Duke vs. Yale Clinical Rotations

[unicorn06]

After doing back-to-back interviews at Duke and Yale, I was shocked by how differently the students at each school depicted the clinical rotations.

Yale students told me that, while the rotations 3rd yr were tiring, students were not overwhelmed, and the school still made an attempt to keep some of their afternoons free. Some even said they had time to continue doing research DURING the clinical year.

At Duke, students said that 2nd year was extremely intense and that they worked more hours than the interns (who were limited by the 80 hr work week restrictions). They also said they were on call every 4th night during the medicine rotation and never got more than an hour of sleep when on call because they always reached their max number of admissions.

I know that the intensity of clinical rotations it not not the same at every school, but does it really vary as much as the students at Yale and Duke seemed to suggest? I did only talk to about 10-15 students at each school, so my "sample size" is not that large, but I DEFINITELY saw a huge difference in their descriptions.

Any insight into this question would be MUCH appreciated!

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[unicorn06]

Anyone???

After doing back-to-back interviews at Duke and Yale, I was shocked by how differently the students at each school depicted the clinical rotations.

Yale students told me that, while the rotations 3rd yr were tiring, students were not overwhelmed, and the school still made an attempt to keep some of their afternoons free. Some even said they had time to continue doing research DURING the clinical year.

At Duke, students said that 2nd year was extremely intense and that they worked more hours than the interns (who were limited by the 80 hr work week restrictions). They also said they were on call every 4th night during the medicine rotation and never got more than an hour of sleep when on call because they always reached their max number of admissions.

I know that the intensity of clinical rotations it not not the same at every school, but does it really vary as much as the students at Yale and Duke seemed to suggest? I did only talk to about 10-15 students at each school, so my "sample size" is not that large, but I DEFINITELY saw a huge difference in their descriptions.

Any insight into this question would be MUCH appreciated!

 

[TommyGunn04]

I'm a current Duke student and can shed some light here and dispel some rumors. In short, this claim about us working harder than the interns is just false! In fact, the Dean of the medical school imposed an 80-hour work week for us a year or two ago, to ensure that we're not working more than the interns. That said, the great majority of Duke students would tell you that it was never an issue anyway. Granted there are exceptions, such as those doing surgery sub-internships, and perhaps during other sub-internships during the 4th year, but that's expected. However, during the 2nd year clerkships you'll never be there even close to 80 hours. In fact, we don't even take overnight call on most rotations, for the learning opportunities at 3am are rather sparse.

Case in point: on our medicine clerkship the residents are told to send students home around midnight, or as soon as they get their admission(s) for the night (usually 1 or 2 for a 2nd year student). This is the official policy, although I've heard a few stories about students feeling like they needed to stay overnight. Apparently you talked to some of these students, but they're definitely not typical. I've found that people often stay because they're afraid to leave, because they think it'll get them extra points, or because their residents weren't aware of the rule, which is unfortunate and unfair, no to mention ridiculous. But there's no way that your average Duke student is working 80 hours or more during the 2nd year! These people are the overwhelming exception, not the rule. I can literally count on one hand the number of times I stayed overnight in the hospital during my 2nd year, and they were all on labor & delivery, where the babies are all born in the middle of the night.

There's also a LOT of scheduled teaching solely for students during the clinical year. So even when you're in the hospital 60 hrs/wk on a tough rotation like medicine or surgery, it's not like Duke students spend their time doing SCUT.

 

[unicorn06]

Wow, thanks. That's definitely a different perspective from what my hosts and their friends said.

I'm a current Duke student and can shed some light here and dispel some rumors. In short, this claim about us working harder than the interns is just false! In fact, the Dean of the medical school imposed an 80-hour work week for us a year or two ago, to ensure that we're not working more than the interns. That said, the great majority of Duke students would tell you that it was never an issue anyway. Granted there are exceptions, such as those doing surgery sub-internships, and perhaps during other sub-internships during the 4th year, but that's expected. However, during the 2nd year clerkships you'll never be there even close to 80 hours. In fact, we don't even take overnight call on most rotations, for the learning opportunities at 3am are rather sparse.

Case in point: on our medicine clerkship the residents are told to send students home around midnight, or as soon as they get their admission(s) for the night (usually 1 or 2 for a 2nd year student). This is the official policy, although I've heard a few stories about students feeling like they needed to stay overnight. Apparently you talked to some of these students, but they're definitely not typical. I've found that people often stay because they're afraid to leave, because they think it'll get them extra points, or because their residents weren't aware of the rule, which is unfortunate and unfair, no to mention ridiculous. But there's no way that your average Duke student is working 80 hours or more during the 2nd year! These people are the overwhelming exception, not the rule. I can literally count on one hand the number of times I stayed overnight in the hospital during my 2nd year, and they were all on labor & delivery, where the babies are all born in the middle of the night.

There's also a LOT of scheduled teaching solely for students during the clinical year. So even when you're in the hospital 60 hrs/wk on a tough rotation like medicine or surgery, it's not like Duke students spend their time doing SCUT.

 

[Mman]

Far be it from me to say that the Duke students have it easy during their 2nd year clinical rotations, but it isn't that bad. As a current intern, I had the pleasure of working with some 2nd year med students on their Gen Med month and less than 5% of the time were they even in the building after midnight when our team was on call. Got sent home by 8 PM sometimes.

 

[rugtrousers]

Yale students work hard during clinical rotations, but the amount of time spent depends on the student. It is possible to leave at a reasonable time each day (even earlier, like 2 pm on anesthesia and rads), but those interested in a particular specialty tend to stay later. There are didactics as a part of most clinical rotations, too, and students commonly go home after afternoon lectures. In no case do the students work harder than the interns unless 1) the interns are brand new and the students are on sub-internships or 2) they are really, really inefficient and wait to be told to go home (the magic phrase is "Is there anything else I can do today?").

 

[DukeDoc08]

Maybe since TommyGun went through 2nd year they have conveniently "forgotten" about students having an 80 hour work week like housestaff because we were told point blank that we DID NOT have work hour limitations and they would TRY to not let us work longer than the interns.
That being said # of hours does not equal amount of work. The interns work MUCH harder than the students and I am sure this is the case at every school, but on certain rotations, medicine and surgery specifically, the students usually get on teams that are very busy and end up working more than 80 hours. We have built in teaching time, noon conferences, morning conferences that keep us from doing things that we are supposed to be doing, which only makes our days longer and we do not have afternoons off but do get one day off every two weeks. The call night is also pretty dependent on the resident. Some residents were sent you home at midnight whether you picked up patients or not and others wanted you there to pick up your two patients (which only benefits you) and have you write it up and practice your presentation (which also benefits you) before you went to bed that night, so it could be 6 hours of sleep or it could be none. A lot of the extra hours come on post call days when the intern and resident goes home at noon or one, the day float comes on and you are still just a 2nd year med student doing 2nd year med student things as if your team was still there, and eventually you get sent home at a decent hour, usually by 6pm.
The only definite is that every week, every team, and every situation is highly variable, and yes can be student's fault for staying to help help the intern on call nights when their pager won't stop going off and patients don't stop getting admitted.
I'm sure there is not a huge difference between school's clinical years as I believe within every school there is a huge range of variability. You do get out what you put in though!

 

[banannie]

i'm a Duke MSIII, and my experience, and the experiences of most of my classmates were much more similar to what dukedoc08 describes. tommygunn, after what you've written, i wish i'd started med school a year earlier! yes, on medicine, many of us worked 80-100 hours a week, and there were no work hours restrictions. we often had to stay up all night on long call nights. i certainly didn't do it to try to impress my residents or because I was afraid. believe me, i am a wreck when i get no sleep, and would never do that to myself unless i absolutely had to.

that said, i think that you need to look at both schools' clinical rotations in the context of their entire curriculums. at both schools you have to write a thesis, correct? now at yale, i believe you have to work that in part time throughout your 4 years. so it seems like yale would pretty much be obligated to give its students some time off to work on research. at duke, you squeeze the 4 years into 3, then get a whole year to just work on research. for me, i'm so glad i had the opportunity to devote my entire second year to immersing myself in my clinical rotations. yes it was tough, but i would have learned a lot less if i'd been trying to balance all that learning with keeping a research project going. it would be really difficult to fully embrace caring for my patients when i knew that putting the extra time into my clinical work would compromise the time i could put into research. there was a strange sort of comfort in basically turning my year over to learning on the wards and not being burdened with overscheduling other things. and now, during third year, i get the big payoff and it is sooooo nice.

and like dukedoc08 said, you get out what you put in. i've heard that duke students tend to become excellent interns and residents. at the very least, i think that we're less liable to be shocked by the amount of work we're slammed with during intern year. and anything to make intern year more palatable seems, to me, to be worth it!

 

[ChocolateKiss]

So dukedoc08 and banannie, would you both consider doing your internships and residencies at Duke? Or are you looking for less intense programs?

 

[DukeDoc08]

I really don't have any other school to compare to Duke, so I would say, SURE I'd do my residency and internship at Duke! I can't imagine wanting to seek a program out just because it was supposedly less intense, unless of course I was going into Radiology and had to do my intern year elsewhere and it really didn't matter what I did that intern year.
Our housestaff works hard but I'm sure it is about the same at any other hospital, I'm not sure how you would compare, maybe housestaff to average yearly admits ratio?
Banannie! glad to hear that I was not the only one with my 2nd year experiences thus far! I absolutely am LOVING 2nd year, and you are right, I can't imagine trying to hurry up just so I could get some research done. Last year I went at my own pace and did my own thing with streaming video, this year Duke owns me!, next year I'll get out what I put in, and 4th year should be the best year of medicine I will ever have!

 

[eejakyule8]

After doing back-to-back interviews at Duke and Yale, I was shocked by how differently the students at each school depicted the clinical rotations.

Yale students told me that, while the rotations 3rd yr were tiring, students were not overwhelmed, and the school still made an attempt to keep some of their afternoons free. Some even said they had time to continue doing research DURING the clinical year.

At Duke, students said that 2nd year was extremely intense and that they worked more hours than the interns (who were limited by the 80 hr work week restrictions). They also said they were on call every 4th night during the medicine rotation and never got more than an hour of sleep when on call because they always reached their max number of admissions.

I know that the intensity of clinical rotations it not not the same at every school, but does it really vary as much as the students at Yale and Duke seemed to suggest? I did only talk to about 10-15 students at each school, so my "sample size" is not that large, but I DEFINITELY saw a huge difference in their descriptions.

Any insight into this question would be MUCH appreciated!

These are both second rate schools. 👎

 

[Mr. Tee]

These are both second rate schools. 👎

I'll take what I can get

 

[gujuDoc]

These are both second rate schools. 👎

 

[TommyGunn04]

i'm a Duke MSIII, and my experience, and the experiences of most of my classmates were much more similar to what dukedoc08 describes. tommygunn, after what you've written, i wish i'd started med school a year earlier! yes, on medicine, many of us worked 80-100 hours a week, and there were no work hours restrictions. we often had to stay up all night on long call nights. i certainly didn't do it to try to impress my residents or because I was afraid. believe me, i am a wreck when i get no sleep, and would never do that to myself unless i absolutely had to.

Well I'm honestly baffled about this, because there is indeed a student work hour rule on the books at Duke (at least from what I've been told), and the official stance of the medicine clerkship was that residents were required to send their students HOME after midnight when on call, provided they've received their admission(s). You might still be awake at home working on your writeup and presentation of the patient, but you should NEVER have been in the hospital for 80-100 hours per week! We were also required to get one full day off per two weeks, but the residents generally gave us one day per week just like the interns. I can't say that your experience is even close to the norm that's on the books, and if it's indicative of what your class experienced then the course director of the medicine clerkship really needs to know about it. Even on surgery I rarely worked close to 80 hours. Make no mistake, the clinical year is tough and you're working a lot at home too, but it's ridiculous to think that Duke students would be working harder than the interns! Did anyone from you class talk to the clerkship director about this? And did you actually log your hours and literally come up with a number between 80-100? (I ask because I often felt like I was working a lot more hours than I actually was, and while I might have estimated 80-100 hours it was always more like 65-75 in reality when I calculated it out. I don't mean this to be insulting, I'm just saying that it often feels much worse than it actually is when you plot it all out).