Horrible preceptor rotations

[AlteredScale]

I think it should be a rule that students rotate at a teaching hospital. My friend just got slapped on the wrist for rounding on patients without the attending present in the room. This was a non-teaching community hospital. Are there similar rules at teaching hospitals regarding medical students rounding on pts?

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[IslandStyle808]

I think it should be a rule that students rotate at a teaching hospital. My friend just got slapped on the wrist for rounding on patients without the attending present in the room. This was a non-teaching community hospital. Are there similar rules at teaching hospitals regarding medical students rounding on pts?

I agree with you on this point. However, a good chunk of DO schools are very mission oriented and want their students to serve in rural/underserved area hospitals. Most of which are not teaching hospitals. It would be difficult to get the schools to budge in this aspect. A good solution would be to have 4 weeks of each core rotation done in a ward setting and the other 4 weeks be done with a preceptor in a rural/underserved area hospital. With DO classes as large as they are, this would be best way to ensure as many of the students as possible are rotating in teaching hospitals. At the same time, the mission oriented DO schools would be satisfied their students are learning in the areas they want them to serve. The only downside would be that the students would have to relocate twice within the year.

 

[Mass Effect]

I think it should be a rule that students rotate at a teaching hospital. My friend just got slapped on the wrist for rounding on patients without the attending present in the room. This was a non-teaching community hospital. Are there similar rules at teaching hospitals regarding medical students rounding on pts?

This has little to do with this being a community hospital and more to do with the attending. Even at teaching hospitals, you can get attendings like that who don't trust students rounding without a resident. I've seen it.

 

[s5260205]

There are mission-based MD schools as well, and yet they still have affiliated academic centres, some level 1 trauma centre. Compared to the preceptor-based rotations, rotations in academic centres offer higher patient loads, structured and standardised learning programmes, and more networking and research opportunities. Though I'm not sure how feasible it is for every DO school to be affiliated with at least one academic centre, I think the qualities of clinical rotations are presently too varied in many DO schools. I should add that most DO students are vigilant about acquiring the best education possible through away rotations but wouldn't it be great if the core rotations are sufficiently adequate to begin with?

 

[Goro]

Sadly, this is true. SOMA is a particular example of this.

That "mission" is a bunch of side talk to cover the fact that they don't have the resources (physical or monetary) to secure enough adequate rotation slots for their giant student bodies.

 

[AlteredScale]

This has little to do with this being a community hospital and more to do with the attending. Even at teaching hospitals, you can get attendings like that who don't trust students rounding without a resident. I've seen it.

But the thing is the attending didn't mind the student rounding. The attending just happened to be elsewhere while the student did rounds alone and was reported by the hospital admin

 

[Mad Jack]

It's horrible and illegal when the attending, didn't even lay eyes on the patient. Essentially having a 3rd year student see the patients, write notes, without you ever seeing the patient or even explaining anything to the student is not teaching in my opinion.

I forgot to include this important tidbit in my original post. You are essentially just using someone for scutwork.

I worked at a top 10's teaching hospital, and it wasn't much different much of the time. There were some attendings that I would damn near have a stroke if they actually went in to see the patients themselves.

 

[Mad Jack]

The OP made multiple derogatory and racist remarks regarding Indian preceptors and pimping. These people are doing you a huge service by trying to expose the deficiencies in your knowledge base that exist as an MS3. I also don't like the superiority in the OP's remarks regarding PA's and NP's, they know more than you know at this level of your training.

The indian caste/class system gave rise to this societies class system and the hierarchy that exists in our medical profession. Think about hierarchy that exists when you hurridly grab your attendings coffee in the morning.

Hierarchical training is a destructive force in the medical profession, in my opinion. It beats the ability to speak up and be independent out of students and residents, cultivating sheep when we should be cultivating wolves. It's this mentality that has made us weak, and let us be walked all over by politicians, nurses, and hospital management. How the hell are we supposed to have strong advocates at the top when everyone is groomed to keep quiet and keep their heads down for over a decade of their lives?

 

[meliora27]

I think it should be a rule that students rotate at a teaching hospital. My friend just got slapped on the wrist for rounding on patients without the attending present in the room. This was a non-teaching community hospital. Are there similar rules at teaching hospitals regarding medical students rounding on pts?

This sounds like a very rare occurrence. I've never heard/had such an occurrence.

During my third year I was pretty much always at community hospitals but they all had in- house residencies. I would advise DO students that if you have any say at all in where you do your third year rotations, community hospitals with residencies is not a bad way to go. Morning reports, noon conference, grand rounds, help to create a good didactic experience.

 

[AlteredScale]

This sounds like a very rare occurrence. I've never heard/had such an occurrence.

During my third year I was pretty much always at community hospitals but they all had in- house residencies. I would advise DO students that if you have any say at all in where you do your third year rotations, community hospitals with residencies is not a bad way to go. Morning reports, noon conference, grand rounds, help to create a good didactic experience.

Oh definitely. I'm not saying this is an issue all around. This just happened to be a preceptor site that was at a community hospital with no residents. I think the issue I'm trying to bring up here is why are preceptorships at hospitals with no teaching even available to students in the first place?

 

[meliora27]

Oh definitely. I'm not saying this is an issue all around. This just happened to be a preceptor site that was at a community hospital with no residents. I think the issue I'm trying to bring up here is why are preceptorships at hospitals with no teaching even available to students in the first place?

Supply and Demand.

DO schools pop up on every corner yet the number of clinical spots to train these students is static. Unlike the LCME that requires students train alongside residents, COCA does not have such a policy. As such, under the guise of "community based clinical experience" (or some other buzzword), DO schools frequently rely on placing students in outpatient settings with random practitioners to serve as their clinical training.

 

[IslandStyle808]

That "mission" is a bunch of side talk to cover the fact that they don't have the resources (physical or monetary) to secure enough adequate rotation slots for their giant student bodies.

A part of me figured that was what it was. However, the other part of me did not know how much of it was that. Kind of a slap to the face to know it was 100% percent.

 

[GUH]

Unlike the LCME that requires students train alongside residents, COCA does not have such a policy.

Is it true that the LCME requires students to train alongside residents?

 

[meliora27]

Is it true that the LCME requires students to train alongside residents?

3.1 Resident Participation in Medical Student Education

Each medical student in a medical education program participates in one or more required clinical experiences conducted in a health care setting in which he or she works with resident physicians currently enrolled in an accredited program of graduate medical education.


Source: http://www.lcme.org/publications/2015-16-functions-and-structure-with-appendix.pdf

I understand that it only stipulates 1 or more, however I know that there are some students who have exclusively preceptor based rotations without any resident contact whatsoever

 

[ModyzMalak]

A part of me figured that was what it was. However, the other part of me did not know how much of it was. Kind of a slap to the face to know it was 100% percent.

Man y'all got me like: so maybe I need to spend a year buffing up my grades so I can get into a MD school after all. I am really content on either but I don't play with my $$ and that's more than a slap in the face to expect a quality clinical education only to be told "lol jk!". Not cool at all.

What I don't understand is that since do classes are usually much bigger than MD, where is all that extra tuition & deposit $$ going? And it's not like the osteopathic field just crept up, it's been around so why haven't good teaching establishments been created over the decades?

Either they have the $$ and just don't feel strong clinical sites are important, or they really don't have the $$.

 

[IslandStyle808]

Man y'all got me like: so maybe I need to spend a year buffing up my grades so I can get into a MD school after all. I am really content on either but I don't play with my $$ and that's more than a slap in the face to expect a quality clinical education only to be told "lol jk!". Not cool at all.

What I don't understand is that since do classes are usually much bigger than MD, where is all that extra tuition & deposit $$ going? And it's not like the osteopathic field just crept up, it's been around so why haven't good teaching establishments been created over the decades?

Either they have the $$ and just don't feel strong clinical sites are important, or they really don't have the $$.

They pretty much build rotations in places where they don't have strong connections, because as SouthernSurgeon has implied, they care too much about expanding and not enough about quality. My state school is also expanding its seats, but is very careful to make sure quality of rotations don't suffer. Thus the expansion is very slow with 2 seats being added each year (going from 62 seats to 75). However, DO schools are not as careful and add rotation sites like they are an after thought.

 

[hallowmann]

3.1 Resident Participation in Medical Student Education

Each medical student in a medical education program participates in one or more required clinical experiences conducted in a health care setting in which he or she works with resident physicians currently enrolled in an accredited program of graduate medical education.


Source: http://www.lcme.org/publications/2015-16-functions-and-structure-with-appendix.pdf

I understand that it only stipulates 1 or more, however I know that there are some students who have exclusively preceptor based rotations without any resident contact whatsoever

Yup, this is true. Ideally, most if not all core rotations should be in an academic setting and not strictly preceptor based. That said, the LCME doesn't require that of all rotations or even of all cores. I know a number of MD students that have rotations that are essentially preceptorships. It is true though that most MD cores are not just preceptorships.

 

[Spikebd]

It's making me feel like I have to set up my fourth year at MD hospitals so I get a proper clinical education at some point. Hopefully my rotations work out this coming Fall. Family med and psych are the only rotations I feel confident I'll be taught well in at my DO school. Most worrisome to me is where my internal medicine rotation will be... It better be inpatient.

 

[NurWollen]

3.1 Resident Participation in Medical Student Education

Each medical student in a medical education program participates in one or more required clinical experiences conducted in a health care setting in which he or she works with resident physicians currently enrolled in an accredited program of graduate medical education.


Source: http://www.lcme.org/publications/2015-16-functions-and-structure-with-appendix.pdf

I understand that it only stipulates 1 or more, however I know that there are some students who have exclusively preceptor based rotations without any resident contact whatsoever

My school requires a ward-based IM rotation third year, and it's not hard to get ward-based peds and ward-based FM as well, if you want it.

 

[Siggy]

My school requires a ward-based IM rotation third year, and it's not hard to get ward-based peds and ward-based FM as well, if you want it.

Just because it's ward based doesn't mean it's with residents. One of the sub-I IM rotations at my hospital is with the mid-day hospitalist team. On occasion they'll have an intern, but the vast majority of the time it's an attending with a bunch of MS4s.

 

[IslandStyle808]

Just because it's ward based doesn't mean it's with residents. One of the sub-I IM rotations at my hospital is with the mid-day hospitalist team. On occasion they'll have an intern, but the vast majority of the time it's an attending with a bunch of MS4s.

In that scenario, would it still technically be considered a preceptor-based rotation?

 

[Siggy]

In that scenario, would it still technically be considered a preceptor-based rotation?

I'm not sure, and I would argue that in reality it doesn't matter. There are awesome/terrible (pick one) resident/preceptor (pick one) rotations. I'm simply arguing that 1. Ward based doesn't mean resident based and 2. preceptor based doesn't mean it's terrible. The hospitalist teams have just as much of a chance of getting a train wreck patient (actually my sickest patient this year was as an intern on one of these teams) as the teaching teams.

 

[IslandStyle808]

I'm not sure, and I would argue that in reality it doesn't matter. There are awesome/terrible (pick one) resident/preceptor (pick one) rotations. I'm simply arguing that 1. Ward based doesn't mean resident based and 2. preceptor based doesn't mean it's terrible. The hospitalist teams have just as much of a chance of getting a train wreck patient (actually my sickest patient this year was as an intern on one of these teams) as the teaching teams.

Thanks for answering my previous question

In terms of the learning experience, what differences are there being in a hospitalist team vs. being in a teaching team? It feels like there are a lot of variations in the way rotations are set up.

 

[Siggy]

Thanks for answering my previous question

In terms of the learning experience, what differences are there being in a hospitalist team vs. being in a teaching team? It feels like there are a lot of variations in the way rotations are set up.

Granted, your milage will vary between hospitals.

Teaching teams:

• Attending, senior resident, 2 interns, multiple medical students (mostly 3rd years).
  
• Morning report M-F
• No weekends unless on call.
  
• "Writes" notes when not on call or post call.
  
• 24 hour call every 3-4 days during which the team takes admissions (from 3pm to 7am) and responds to codes and rapid response calls.
• Much less informal lectures
• Student presents admissions to senior resident on on-call attending

Hospitalist:

• Attending, multiple 4th year medical students, occasionally an intern
• No morning report
• 1 weekend /month
• Writes the formal note (well, notes are written in Word and printed out)
• Hospitalist teams take admissions from 7am to 3pm every day, so the students are admitting patients every day, but don't respond to codes/rapid response calls unless that team's patient.
  
• More informal lectures.
• Student presents admissions to the hospitalist, or intern if intern is on board.

 

[IslandStyle808]

Granted, your millage will vary between hospitals.

Teaching teams:

• Attending, senior resident, 2 interns, multiple medical students (mostly 3rd years).
  
• Morning report M-F
• No weekends unless on call.
  
• "Writes" notes when not on call or post call.
  
• 24 hour call every 3-4 days during which the team takes admissions (from 3pm to 7am) and responds to codes and rapid response calls.
• Much less informal lectures
• Student presents admissions to senior resident on on-call attending

Hospitalist:

• Attending, multiple 4th year medical students, occasionally an intern
• No morning report
• 1 weekend /month
• Writes the formal note (well, notes are written in Word and printed out)
• Hospitalist teams take admissions from 7am to 3pm every day, so the students are admitting patients every day, but don't respond to codes/rapid response calls unless that team's patient.
  
• More informal lectures.
• Student presents admissions to the hospitalist, or intern if intern is on board.

Wow excellent post. Thank you for taking the time to write it.

 

[Mass Effect]

Granted, your milage will vary between hospitals.

Teaching teams:

• Attending, senior resident, 2 interns, multiple medical students (mostly 3rd years).
  
• Morning report M-F
• No weekends unless on call.
  
• "Writes" notes when not on call or post call.
  
• 24 hour call every 3-4 days during which the team takes admissions (from 3pm to 7am) and responds to codes and rapid response calls.
• Much less informal lectures
• Student presents admissions to senior resident on on-call attending

This all depends on where you are, but it is a general description. Some places don't have overnight call. Some places you work 6 days a week, every week (no such thing as no weekends at these places). It all just depends.

 

[JimmyB123]

CCOM for the win

 

[Siggy]

This all depends on where you are, but it is a general description. Some places don't have overnight call. Some places you work 6 days a week, every week (no such thing as no weekends at these places). It all just depends.

As I said, your mileage will vary between hospitals. The inpatient family medicine service has a weird schedule with 2 days off in 10 days, one of which is a post nights day. The point I'm trying to make is that preceptorship shouldn't be synonymous with "bad" and teaching team with "good."

 

[235009]

Hospitalist:

• Attending, multiple 4th year medical students, occasionally an intern
• No morning report
• 1 weekend /month
• Writes the formal note (well, notes are written in Word and printed out)
• Hospitalist teams take admissions from 7am to 3pm every day, so the students are admitting patients every day, but don't respond to codes/rapid response calls unless that team's patient.
  
• More informal lectures.
• Student presents admissions to the hospitalist, or intern if intern is on board.

Is this at an AOA program? Having an intern on that team sounds like a blatant acgme violation.

 

[Siggy]

Is this at an AOA program? Having an intern on that team sounds like a blatant acgme violation.

I believe that when interns are on the team it's AOA off-service interns. The IM interns (AOA or ACGME) never rotate on the hospitalist teams (however we do take signout from the hospitalist teams for night coverage and will redistribute patients admitted overnight to the hospitalist teams).

Also, how would it be a violation? We're still talking about board certified internal medicine physicians supervising the intern, there just isn't a senior resident involved. The only possible violation was that the hospitalist teams generally have 10-15 patients, but, to be honest, I was officially responsible for more patients when on the teaching teams than the hospitalist teams, even if I was peaking in and helping oversee the MS4s.

 

[sylvanthus]

Still think I have you dudes beat for worst rotation ever as a med student. Some may remember, general surgery with a RN as preceptor. Yup, still think that one wins as worst ever.

 

[GUH]

Still think I have you dudes beat for worst rotation ever as a med student. Some may remember, general surgery with a RN as preceptor. Yup, still think that one wins as worst ever.

lol yeah you do like to remind us about that one.

 

[NurWollen]

lol yeah you do like to remind us about that one.

To be fair, when I went on a tour of his school during my premed years, I did get a sort of shady feeling about his school. Someone asked their recruiter what percentage of their students took the USMLE and he got all defensive, saying "about 10%. I don't know why you would want to take that test, the COMLEX is THE board exam for DO students." They have an awesome cadaver lab though. Nice big windows that allow you to gaze out at Yakima's dead, brown, treeless hills.

Then again, I wasn't turned off enough to not apply there, but when I got into my school (which was my #1) I didn't fill out the secondary.

 

[JimmyB123]

To be fair, when I went on a tour of his school during my premed years, I did get a sort of shady feeling about his school. Someone asked their recruiter what percentage of their students took the USMLE and he got all defensive, saying "about 10%. I don't know why you would want to take that test, the COMLEX is THE board exam for DO students." They have an awesome cadaver lab though. Nice big windows that allow you to gaze out at Yakima's dead, brown, treeless hills.

Then again, I wasn't turned off enough to not apply there, but when I got into my school (which was my #1) I didn't fill out the secondary.

Didn't Sylvanthus go to CCOM?

 

[NurWollen]

Didn't Sylvanthus go to CCOM?

PNWU, I believe. And by the way, I mean no offense to anyone who goes there. I was just sharing my impressions from what I saw there. They've expanded their facilities since then and it's entirely possible the school has gotten stronger since then.

 

[IslandStyle808]

lol yeah you do like to remind us about that one.

Yep. Even likes to remind the osteo pre-meds as well. LOL

 

[67552931811]

Didn't Sylvanthus go to CCOM?

No.

 

[Mass Effect]

Is this at an AOA program? Having an intern on that team sounds like a blatant acgme violation.

Huh? How is that a violation?

 

[jw3600]

Yep. Even likes to remind the osteo pre-meds as well. LOL

As he should. LOL.

 

[GUH]

Yeah I'm as big a defender of osteopathic medical education as any but that kind of thing just shouldn't happen.

 

[SLC]

Sadly, this is true. SOMA is a particular example of this.

SOMA (assuming you mean ATSU-SOMA) has neither a huge student body, nor inadequate rotation sites. I'm not sure where this comment stems from but it's not at all true in my (first hand) experience.

 

[NurWollen]

Yeah I'm as big a defender of osteopathic medical education as any but that kind of thing just shouldn't happen.

Fortunately, I think Sylvanthus' experience was a hideous exception and not a rule.

A more common problem though I think is that students will be sharing a preceptor with another med student(s) and a couple of nurse practitioner students etc.

Overall though, while people on here complain about their preceptor-based rotations, I have heard mostly positive things from the 3rd years I know in real (non-internet) life.

 

[Goro]

I didn't say that they were bad, just that they send their students all over the Grand Canyon state to lots of little clinics and hospitals, due to the lack of major teaching hospitals. This was told to me by a Dean from ATSU-SOMA who was here on a job interview. He didn't get the job, either.

SOMA (assuming you mean ATSU-SOMA) has neither a huge student body, nor inadequate rotation sites. I'm not sure where this comment stems from but it's not at all true in my (first hand) experience.

 

[SLC]

I didn't say that they were bad, just that they send their students all over the Grand Canyon state to lots of little clinics and hospitals, due to the lack of major teaching hospitals. This was told to me by a Dean from ATSU-SOMA who was here on a job interview. He didn't get the job, either.

Soma students in AZ rotate at Banner Good Samaritan, St. Joseph's in Phoenix, Phoenix Children's hospital, University of AZ main campus (only official DO rotation at an MD institution I know of), plus a variety of community health centers (which makes sense since our mission is to train CHC aware docs and we are officially partnered with the NACHC)

 

[IslandStyle808]

I didn't say that they were bad, just that they send their students all over the Grand Canyon state to lots of little clinics and hospitals, due to the lack of major teaching hospitals. This was told to me by a Dean from ATSU-SOMA who was here on a job interview. He didn't get the job, either.

Wasn't sure if you were mentioning ATSU-SOMA in your initial post. I believe this school is one of the exceptions to the rule. The school has kept their class sizes small to ensure the quality of their rotations, when there are DO school that have been around just as long who have doubled their class sizes. One of the CHC sites is also in my home state, but is not going to be there anymore. The reason is because of the expansion of the MD school there and thus them having priority over rotation spots. SOMA could have just kept their students there have them rotate in the non-teaching hospitals, but instead set up the next class in Chicago. I really believe the school does the best it can to make sure the students have access to teaching hospitals for rotations.

 

[WalkingCorpse]

The preceptor for my entire psychiatry rotation was a guy with a masters in psychology. He didn't even have a doctoral degree.

 

[NurWollen]

Wasn't sure if you were mentioning ATSU-SOMA in your initial post. I believe this school is one of the exceptions to the rule. The school has kept their class sizes small to ensure the quality of their rotations, when there are DO school that have been around just as long who have doubled their class sizes. One of the CHC sites is also in my home state, but is not going to be there anymore. The reason is because of the expansion of the MD school there and thus them having priority over rotation spots. SOMA could have just kept their students there have them rotate in the non-teaching hospitals, but instead set up the next class in Chicago. I really believe the school does the best it can to make sure the students have access to teaching hospitals for rotations.

Now that is something that makes my blood boil. Sometimes it has to do with MD schools paying money to the hospital and DO schools being cheap, but other times I suspect it's plain old DO discrimination.

 

[meliora27]

.

 

[NurWollen]

The preceptor for my entire psychiatry rotation was a guy with a masters in psychology. He didn't even have a doctoral degree.

Lol what? Seriously? Psychology is not psychiatry. That would be like having an internist as your peds preceptor.

 

[meliora27]

Lol what? Seriously? Psychology is not psychiatry. That would be like having an internist as your peds preceptor.

Gotta love those lax COCA standards for acceptable clinical training...