Community vs. academic hospital

[Rollo]

M2 here in the process of figuring out rotations stuff for next year.

Community hospital

Pros (these would be cons for academic): no residents, more exposure with attending, more opportunities to do procedures i.e. develop skills, more autonomy i.e. develop confidence

Cons (these would be pros for academic): no structured didactics, lack of insight into resident life, more exposure to really sick patients, network with key individuals

Ok that's my understanding so far. Feel free to correct it if you wish.

I'm thinking that I do most of my rotations at community hospital and save the important ones like IM, Surgery (interested), elective audition rotation for big academic places. My main reasoning is to develop skills and be clinically competent.

I mean, as long as I do my IM, Surg, and specialty I want to pursue at academic places, get good grades, and get LORs...nobody is going to question me doing all my other ones at community hospitals, right?

And I keep hearing didactics over and over. What's the big deal?

Can't I just learn stuff on my own outside of work? One big advantage I imagine with scheduled didactics is that the study time is built into my regular work hours at academic places. Where as in community places, I will have to go home and spend an hour or two to study.

What do you folks think?

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[BigRedBeta]

If surgery is really what you're going to do, then you ABSOLUTELY must do surgery at the academic center. Surgery is definitely one of those fields where if you know the right people, or have the right people write your LOR's, it makes the Match much easier.

As for everything else, talk to the upperclassmen. Presumably all the things you've mentioned as benefits for the community hospital could be true, but there are certainly no guarantees. Talking to the M3's and M4's you can find out where the good experiences are. Maybe community peds is awful, but community psych is the best 4-8 weeks of third year. Maybe if you get with exactly one community OB-GYN, you are guaranteed to rock the shelf and learn everything there is to know about the field, whereas if you get stuck with a different one, you're unlikely to have any clue what a vagina actually looks like, let alone how a baby is born. So ask around.

 

[turkeyjerky]

You need to find out about the specific sites--this generalizing about "community vs academic" hospitals is bunk. There are some community sites where you'll essentially be shadowing a doctor who doesn't want you anywhere near his patients; others will let you almost function as a resident. Some academic sites will have you at the bottom of a 15 person food chain, whereas others make it a goal to throw students procedures and practical knowledge. A lot of this is rotation (and attending) specific.

 

[MossPoh]

It depends on how your school does community rotations. My school is ALL community rotations really. There are a few hospitals with small residency programs, but nothing spectacular. All of the docs sign-up for it because they want to do it. They have to do a bunch of training session stuff afterwards to make sure they are up to par for teaching as well. We also see plenty of rare stuff and sick people but are especially strong at the common stuff. I'm guessing that is why we are way above the averages on Step 2 (when we're a little below the averages on Step 1). We also have structured didactic type stuff every week.

If there isn't organization and structure then I wouldn't go for it.

 

[Jolie South]

I agree with what's been said above. I'd talk with upperclassmen to get the low-down on each particular rotation. Being private doesn't guarantee a "shadowing" type experience, nor does being at an academic institution guarantee lots of procedures or a "being the doctor" type experience. Or vice versa. I think it's definitely specialty and team dependent.

Also, here's my $.02. I personally like working with residents better. They're less far removed from medical school and have a better idea of how to teach and what you're capable of. Again, that's just my experience.

 

[Ableton]

For 3rd year, go where you'll have the best experience. You will always have your AI in 4th year to make those connections and get letters from attendings who will be able to evaluate your performance much better. You're not going to impress any attending at your university hospital as a 3rd year student, where most of the time you're really just trying to figure out how to stay out of everyone's way while trying to find enough time to study to pass that shelf exam.

I picked a community hospital where I scrubbed in on over 30 surgeries in a month (even got to do a few small ones from start to finish) over my university hospital with all the big wigs where you had to fight to even see the inside of an OR. Most of my classmates at the mother ship even said they wouldn't have done their rotation there had they known.

 

[km11]

I basically went with your plan. Academic hospitals for the big 2 (IM and surg) and kind of took whatever for the rest. The biggest thing is getting LORs. If you're interested in academic residencies, LORs from academic physicians carries more weight, especially if you can get a full professor to write you a rec.

The education itself is pretty different between the sites and depends totally on your learning style. I think community places are much more unstructured and more of a learn-as-you-go kind of thing. Academic centers have a long tradition of education and the residents/attendings are all familiar with the process so you'll get more structured teaching.

The good thing about having residents/interns around is that you can ask them really really dumb questions without fear of really being judged. And they're also much closer in age and rank to you so theyre people you can chat with.

 

[Rollo]

I basically went with your plan. Academic hospitals for the big 2 (IM and surg) and kind of took whatever for the rest. The biggest thing is getting LORs. If you're interested in academic residencies, LORs from academic physicians carries more weight, especially if you can get a full professor to write you a rec.

The education itself is pretty different between the sites and depends totally on your learning style. I think community places are much more unstructured and more of a learn-as-you-go kind of thing. Academic centers have a long tradition of education and the residents/attendings are all familiar with the process so you'll get more structured teaching.

The good thing about having residents/interns around is that you can ask them really really dumb questions without fear of really being judged. And they're also much closer in age and rank to you so theyre people you can chat with.

What exactly do you mean by structured vs. unstructured education? Do you mean scheduled conferences, lecture series, journal clubs, etc.?

If you don't mind me asking, what specialty are you looking into and how did your plan work out?

 

[SLUser11]

M2 here in the process of figuring out rotations stuff for next year.

What I can say is that typically, nurses at community hospitals are hotter and much nicer....just saying....

 

[km11]

What exactly do you mean by structured vs. unstructured education? Do you mean scheduled conferences, lecture series, journal clubs, etc.?

If you don't mind me asking, what specialty are you looking into and how did your plan work out?

Right, scheduled noon conferences, daily morning report, specific lectures for students etc.

My plan worked out really well, I'm applying to internal medicine. I got honors in my ms3 rotations, and good LORs from academic IM docs so I'm in a good place as far as applications go. I think ideally if I had known I was for sure going into IM and not surgery, I would have switched surgery to a community site and did peds at an academic site. But it's not a big deal.

 

[MossPoh]

What I can say is that typically, nurses at community hospitals are hotter and much nicer....just saying....

Well, now I'm even more excited to get to my little community hospitals.

 

[Rollo]

Right, scheduled noon conferences, daily morning report, specific lectures for students etc.

My plan worked out really well, I'm applying to internal medicine. I got honors in my ms3 rotations, and good LORs from academic IM docs so I'm in a good place as far as applications go. I think ideally if I had known I was for sure going into IM and not surgery, I would have switched surgery to a community site and did peds at an academic site. But it's not a big deal.

Can you explain some of the advantages of a structured education?

The way I'm thinking is that I'm an independent learner. I don't like sitting in lectures with powerpoints and stuff. I'd rather pick up a textbook and study on my own.

So you see why I'm wondering how structured education can benefit me?

Or maybe its the nature of academics that will be completely different in a hospital setting like I'll actually enjoy sitting through those lectures/conferences?

 

[Jolie South]

Can you explain some of the advantages of a structured education?

The way I'm thinking is that I'm an independent learner. I don't like sitting in lectures with powerpoints and stuff. I'd rather pick up a textbook and study on my own.

So you see why I'm wondering how structured education can benefit me?

Or maybe its the nature of academics that will be completely different in a hospital setting like I'll actually enjoy sitting through those lectures/conferences?

Morning report sucks balls. I always found myself surfing the web on my Blackberry. This is on internal medicine, btw.

I think I would have liked it more if I could have just taken care of my patients, rounded, and gotten the hell out of there by noon. I've said it once and I'll say it again. Internal medicine could be a lifestyle specialty, but there is way too much talking and inefficiency, especially on academic services.

I learn better by actually working and seeing patients with different issues, but some people find lectures and morning report helpful. I only like conferences that provide free food.

 

[Rollo]

So any more opinions on this topic from current students or residents?

Something else I was thinking of:

If I do my IM rotation at an academic place with a surgical residency, how feasible is it for me to get to know some surgery residents and/or attendings? Let them know that I'm interested in the program.

I guess what I'm saying is are there any advantages to doing both my IM and surgery rotations at the place that has the surgery residency I'm interested in?

 

[desijigga]

I only like conferences that provide free food.

HHAHAHA touche my friend...

IMO you should go to an academic center, you work hard but learn s** load more. I am half way through my 3rd year, and have done rotations at both community and academic hospitals. I have to say the teaching, conferences, attendings, residents are completely different. I am on surgery right now at a big hospital, and even though I work ridiculous hours, I have learned so much. Seen some very good cases, and got to work with Attendings that are pioneers in their field. Even though these guys are extremely busy, they make sure the residents are teaching us students. The attending also pimps the hell out of me, and asks me what I have done today at the end of the day.