clinical rotations only outpatient

[b1209]

Hello,

I thought it would be appropriate to post this here (if not, sorry lol). I am currently considering attending a medical school (KPSOM) that only has clinical core rotations that are outpatient. No large academic center or Univ. Hospital.
We would have to supplement our rotations with electives in inpatient settings and EM would be inpatient.

I consulted my mentor about this and he said it was concerning considering inpatient is where you see a lot of interesting cases (inpatient peds/obgyn) and where he mostly did his core rotations. Should I be greatly concerned about this? I don't know enough about rotations/outpatient/inpatient.

All advice is appreciated, thanks

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[Skarl]

You absolutely should be concerned despite what seems to be a large amount of Kaiser kool-aid sipping on these forums, judging from recent School X vs. Y threads and their replies. Just my 2 cents!

 

[b1209]

You absolutely should be concerned despite what seems to be a large amount of Kaiser kool-aid sipping on these forums, judging from recent School X vs. Y threads and their replies. Just my 2 cents!

can you explain tho lol i understand in a broad sense but down the line what does strictly outpatient rotations for core clerkships mean for step 2 or residency?

 

[newaccount4decisionss]

I am also slightly concerned about this. How is this going to affect my clinical training? I want a real hospital experience.

 

[OchemOficionado]

This is interesting... and shocking that they can't set up rotations for you in some of their many hospitals or the many many many hospitals in the area... yet, I guess.

Well, at least there is the option to supplement with away inpatient settings. What is your concern though? That you won't be prepared for step 2 or that residencies will think you're less competitive?

 

[b1209]

This is interesting... and shocking that they can't set up rotations for you in some of their many hospitals or the many many many hospitals in the area... yet, I guess.

Well, at least there is the option to supplement with away inpatient settings. What is your concern though? That you won't be prepared for step 2 or that residencies will think you're less competitive?

Similar to what the post above stated, I feel like I will be missing out on a holistic medical school experience without inpatient core clerkships. No cases that are going to be abnormal or things that will keep me uniquely engaged. I think outpatient is primarily preventative care and that only encapsulates a fraction of medicine and maybe something that I wouldn't be interested in. Also, I am not worried about it impacting step 2 per se, but mostly how I will be able to maneuver my internship/residency and if residencies would even think I am prepared for their program considering the way my curriculum at med school was set up.

I don't think other LIC modeled schools are all outpatient ...

Any advice and insight would be helpful as I am trying to make a final decision before Monday!

 

[aSagacious]

Yeah that sounds really not ideal. Managing inpatients is important for learning:
- How to eyeball a patient and decide sick vs not sick
- The typical course of a hospital stay for common acute illnesses (ACS, COPD exacerbation, DKA, CAP, pancreatitis, acute chole, appy, RSV bronchiolitis, chron's flare, upper or lower GI bleed, stroke, etc, etc)
- The relationship and contribution from ancillary staff (floor nurses, social workers, pharmacists, nutritionists, etc)
- When and how to consult; the scope of various specialties
- Get procedure reps (central line, para/thora, intubation, a line, etc)
- The normal cadence of table rounding, walking rounds, running the list
- The difference in levels of care (ED obs, floor med/surg, tele, progressive/step-down, ICU)
- Criteria for hospital admission and discharge
- Who belongs at home versus acute care facility, SNF, or LTAC

Outpatient medicine is very important, as it comprises the overwhelming majority of healthcare. But as far as education goes I'd say inpatient medicine is just as important.

Sure, you could do away electives as an M4 but you will potentially be the red-headed stepchild as a rotating student among home med students. The rotation sites will likely be of variable educational quality.

If I had a choice of med schools, I would avoid this type of school.

 

[nymedschoolfan]

Hello,

I thought it would be appropriate to post this here (if not, sorry lol). I am currently considering attending a medical school (KPSOM) that only has clinical core rotations that are outpatient. No large academic center or Univ. Hospital.
We would have to supplement our rotations with electives in inpatient settings and EM would be inpatient.

I consulted my mentor about this and he said it was concerning considering inpatient is where you see a lot of interesting cases (inpatient peds/obgyn) and where he mostly did his core rotations. Should I be greatly concerned about this? I don't know enough about rotations/outpatient/inpatient.

All advice is appreciated, thanks

Sounds like a red flag. Kaiser is so overhyped on these forums, and this is a major flaw that of course everyone worshipping Kaiser has overlooked. Maybe ask folks in the medical student forum as well and on reddit?

 

[OchemOficionado]

Similar to what the post above stated, I feel like I will be missing out on a holistic medical school experience without inpatient core clerkships. No cases that are going to be abnormal or things that will keep me uniquely engaged. I think outpatient is primarily preventative care and that only encapsulates a fraction of medicine and maybe something that I wouldn't be interested in. Also, I am not worried about it impacting step 2 per se, but mostly how I will be able to maneuver my internship/residency and if residencies would even think I am prepared for their program considering the way my curriculum at med school was set up.

I don't think other LIC modeled schools are all outpatient ...

Any advice and insight would be helpful as I am trying to make a final decision before Monday!

Wanting a "holistic medical school experience" is different than fears it will impact your boards scores or residency placements, so I was just seeking more clarity from you. Kaiser has plenty of their own residency spots so I don't think it will be an issue. They aren't the first new school that needs time to get on their feet in terms of rotations or a linked hospital so I don't think it will have long term implications on their graduating physicians.

I haven't gotten to clerkships yet so I really can't speak to that part, but one thing I know is that you will see abnormal and uniquely engaging things in the outpatient settings as well. You can even follow up on their chart after they are referred if you're interested. It seems like Kaiser will fully support you in gaining inpatient experience though so factor that in your decision.

 

[aSagacious]

It seems like Kaiser will fully support you in gaining inpatient experience though so factor that in your decision.

So says every Carribean, bottom-tier DO, and NP school. This is often followed by "but we encourage our students to be proactive and seek their own rotation sites."

 

[OchemOficionado]

So says every Carribean, bottom-tier DO, and NP school. This is often followed by "but we encourage our students to be proactive and seek their own rotation sites."

Kaiser could do the same perhaps. Do we have any reason to hope that Kaiser may operate different than every Carribean, bottom-tier DO, and NP school? If not, then I'd be worried.

 

[aSagacious]

Time will tell. My point is: talk is cheap.

 

[ciestar]

The high number of DO schools with outpatient only rotations is in part why they get hit so often with criticism in the first place.

You’re going to spend most of your time as an intern in the hospital most residencies you could end up at. It is important to get that experience.

I wouldn’t worry about Step 2, but based on what i’ve seen in some of the DO forums, not having inpatient rotations can absolutely hurt you.

 

[longhaul3]

This sounds like a nightmare. I would say that at least 80% of your med school clinical education should be inpatient. Outpatient rotations should be the elective ones. I don't see how you would really learn anything from going to 5000 clinic visits.

 

[lanzhou_lamian]

Kaiser's core clerkships, which take place in the 2nd year, are primarily outpatient, with the exception of EM. But, there are inpatient immersive experiences built into the curriculum in the first two years. In 3rd and 4th year, there is significant inpatient exposure, including most electives and inpatient sub-I's.

Additionally, most of the LIC sites are not strictly outpatient clinics. They are Kaiser's flagship hospitals in the region. They are large, several hundred bed inpatient hospitals that Kaiser med students will be in from year 1.

 

[Angus Avagadro]

OP, this topic comes up more and more as more med schools open. As other posters have said, an inpatient experience, on a teaching service with residents is very important. PDs have commented on SDN on this very topic. Students graduating with no inpatient experience, according to these PDs, are not prepared to take over as a PGY1 in July. They dont have time to bring them up to speed on an inpatient service. Plus, noon conferences, journal club, article critiques, and bedside lectures are not available for outpatient rotations. I also agree that trying to do this as an M4 while you might be auditioning will reveal your deficiencies on inpatient medicine. The students, and residents for that matter, from St Elsewhere always get a little extra scrutiny. My advice would be to try and get accepted at a program with a home teaching hospital with residents. Not all teaching programs are the same. Some have residents of every specialty, others just IM or FM. Hope this helps a little. Good luck and best wishes!

 

[b1209]

Kaiser's core clerkships, which take place in the 2nd year, are primarily outpatient, with the exception of EM. But, there are inpatient immersive experiences built into the curriculum in the first two years. In 3rd and 4th year, there is significant inpatient exposure, including most electives and inpatient sub-I's.

Additionally, most of the LIC sites are not strictly outpatient clinics. They are Kaiser's flagship hospitals in the region. They are large, several hundred bed inpatient hospitals that Kaiser med students will be in from year 1.

I am not here to bash KP at all I don't know why this thread took that turn -- I am genuinely just trying to be super cautious with where I spend my next four years. That said, if we are spending our electives in inpatient experiences, wouldn't we be missing out on inpatient in other specialties that we might not necessarily want to specialize in like pediatrics or surgery (for example)? Why would I do an inpatient elective in peds when I know I don't want to specialize in that, it would just be nice to be able to see that automatically.

Also, with so many different clinical sites in the LA area, having to take a two-hour drive to South Bay for three weeks just to see some inpatient work I am interested in seems like such a hassle rather than walking down the street and gaining it immediately. I guess I am going through everything with a super fine tooth comb right now and trying to rely less on what is said and what I know is to be true right now.

OP, this topic comes up more and more as more med schools open. As other posters have said, an inpatient experience, on a teaching service with residents is very important. PDs have commented on SDN on this very topic. Students graduating with no inpatient experience, according to these PDs, are not prepared to take over as a PGY1 in July. They dont have time to bring them up to speed on an inpatient service. Plus, noon conferences, journal club, article critiques, and bedside lectures are not available for outpatient rotations. I also agree that trying to do this as an M4 while you might be auditioning will reveal your deficiencies on inpatient medicine. The students, and residents for that matter, from St Elsewhere always get a little extra scrutiny. My advice would be to try and get accepted at a program with a home teaching hospital with residents. Not all teaching programs are the same. Some have residents of every specialty, others just IM or FM. Hope this helps a little. Good luck and best wishes!

Kaiser does have teaching hospitals and they have a long history of training residents. I'm just not sure what our role will be on that medical team during our time there and it was never really explained fully

 

[Angus Avagadro]

I am not here to bash KP at all I don't know why this thread took that turn -- I am genuinely just trying to be super cautious with where I spend my next four years. That said, if we are spending our electives in inpatient experiences, wouldn't we be missing out on inpatient in other specialties that we might not necessarily want to specialize in like pediatrics or surgery (for example)? Why would I do an inpatient elective in peds when I know I don't want to specialize in that, it would just be nice to be able to see that automatically.

Also, with so many different clinical sites in the LA area, having to take a two-hour drive to South Bay for three weeks just to see some inpatient work I am interested in seems like such a hassle rather than walking down the street and gaining it immediately. I guess I am going through everything with a super fine tooth comb right now and trying to rely less on what is said and what I know is to be true right now.



Kaiser does have teaching hospitals and they have a long history of training residents. I'm just not sure what our role will be on that medical team during our time there and it was never really explained fully

I would try to get a straight answer out of them. If they cant provide one, then that would set my Spidey senses tingling. You can do a search on SDN, but I recall one PD in particular saying that he wont take students from a certain school anymore because they never had an inpatient medicine rotation. They were too far behind in July. Agreed, away rotations are expensive. Either drive or get short term housing. Some places will rent you student housing, some provide it. Hey, if that is your only choice, roll with it and do the best you can to make the best app for residency you can.
Secondly, many people think they know what specialty they want to enter and change their minds in med school. My wife and I both did. Something to consider. Try to be a well rounded generalist before specializing, is what I would recommend.