Clinical experience first and second years

[iowatheodore]

I was wondering what clinical experiences other schools require/offer for first and second year students. We have a program where every few weeks we go to a local school and help with physicals, but no required clinical clerkships until third year.

I am under the impression most schools wait until third year for clinical rotations. My brother is dating a girl in the 6 year UMKC BA/MD program (she is a first year), and she has a "docent" program for a few hours one day a week which sounds like a combination of shadowing a physician and some hospital work.

Any statistics would be appreciated if anyone knows a good site.

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[slick177]

First Year - we spent 2 hours a week shadowing a local physician as part of our Intro to Clinical Medicine class. Highly preceptor dependent as to what we were able to do. With my preceptor I did alot of Supartz Knee injections, as well as order films to speed up the preceptors office practice. He also let me close in the OR. Other students were only allowed to observe.

Second Year - we spend mainly 2 hours a week with a preceptor working on various aspect of the Physical Exam. So far this semester I have done minor skin lesion removal and other small office procedures.

 

[deleted109597]

First year, 1 day per week shadowing from 10am until the clinic closes.
Second year we do two one week externships (fall and spring breaks).

 

[Tired]

For my school:

MS1 - weekly "Clinical Skills Preceptorship" where groups of 3-4 students would round on interesting patients selected by the attending in charge. It would change every month so we covered a different organ system (cardio, pulm, GI, etc). Also had a mandatory weekly home visit thing.

MS2 - continuation of the "Clinical Skills Preceptorship", also had three required clinical exams where we were forced to demonstrate our proficiency at the Basic Physical Exam and its branch steps (extended cardio and neuro exam, pelvic exam, etc)

Finally, we had frequent exams where we were video taped doing full H&Ps on professional patients. (I hated the rectal exam test)

 

[bjackrian]

MS1 Fall: One-on-one preceptorship 4 hrs per month
MS1 Spring and MS2: One-on-one preceptorship with same physician for four hours every other week.

The idea is that you get escalating responsibility as you learn more interviewing/physical diagnosis skills in our practice of medicine. This year, as an MS2, I see patients on my own, examine them, and present them to the preceptor with an assessment/plan--he of course examines the patient and half the time I'm wrong, but I do appreciate having the experience.

The preceptorships are highly variable depending on who you have as your preceptor--with a general pediatrician, like I have, I'm able to do a lot more than my friends who have super-sub-specialists.

 

[vtucci]

We have LCE (longitudinal clinical experience) where we work with a physician in the community for at least 4 hours per week during first and second years. We are required to work with one primary care doc (out of three rotations for first and second year).

It more than just mere shadowing however, as we often take and perform the full H&P and then present to the attending.

 

[psipsina]

1st year: 1 wk required preceptorship at the beginning of second semester, we were supposed to follow a PCP and do physicals/histories but some classmates ended up in the OR, lucky bastards
We also have alot of volunteer opportunities if you are looking for more like a student run homeless clinic and hangin in the Charity ER (which does still exist, yay)
Not sure yet about 2nd year

 

[Wizard of Oz]

We do shadowing as well, but people who ask for a surgical specialty get to stand and watch surgeries. To me, I've seen enough surgeries for my taste without actually doing anything; and I'd like to think that the emphasis of an M1 ought to be more on the patient communication side.

Really there is no real clinical experience at my place during M1, at least none that I couldn't have gotten shadowing before I got here. If I wasn't qualified to do a patient interview by this time, they shouldn't have let me in. Don't get me started on standardized patients (actors).

In times like these, I think back to the nursing school that I never finished when they actually taught us how to do something during the first semester; and I'm also jealous of my PA student friends who go straight to the clinic, do H/P's, and present early on without all of the wasted time on preliminary fluff.

 

[8744]

I was wondering what clinical experiences other schools require/offer for first and second year students. We have a program where every few weeks we go to a local school and help with physicals, but no required clinical clerkships until third year.

I am under the impression most schools wait until third year for clinical rotations. My brother is dating a girl in the 6 year UMKC BA/MD program (she is a first year), and she has a "docent" program for a few hours one day a week which sounds like a combination of shadowing a physician and some hospital work.

Any statistics would be appreciated if anyone knows a good site.

Clinical exposure in first and second year: Way, way over-rated. You have other priorities and this is a low-yield activity since you really can't do enough of it to make it meaningful. A week of third year will give you the equivalent of the clinical exposure you are likely to get in first and second year. Not to mention that as a first year you don't have enough background to do anything but follow the doctor looking sheepish.

Bottom line: Don't make decisions on which medical school to attend based on the amount of first and second year clinical exposure. In fact, the less the better as the time you will waste flitting uselessly around the hospital or empathizing with a patient for whom you have no responsibility is coming out of your study time and thus, out of your free time.

 

[Droopy Snoopy]

Other than our Clinical Medicine class (both years), we have little school-sponsored exposure. We have a free clinic open on the weekends that anybody can go volunteer at, and many in my class (including myself) have taken various lecturers up on "coming by anytime to see what the ED is like", etc. The main component of the CM class is preceptorship, and as others have described above, its worthful/lessness pretty much dependent on who your preceptor is.

 

[dilated]

Clinical exposure in first and second year: Way, way over-rated. You have other priorities and this is a low-yield activity since you really can't do enough of it to make it meaningful. A week of third year will give you the equivalent of the clinical exposure you are likely to get in first and second year. Not to mention that as a first year you don't have enough background to do anything but follow the doctor looking sheepish.

I don't know, I think it's useful. Certainly not if you're shadowing, but we go on the inpt wards and clinics, examine patients, write H&Ps on them and present them. Needless to say Step 2 CS is a joke and we hit 3rd year with pretty good exam abilities. I can see it getting boring eventually though, even with mixing up the departments and clinics.

 

[dpmd]

Our school has introduction to clinical medicine over the first two years. We were systems based, and the clinical teaching tended to parallel that. We did one morning a week where we would go to the hospital and do H+P's then meet back up to present to our colunteer community physician (various specialties represented). In addition to that we would have numerous workshops on the various elements of the interview and physical exam (and blood drawing). Some of these were do it on your partner type things, but we also had a lot of standardized patient workshops for things like "breaking the bad news", "dealing with the angry patient", etc (and of course the pelvic, testicular, and rectal exams). We also had tests on standardized patients to evaluate what we learned. I think it was helpful in terms of not being completely lost when starting first year, but I can see how simply shadowing a physician wouldn't be that useful. Another benefit to early clinical exposure, is getting a break from the monotony of class. I can say that I have been told that it is quite easy to tell our third year students apart from another school in our city (by attendings who deal with students from both schools). Whether this makes any difference in the long term is debatable, but I think its nice to have a background on which to build instead of being thrown to the wolves into what is already going to be a stressful situation.

 

[dancinjenn]

MS I: We really only have about a week of required clinical exposure as related to our Clinical Medicine class. Most of Clin Med revolves around how to take a history. At the end of the year we have a OSCE with standardized patients where we are graded on our history taking skills.

MS II: MUCH more involved. We have lectures for the first part of the year. In January we started the Physical Diagnosis portion of the class.

1) We have a lecture on an area (head/neck, thoracic, etc.). Usually takes place for 1-2 hours a week.
2) We have a Clinical Skills Center where we do full-histories (related to that unit) on standardized patients(SP). On the same day we have SP's who have been trained in physical diagnosis skills and we run through how to examine, palpate, percuss, and ascultate all structures in that unit. Then we have a debriefing about how to come up with a relevant problem list for that days case. (Once per unit for about 2 hours)
3) We then have 2 hospital sessions where we go and practice out PD skills on real patients in the hospital, with supervising residents/attendings. They try to get us patients relevant to that unit so we can hear/see/feel relevant pathology. (hospital sessions are each 2 hours long)

So per week right now I spend probably 5-6 hours.

At the end of the year we have another OSCE where we have to do a full H & P on a SP (something like a 200 point checklist) to pass the class.

Whew...I'm tired just typing that!

 

[kesse]

Clinical exposure in first and second year: Way, way over-rated. You have other priorities and this is a low-yield activity since you really can't do enough of it to make it meaningful. A week of third year will give you the equivalent of the clinical exposure you are likely to get in first and second year. Not to mention that as a first year you don't have enough background to do anything but follow the doctor looking sheepish.

Bottom line: Don't make decisions on which medical school to attend based on the amount of first and second year clinical exposure. In fact, the less the better as the time you will waste flitting uselessly around the hospital or empathizing with a patient for whom you have no responsibility is coming out of your study time and thus, out of your free time.

maybe in retrospect it wont seem important, but the clinical experiences help remind me why i came here in the first place. it's cool when i can apply things i'm learning. i've slowly seen progress in my level of understanding about what's going on, which keeps me going!

 

[FenderHM]

I kinda agree with Panda Bear, I just end up shadowing my guy and trying not to get in his way as I follow him from sick child needing strep test to healthy baby needed vaccinations....

one time he had a kid with a partial chromosome deletion that was sad but interesting, and I got to see a cataract pupil not respond to light, but other than that its just kinda a waste of time...

that said, generally it seems like the hospitals are open to letting med students of pre-clinical years volunteer in their free time, so if you feel like u want to see more just start emailing attendings at your hospitals

 

[The Buff]

I could not agree with Panda more. I think teaching basic history taking and physical exam skills in the first two years is clearly justified, but I have no idea why some schools are focusing more on doing things like sutures or starting lines right away. I'm sure it is cool for those doing it, but it just seems like there is time enough for that stuff in third and fourth year.

I personally think some schools are going that direction only to try and draw more people to their program since most pre-meds think it is better to jump in and close in the OR right away.

My school offers nothing beyond basic H&P skills during the first couple years(on Sps and real pateints), and I think that has been perfect for me. A little dry, yes, but I think start slow is fine. 👍

 

[bjackrian]

Clinical exposure in first and second year: Way, way over-rated. You have other priorities and this is a low-yield activity since you really can't do enough of it to make it meaningful. A week of third year will give you the equivalent of the clinical exposure you are likely to get in first and second year. Not to mention that as a first year you don't have enough background to do anything but follow the doctor looking sheepish.

Bottom line: Don't make decisions on which medical school to attend based on the amount of first and second year clinical exposure. In fact, the less the better as the time you will waste flitting uselessly around the hospital or empathizing with a patient for whom you have no responsibility is coming out of your study time and thus, out of your free time.

While it may not be useful for our long-term education, it is certainly useful as a motivational tool (oh yeah, I'm learning this because I'm actually going to be using it). This is especially true when my attending pulls some random obscure fact from basic sciences out of his hinder--wow! I'll actually remember this in 20 years.

 

[turkleton]

I wouldn't worry terribly about the amount of clinical experience you get as a 1st and 2nd year. Most schools have some sporadically throughout both years, but it's- from what I saw- glorified shadowing and getting a feel for patient interaction. The actual medical stuff is useless without completing the basic sciences, actually taking charge of your own patients, and being on a ward day in day out. Whatever opportunities you get, just figure out what demanor makes a particular doctor "good".

 

[Sophie]

...it is certainly useful as a motivational tool (oh yeah, I'm learning this because I'm actually going to be using it).

I totally agree. For instance, we're in our hematology block right now, and I had an anemic patient during the 2nd week (very nice coincidence). It was really cool to have sat through an 'Intro to Anemia' lecture a few days prior, in which we learned the clinical signs and symptoms, causes, etc, and then go take an H&P on a patient who described pretty much every one of those symptoms. It makes learning that much more interesting.

Btw, we see patients every Tuesday morning. We're each assigned a patient to go interview (based just on who the nurses think would be good - our instructor has no idea what the patient has) on our own (no supervision), and do a brief physical. We all meet back up with the instructor afterwards and each present our patient, and the instructor teaches us more about the specific things we saw. Afterwards we have to do a full write up (CC, HPI, PMH, FH, SH, ROS, PE, Assessment, etc).

I actually think it'll be useful long-term, but maybe that'll change once I get to 3rd year.

 

[iowatheodore]

Thank you to everyone for responding. It seems like a majority of schools have at least physicals and often hospital experiences for 3-5 hours, especially during second year.

There is a very mixed reaction on how useful these experiences are, however.

Is this a relatively good summary?