peds rotations in your sub-specialty. I would hate to be the surgeon covering peds surgery call overnight and not know anything about kids.

 

[Anastomoses]

I disagree. Sure, if you go into IM, you won't be exposed to peds patients ever again, but in pretty much every other specialty, you will at some point in your training.

So Peds... Pretty important.

OB, on the other hand... Most people will send the pregnant or newly postpartum lady to the OB, rather than attempting to treat her themselves, and the aspects that are important for everyone to know are gone over again in other specialties (cervical cancers screening, stds, abdominal pain that might or might not be pregnancy, etc).

Okay, I'm interested in peds even less than OBGYN. At least with OBGYN I "might" get to do something like deliver a baby out in the middle of Timbuktu...I mean...the fantasy is there. But peds? Ugh...I don't even like them. Cooties!

 

[tco]

I'd argue that OB/GYN is one of those specialties that require people-skills. You don't really get the day-to-day workings of OB/GYN without going through the rotation. I'd venture a guess that over half of the obs going into the profession (I am one of them) today would not have chosen it if they hadn't been forced to do a rotation in it.

It seems like you, tco, are mostly interested in the specialties with little-to-no patient interaction, and that's fine, it's just that you don't need to do a required rotation to be interested in them (interventional IR, surgical subspecialties, diagnostic rads, path, etc.)

This is why I think ob/gyn should be kept in the required rotation block.

The point is that if it wasn't for chance, I wouldn't be going down the road I'm on.

Just because you think it's important to force people to do a rotation in OB for the sake of making more OBs doesn't make it any more true. It's great that you figured it out based on being forced into it, but what if I didn't have my one chance encounter with IR? We need more flexibility in our third year rotations.

Lucky for people like you, the NBME is making too much money off of this setup to change it. Unlucky for people like me.

 

[PTPoeny]

I realize this may not be exactly in the spirit of the question but my answer is whatever you do first. Most of the day to day stuff off being on a rotation is not covered in the first two years of medical school. From there on out the biggest learning curve is going to depend a lot on what you did first- inpatient versus outpatient mostly.

For clinical experiences, there is a lot of variability, but I would say for me the answer was psych. But I did a child psych rotation and basically none if the things that can get a 5 year old put in a psych hospital are covered in the first two years or on step 1. There is more adult stuff so that may not be generalizable to most people's experiences. For the shelves you have to learn a lot period. Family and IM help prepare for everything else and everything else helps with them so it depends on order again.

As stated before, most residents will treat children, other than IM. Every residency period will treat pregnant women. Please don't be the resident that calls an rrt because "I don't know what a 15 year old kid's lungs are supposed to sound like".

 

[ECkayak]

So you're making the point that IR is equally as important to see as a med student as OB/GYN or Peds? Also, you talk about flexibility, but then you also go ahead and say that it was lucky that you had a chance encounter with IR, which means that you would not have used that flexibility to pick IR even if you had the chance. The required rotations are required because they cover the widest range of patients.

So if you could go back and redesign your schooling, your third year would be something like: IR, neuroradiology, interventional cards, interventional critical care, maxillofacial surgery, diagnostic radiology? Would this really be a better general education, which is what med school is supposed to be?

 

[Perrotfish]

. The required rotations are required because they cover the widest range of patients.
?

No, they're not. The range of patients (or pathology, or whatever) is fairly narrow on OB. One gender, narrow age range, and all variations on a single condition. On the other hand IR, ER, anesthesia, PM&R, and all the other rotations that aren't required for medical school accreditation cover a very broad range of patients. The only reason that these are the rotations we do is because these are the rotations we've always done since they nationalized the system.

The reason we learn OB is that medical school was designed to produce 'general doctors' who did everything that (again) a WWI would be expect to do in a small town: heal the young and old, run a lab, interpret films/pathology slides, do surgery in the office, and delivered babies on kitchen tables. As medicine got more an more specialized, and as better transportation allowed for easy evacuation to tertiary care, the sane thing to do would have been to adapt by splitting off into different, more specialized schools: Pediatrican school, Medicine school, surgery school, etc. However medical schools had a government backed monopoly on healthcare and therefore had no reason to give up money by adapting, and so instead we just added several years of specialization training called residencies. Then when those specializations again became to general we added fellowships. Then the residencies and fellowship started getting longer. They are even beginning to add fellowships beyond fellowship for doctors who weren't specialized enough the first fellowship around.

We are at the point where you can go through 4 years of useless undergrad to get to 4 years of 80% usless medical school to go to 3 years of 80% useless IM residency for the sole purpose of being allowed to apply for 3 years of training in gastroenterology where you are allowed to finally, actually learn your profession. Much better than just having a 6 year gastroenterology school you go to straight out of high school, right?

And then we whine when the NPs bypass the whole idiotic thing and start practicing subspecialty care in their mid 20s with six years of education.

 

[Yoyomama88]

totally agree with perott. If you want...make third year IM, Peds, Surgery, Psych required. Remove Obgyn, Remove FM (same thing as IM anyways). The rest of the curriculum should be electives based on the students interests.

 

[KnuxNole]

No, they're not. The range of patients (or pathology, or whatever) is fairly narrow on OB. One gender, narrow age range, and all variations on a single condition. On the other hand IR, ER, anesthesia, PM&R, and all the other rotations that aren't required for medical school accreditation cover a very broad range of patients. The only reason that these are the rotations we do is because these are the rotations we've always done since they nationalized the system.

The reason we learn OB is that medical school was designed to produce 'general doctors' who did everything that (again) a WWI would be expect to do in a small town: heal the young and old, run a lab, interpret films/pathology slides, do surgery in the office, and delivered babies on kitchen tables. As medicine got more an more specialized, and as better transportation allowed for easy evacuation to tertiary care, the sane thing to do would have been to adapt by splitting off into different, more specialized schools: Pediatrican school, Medicine school, surgery school, etc. However medical schools had a government backed monopoly on healthcare and therefore had no reason to give up money by adapting, and so instead we just added several years of specialization training called residencies. Then when those specializations again became to general we added fellowships. Then the residencies and fellowship started getting longer. They are even beginning to add fellowships beyond fellowship for doctors who weren't specialized enough the first fellowship around.

We are at the point where you can go through 4 years of useless undergrad to get to 4 years of 80% usless medical school to go to 3 years of 80% useless IM residency for the sole purpose of being allowed to apply for 3 years of training in gastroenterology where you are allowed to finally, actually learn your profession. Much better than just having a 6 year gastroenterology school you go to straight out of high school, right?

And then we whine when the NPs bypass the whole idiotic thing and start practicing subspecialty care in their mid 20s with six years of education.

I don't think having a GE school straight out of high school would be right though. Can't skip college....maybe I'm in the minority on this board, but it's one of the best times in my youth, and something to not be bypassed.

NPs can start being "cardiologists, orthopedic surgeons, dermatologists" like they claim to be in two/three years post undergrad...but is that truly enough to feel comfortable?

 

[link2swim06]

totally agree with perott. If you want...make third year IM, Peds, Surgery, Psych required. Remove Obgyn, Remove FM (same thing as IM anyways). The rest of the curriculum should be electives based on the students interests.

Um no it isn't.

 

[Yoyomama88]

Whats the diff? You get to treat peds as well? You're only outpatient based?

 

[link2swim06]

Whats the diff? You get to treat peds as well? You're only outpatient based?

Family trains to do medicine + peds + ob/gyn.

Internal medicine is just adult medicine no peds and no ob.

For "many" 3rd year students internal medicine is "mostly" an inpatient rotation while family medicine is "mostly" an outpatient/clinic based rotation (I use quotes because this is a generalization).

Completely different diseases to manage for pt's who are clinic vs inpatient. People don't get admitted to the hospital to manage mild hypertension while nasty CHF exacerbations aren't treated in on an outpaitent basis.

You as a student learn different stuff on each rotations. Trust me.

 

[tco]

So you're making the point that IR is equally as important to see as a med student as OB/GYN or Peds? Also, you talk about flexibility, but then you also go ahead and say that it was lucky that you had a chance encounter with IR, which means that you would not have used that flexibility to pick IR even if you had the chance. The required rotations are required because they cover the widest range of patients.

So if you could go back and redesign your schooling, your third year would be something like: IR, neuroradiology, interventional cards, interventional critical care, maxillofacial surgery, diagnostic radiology? Would this really be a better general education, which is what med school is supposed to be?

That's a cute straw man that you built, but no. I would have done procedural related rotations in EM, anesthesia, surgical critical care, surgery, and surgical subspecialties. Who's to say that I'd still end up down the same path? Maybe there's one out there better fit for me. Now, I remain ignorant to everything except for what I think is the best for me due to our limited flexibility in electives.

Why does medical school have to be broad? There should be surgery school and medical school. From there, you'd learn more applicable information for your specialty of choice. However, there'd be nothing to keep you from transferring to the other school if you have an epiphany.

 

[roinom]

In my home country, anesthesiologist are trained in both anesthesia and critical care, hence all of them covers both OR and ICU.

At this 4 weeks rotation, I really felt the learning curve was steep. Really, it was all about applied physiology. I learned taking ABG, put in central lines etc. You learn how to manage the most urgent emergencies. You learn to interpret all types of parameters. You get some insight into managing patients from medicine and surgery.

 

[jerseytrash]

That's a cute straw man that you built, but no. I would have done procedural related rotations in EM, anesthesia, surgical critical care, surgery, and surgical subspecialties. Who's to say that I'd still end up down the same path? Maybe there's one out there better fit for me. Now, I remain ignorant to everything except for what I think is the best for me due to our limited flexibility in electives.

Why does medical school have to be broad? There should be surgery school and medical school. From there, you'd learn more applicable information for your specialty of choice. However, there'd be nothing to keep you from transferring to the other school if you have an epiphany.

Right because people from other non surgical specialties NEVER have to deal with surgical disease amirite

Excuse me as I go read up on my patient who threw a clot into her SMA and is now back on our team s/p thrombectomy

 

[Kal EI]

No, they're not. The range of patients (or pathology, or whatever) is fairly narrow on OB. One gender, narrow age range, and all variations on a single condition. On the other hand IR, ER, anesthesia, PM&R, and all the other rotations that aren't required for medical school accreditation cover a very broad range of patients. The only reason that these are the rotations we do is because these are the rotations we've always done since they nationalized the system.

The reason we learn OB is that medical school was designed to produce 'general doctors' who did everything that (again) a WWI would be expect to do in a small town: heal the young and old, run a lab, interpret films/pathology slides, do surgery in the office, and delivered babies on kitchen tables. As medicine got more an more specialized, and as better transportation allowed for easy evacuation to tertiary care, the sane thing to do would have been to adapt by splitting off into different, more specialized schools: Pediatrican school, Medicine school, surgery school, etc. However medical schools had a government backed monopoly on healthcare and therefore had no reason to give up money by adapting, and so instead we just added several years of specialization training called residencies. Then when those specializations again became to general we added fellowships. Then the residencies and fellowship started getting longer. They are even beginning to add fellowships beyond fellowship for doctors who weren't specialized enough the first fellowship around.

We are at the point where you can go through 4 years of useless undergrad to get to 4 years of 80% usless medical school to go to 3 years of 80% useless IM residency for the sole purpose of being allowed to apply for 3 years of training in gastroenterology where you are allowed to finally, actually learn your profession. Much better than just having a 6 year gastroenterology school you go to straight out of high school, right?

And then we whine when the NPs bypass the whole idiotic thing and start practicing subspecialty care in their mid 20s with six years of education.

Yeah, I agree. Medical education is very inefficient.

It's why we have trouble right now with midlevels. The people training physicians have not sought out to make it efficient and effective, but rather made it a hazing process to earn your stripes. You can't waste time, energy, and effort on useless stuff for long and expect to keep the status quo.

I don't think anyone could make a good argument against a GI or Cardio doc starting to train earlier in specialization. There are 4 yrs UG, 4 yrs MS, 3 yrs IM, then fellowship. There MUST be a better way to spend the 11 years before fellowship for a Cardio doc. I recommend the midlevel path to future healthcare workers for many reasons.

I don't think having a GE school straight out of high school would be right though. Can't skip college....maybe I'm in the minority on this board, but it's one of the best times in my youth, and something to not be bypassed.

NPs can start being "cardiologists, orthopedic surgeons, dermatologists" like they claim to be in two/three years post undergrad...but is that truly enough to feel comfortable?

Hmm, plus or minus.

I think the reason we all want to hold on to college is because we've gotten used to the idea of a crappy lifestyle. It would probably be better to work hard but not insanely over a steady pace for 11 years before fellowship and enjoy ALL 11 years rather than saying, oh - enjoy the 4 years of college and then all that enjoying life is over when you start residency or whatever.

 

[IJL]

No, they're not. The range of patients (or pathology, or whatever) is fairly narrow on OB. One gender, narrow age range, and all variations on a single condition. On the other hand IR, ER, anesthesia, PM&R, and all the other rotations that aren't required for medical school accreditation cover a very broad range of patients. The only reason that these are the rotations we do is because these are the rotations we've always done since they nationalized the system.

The reason we learn OB is that medical school was designed to produce 'general doctors' who did everything that (again) a WWI would be expect to do in a small town: heal the young and old, run a lab, interpret films/pathology slides, do surgery in the office, and delivered babies on kitchen tables. As medicine got more an more specialized, and as better transportation allowed for easy evacuation to tertiary care, the sane thing to do would have been to adapt by splitting off into different, more specialized schools: Pediatrican school, Medicine school, surgery school, etc. However medical schools had a government backed monopoly on healthcare and therefore had no reason to give up money by adapting, and so instead we just added several years of specialization training called residencies. Then when those specializations again became to general we added fellowships. Then the residencies and fellowship started getting longer. They are even beginning to add fellowships beyond fellowship for doctors who weren't specialized enough the first fellowship around.

We are at the point where you can go through 4 years of useless undergrad to get to 4 years of 80% usless medical school to go to 3 years of 80% useless IM residency for the sole purpose of being allowed to apply for 3 years of training in gastroenterology where you are allowed to finally, actually learn your profession. Much better than just having a 6 year gastroenterology school you go to straight out of high school, right?

And then we whine when the NPs bypass the whole idiotic thing and start practicing subspecialty care in their mid 20s with six years of education.

 

[mvenus929]

I can also tell you that I saw ONE adult patient with tetrology of Fallot. What other congenital diseases are you talking about? I saw very few weird things, and most of those don't make it to adulthood (Edwards syndrome, for example)...

Did you see no one with cystic fibrosis? Those people used to only live into their teens and now live into their thirties on average. We had a joint clinic when I was on peds specifically to transition those kids (some of whom were in their 20s) to the adult pulm docs. I am actually impressed that you saw an adult tet patient, as I haven't seen one of those. Adult cardiologists will see more hypo plastic left hearts in the coming years, or kids who have had heart transplants. The leukemia/lymphoma kids who survive have to be followed by an adult oncologist eventually.

Okay, I'm interested in peds even less than OBGYN. At least with OBGYN I "might" get to do something like deliver a baby out in the middle of Timbuktu...I mean...the fantasy is there. But peds? Ugh...I don't even like them. Cooties!

You know, there was a girl in my class who insisted throughout first and second year that she hated kids. Absolutely hated them. Then she did her peds rotation and realized that she didn't hate them so much, and is now going into family medicine.

No, they're not. The range of patients (or pathology, or whatever) is fairly narrow on OB. One gender, narrow age range, and all variations on a single condition.

Not that I completely disagree with you, but many places do some combination of OB and GYN, which broadens the age range and pathologies considerably... Still narrowed to one gender, but you have everything from 16 year olds with STDs to 80 year olds with endometrial cancer.

 

[Trogghunter]

which country?

In 'murica you can do critical care as an anesthesiologist with a 2year fellowship. I know that some western European countries have medicine training in critical care.

Sent from my Nexus 7 using SDN Mobile

 

[roinom]

which country?

Sweden, I don't know by which European countries this also applies.
There are no critical care positions/fellowships for doctors in other specialties. So, in order to become one you go through 5 years of anesthesiologist and critical care (you can't just choose one). The older docs tends to go for anesthesia/OR later in their career due to less calls. Anyway, in Sweden the work load is not huge, about 50h/week.

 

[tco]

You guys are kinda proving my point, rather than refuting it.

Tell me, how is the medical management of an SMA thrombosis any different than any other thrombosis, other than NPO? I'm asking because I'm ignorant to the condition, not to be a smartass. Too bad I didn't have eight weeks of internal medicine during my third year of medical school, or I'd be able to treat it just like COPD...Oh I did, and I don't (now I'm being a smartass)? On the flipside, I wonder if the internist knows the intricacies of SMA thrombolysis and clot retrieval from his eight week surgical rotation?

CF is common enough that it's a common condition seen in the adult population. Yes, this is a testament to treatment by pediatricians, however, it does not justify why a surgeon needs to know about the 150 mutations of the CFTR, or how to manage the patient's enzyme regimen. I say that the surgeon doesn't need to know this because they don't know it now, and this is after having their typical third year clerkship in pediatrics. The internist gets enough exposure that he can learn to treat it during residency. After all, we know that "kids aren't just little adults," right?

The conditions that you all have quoted are not managed (or not known how to be managed) by the "other" specialty, and this is after having been through said "necessary" clerkships.

 

[Anastomoses]

In 'murica you can do critical care as an anesthesiologist with a 2year fellowship. I know that some western European countries have medicine training in critical care.

Sweden, I don't know by which European countries this also applies.
There are no critical care positions/fellowships for doctors in other specialties. So, in order to become one you go through 5 years of anesthesiologist and critical care (you can't just choose one). The older docs tends to go for anesthesia/OR later in their career due to less calls. Anyway, in Sweden the work load is not huge, about 50h/week.

This makes anesthesiology sound like a more interesting choice.

mvenus: I don't hate kids...I just don't have that sort of patience for other people's children. I'm gonna save that for when I have my own.

 

[thedoctor8706]

I'd say that no matter what rotation you start with, the first few weeks of 3rd year has a very steep learning curve. Not because of science knowledge, but because of learning how to function as a 3rd year. Even if you spent a little bit in time shadowing as a first or second year, there's no way sitting and studying for tests can prepare you for running off to your first code, or how to deal with combatative patients, or how to navigate an electronic health record, etc etc. There's so many things about how to function in a hospital environment and please your attending that I feel like we are never taught in the first two years, and you have to quickly learn how to swim or you'll drown. The learning curve has a lot more to do with practical things then with what basic science you did or didn't learn IMHO.

 

[ECkayak]

I love when people know they're beat, so they attack a person's argument as a "straw man," it brings a smile to my face.

I think it's scary that a person like TCO can sit there with a straight face and say, "Why should I have to know what other doctors who aren't procedural-based do? I'm not practicing that kind of medicine; therefore, I shouldn't have to know a damn thing about it. And if I don't know what the hell is going on with a patient of mine, I'll just dump him on someone else and forget that patient even exists." What's not said out loud is, "I'm the best kind of doctor, **** everyone else."

 

[tco]

I love when people know they're beat, so they attack a person's argument as a "straw man," it brings a smile to my face.

I think it's scary that a person like TCO can sit there with a straight face and say, "Why should I have to know what other doctors who aren't procedural-based do? I'm not practicing that kind of medicine; therefore, I shouldn't have to know a damn thing about it. And if I don't know what the hell is going on with a patient of mine, I'll just dump him on someone else and forget that patient even exists." What's not said out loud is, "I'm the best kind of doctor, **** everyone else."

Not quite what I said, but you can believe what you want. You did, however, create a straw man by suggesting rotations that I not only wouldn't focus on, but I'm not even sure exist. Creating a fictitious argument is the definition of a straw man.

It's not possible to know everything about medicine, and each particular modality of training should have some overlap for the common conditions. Just out of probability, surgeons will be able to manage Htn, diabetes, and keep the O2 sats of COPDers above 90. However, what is the utility in a OB understanding the treatment or clinical progression of usual interstitial pneumonia? If that patient has a GYN issue that requires
pulmonary treatment, a pulmonologist will be consulted. On the other hand, medical management of surgical patients is an excellent way to understand glucose management, acid base, and electrolyte management.

There is some overlap, but can be covered in a more applicable way with a dedicated training pathway. Just because you think I'm wrong doesn't mean that I am. This isn't an argument about correct vs incorrect, it's an argument about efficiency of training.

What's scary to me is that you can make a judgement of what type of physician I will be based on a post I made on a message board. I wonder what kind of judgements you incorrectly (as in this case) pass on to your patients.

 

[tco]

To that end, I'm going to stop posting on this thread. PM me if you'd like further discussion. I enjoy it, but we've hijacked it enough.

 

[ECkayak]

To that end, I'm going to stop posting on this thread.

That's good. I've heard just about all I need to hear from you. You've clearly established your gunner mentality to medicine, just as I've clearly established my all-inclusive approach, and we have nothing more to say to each other.

 

[Anastomoses]

I'd say that no matter what rotation you start with, the first few weeks of 3rd year has a very steep learning curve. Not because of science knowledge, but because of learning how to function as a 3rd year. Even if you spent a little bit in time shadowing as a first or second year, there's no way sitting and studying for tests can prepare you for running off to your first code, or how to deal with combatative patients, or how to navigate an electronic health record, etc etc.

Combative patients? huh? what?

 

[thedoctor8706]

Combative patients? huh? what?

Yes, I meant combative, not combatative. Typo haha! Unless you are expressing surprise about the fact I've seen a combative patient, in which case where do you work that they are so nice?? Haha.