Horrible preceptor rotations

[hallowmann]

... I really believe the school does the best it can to make sure the students have access to teaching hospitals for rotations.

To be completely honest, I think this is true of most schools (especially established ones). No school sets out to have crappy rotations, and most change them/adjust if they get reasonable complaints (very good reason for current students to give mature and constructive reviews of rotations to their school). This is exactly what happened when Sylvanthus notified his school about it.

The thing is that there is no standardization, and without their own massive teaching centers (not very common in the relatively rural/suburban areas in which most DO schools exist), students get sent all over to many different sites. You can't really control quality when your students are spread across 10-20 hospitals. This is more of a problem with DO school regulation than anything else.

At this point, there's not much we as students can do except try to get the best education available, even if it means making the best of bad situations, and making sure that we give constructive feedback about our rotations to the school for the benefit of future students.

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[IslandStyle808]

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.

The school has been around for 30 years and is the state school. However, it is really difficult to even expand out the class size, due to limited amount of students being able to rotate at a time. Once the school decided to expand the spots in 2010, the problem was pretty much inevitable and students at my state school would have to be given priority. As mention from a friend of mine who is just graduating, my state school signed contracts with the locals hospitals to prioritize their students. So it is true that my state school did "muscle out" SOMA students. It is not so much a DO thing as it is a local school thing.

 

[IslandStyle808]

To be completely honest, I think this is true of most schools (especially established ones). No school sets out to have crappy rotations, and most change them/adjust if they get reasonable complaints (very good reason for current students to give mature and constructive reviews of rotations to their school). This is exactly what happened when Sylvanthus notified his school about it.

The thing is that there is no standardization, and without their own massive teaching centers (not very common in the relatively rural/suburban areas in which most DO schools exist), students get sent all over to many different sites. You can't really control quality when your students are spread across 10-20 hospitals. This is more of a problem with DO school regulation than anything else.

At this point, there's not much we as students can do except try to get the best education available, even if it means making the best of bad situations, and making sure that we give constructive feedback about our rotations to the school for the benefit of future students.

It still makes me wonder why they radically expand out as such? This expansion can be as large a 70-100 students in one year. I am sure a lot of the kinks can be worked out better with a slower increase in class sizes.

 

[WalkingCorpse]

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

Dead serious. Also, one of my friends had his entire general surgery rotation with an orthopedic surgeon. Dead serious about that too. It was a new rotation site and they hadn't found a general surgeon to be a preceptor yet but sent students to the site to rotate anyway. Luckily he had no interest in going into general surgery. And now I'm angry all over again about how much tuition I paid 3rd/4th year for so little in return from my school..

 

[meliora27]

Dead serious. Also, one of my friends had his entire general surgery rotation with an orthopedic surgeon. Dead serious about that too. It was a new rotation site and they hadn't found a general surgeon to be a preceptor yet but sent students to the site to rotate anyway. Luckily he had no interest in going into general surgery. And now I'm angry all over again about how much tuition I paid 3rd/4th year for so little in return from my school..

You have every right to be angry. COCA cannot keep short changing our education. The thing is, I'm not sure they (COCA) see anything wrong with the status quo.

 

[SLC]

The school has been around for 30 years and is the state school. However, it is really difficult to even expand out the class size, due to limited amount of students being able to rotate at a time. Once the school decided to expand the spots in 2010, the problem was pretty much inevitable and students at my state school would have to be given priority. As mention from a friend of mine who is just graduating, my state school signed contracts with the locals hospitals to prioritize their students. So it is true that my state school did "muscle out" SOMA students. It is not so much a DO thing as it is a local school thing.

The problem with SOMA is that their model does make it easy to be "muscled out" because there are at max 20 or so students at any one location who are rotating. If another school wanted to come in and take over, the hospital wouldn't have to abandon hundreds of students like they might with any other school.

But the flip side of that is that we often get into some pretty nice places even when there are other schools around because accommodating so few students isn't that difficult. I rotated with students from PNWU, COMP-NW, OHSU, UDub while at the Portland CHC, it wasn't a big deal because I was only one student and my classmates were each on other rotations.

When I wanted to do some electives in Utah, Intermountain Healthcare was very accommodating, and I rotated with students from the UofU (and a few from KCOM too).

Though as NurWollen alluded to, some places are still "DO-discriminatory" and Intermountain Health Care's main flagship has a "no-student DO" policy. Their other hospitals are fine though and I got great teaching there. The flagship has a transitional year in IM, but no other resodencies. The two hospitals I spent the most time at have top tier Family Med residencies, and I applied to and interviewed with both.

 

[user3]

You have every right to be angry. COCA cannot keep short changing our education. The thing is, I'm not sure they (COCA) see anything wrong with the status quo.

I guess as long as we're qualified to enter primary care GME...

 

[IslandStyle808]

The problem with SOMA is that their model does make it easy to be "muscled out" because there are at max 20 or so students at any one location who are rotating. If another school wanted to come in and take over, the hospital wouldn't have to abandon hundreds of students like they might with any other school.

But the flip side of that is that we often get into some pretty nice places even when there are other schools around because accommodating so few students isn't that difficult. I rotated with students from PNWU, COMP-NW, OHSU, UDub while at the Portland CHC, it wasn't a big deal because I was only one student and my classmates were each on other rotations.

When I wanted to do some electives in Utah, Intermountain Healthcare was very accommodating, and I rotated with students from the UofU (and a few from KCOM too).

Though as NurWollen alluded to, some places are still "DO-discriminatory" and Intermountain Health Care's main flagship has a "no-student DO" policy. Their other hospitals are fine though and I got great teaching there. The flagship has a transitional year in IM, but no other resodencies. The two hospitals I spent the most time at have top tier Family Med residencies, and I applied to and interviewed with both.

I think that is the plus size of having a smaller class in those areas, because it doesn't take too much to accommodate the students. In extremely large places, SOMA would not have much of a problem placing their students in teaching hospitals. However, my home state is not a very large place and so the problem was bound to occur.

I am sure that there are instances, as NurWollen implied, where their are anti-DO forces that come into play with rotating in hospitals. However, in this instance it was more a local school pushing out the non-local school.

 

[user3]

Dead serious. Also, one of my friends had his entire general surgery rotation with an orthopedic surgeon. Dead serious about that too. It was a new rotation site and they hadn't found a general surgeon to be a preceptor yet but sent students to the site to rotate anyway. Luckily he had no interest in going into general surgery. And now I'm angry all over again about how much tuition I paid 3rd/4th year for so little in return from my school..

I can't imagine how much of a toll your school's class size increase must be taking on clinicals.

 

[IslandStyle808]

Dead serious. Also, one of my friends had his entire general surgery rotation with an orthopedic surgeon. Dead serious about that too. It was a new rotation site and they hadn't found a general surgeon to be a preceptor yet but sent students to the site to rotate anyway. Luckily he had no interest in going into general surgery. And now I'm angry all over again about how much tuition I paid 3rd/4th year for so little in return from my school..

Student quality decreases because of the rapid expansion and these examples are more common than they should be. Schools of course get the kinks out, but students of the initial expansion year and few years later suffer because of this. Sorry your friend had to go through this.

 

[hallowmann]

It still makes me wonder why they radically expand out as such? This expansion can be as large a 70-100 students in one year. I am sure a lot of the kinks can be worked out better with a slower increase in class sizes.

Oh I agree that rapid expansion is a huge problem. As it stands though, the schools expanding the fastest seem to be some of the newest. Its one thing if a school expands after being around for a while and having established rotations, but for example BCOM's plan to double in size before graduating 2 classes is crazy.

 

[IslandStyle808]

Oh I agree that rapid expansion is a huge problem. As it stands though, the schools expanding the fastest seem to be some of the newest. Its one thing if a school expands after being around for a while and having established rotations, but for example BCOM's plan to double in size before graduating 2 classes is crazy.

I am more worried about schools just suddenly increasing their class sizes radically (in the range of 70+ seats in one year), even if they have been established for some time. With slow expansions a lot of kinks can be worked out. My state school as been around for decades, but there is no way they can do an expansion of 13 students so quickly (there are not many hospitals with residents, as well as attendings willing to teach). You would need the right amount of attendings to make sure that all the students are getting attention. This is why the expansion is slow with 2 seats being added on per year. Also if a rotation site does not work out for a student, that student can also be transferred to another site as long as the numbers are small (worst case scenario). With large expansions, proper safety nets cannot be implemented well.

 

[AlteredScale]

I honestly think it's more of a travesty to see DO students experience subpar clinical training and not do anything about it rather than figure out how to make a change.

If a few hundred DO students collect records of their training on paper and send it out with a proposal for revaluation of COCA standards to clinical training it could make a difference.

Something needs to be done because we are spending tens of thousands of dollars for training that will give use the greatest exposure to what we need to become competent physicians. Greatest exposure does not equal having a preceptor who is a nurse, or a masters-level PsyD, or an internal medicine attending who only does house call. It means secondary to tertiary care hospitals with GME and nothing less than that.

 

[DocVader1990]

Accidental bump

 

[microshar88]

I have had to deal with a lot of preceptor rotations and its really just luck sometimes. But mostly they've been good.

I do think that some of my rotations are a bit too easy sometimes. For instance, I have an ER rotation where I have to go to a hospital where there is no set didactics. Whereas my friends from another school, are required to atttend didactics 3 days a week. So it's not very organized at my school IMO.

 

[WalkingCorpse]

The only time I had actual didactics 3rd/4th year was when I was on away/audition rotations.