How difficult to match Psych in California as a DO?

[surfguy84]

I've been taking a real interest in the field lately, but would love to stay in California. Wondering how difficult it would be to match somewhere in SoCal/Bay area (avoiding the Bakersfield's, Fresno's).

My pre-clinical grades are top 10%, and obviously hoping for good board scores. Anything else I can/should be doing in the meantime to strengthen my application?

---

Members don't see this ad.

 

[OldPsychDoc]

Show your interest in your clerkship, try to get an elective in psych by next September, and get really good letters from psychiatrists along the way. But with decent Step 1 and grades that good---no problem.

 

[PistolPete]

UCSF/UCLA/Stanford will be pretty tough, there's still quite a bit of anti-DO bias, from what I hear at people I know there. Other places are pretty fair game though.

 

[notdeadyet]

UCSF/UCLA/Stanford will be pretty tough, there's still quite a bit of anti-DO bias, from what I hear at people I know there.

These places do not have anti-DO bias that I have heard (and I know one of them at least has taken DOs in the past), but they are some of the more competitive programs in the country.

The most competitive programs in the country tends to make it challenging from IMGs/FMGs/DOs to match there since you are likely competing against folks from some of the best medical schools out there who are getting letters from big names in the field who are often known personally by the PDs. I don't think it's really DO bias, particularly when programs have taken DOs on the past.

I agree with OPDs advice. And if you are a DO with aspirations for a very competitive program (west coast or otherwise), strongly consider an away rotation. There isn't much more compelling for an admissions committee than t have their own faculty say, "we would LOVE to have her match here."

 

[notdeadyet]

Incidentally, if you REALLY want to stay in California, keep an open mind geographically. Sacramento is a lovely spot and include non-coastal SoCal on your radar. Do this and you'll likely have lots of fantastic training opportunities available to you if you've worked hard on medical school and have some interesting experiences, a decent step, and some good LORs.

 

[WalterDonnie]

from personal experience this year, and friends experience, I say you have a chance of interiewing at loma linda, kaiser fontana, uscsf fresno, kern, UCI, UCR. Thats if you have a strong app. No other program in CA has any DO's currently, and the recent increase in competiviness pretty much rules us DOs out. Maybe if you do an away at a place and you are just SOOO impressive that they go home and tell their family about you, you might have a shot. Take USMLE 1/2 and kill them. if you are going to try to get an away somewhere apply on the first day possible. Dont be afraid to PM me either if you'd like.

 

[splik]

ucsd tends to take a fair few DOs and ucsf has taken a few DOs in the past a least. i am not sure any of these places except UCLA has a clear anti-DO bias. the reality is many DO schools are proliferating that no one has heard of, medical school of attendance does matter to programs as it speaks the the general caliber of the applicant, and the quality of education at many DO schools leaves a lot to be desired. further DO students may not have appropriate letters of recommendation and tend to not be as well advised on the application process that disadvantages them. some don't even give clerkship grades and the quality of the clerkships at some places certainly raises eyebrows.

there are some excellent osteopathic applicants out there but the large proportion of the ones applying for psychiatry are just terrible and doing an away only further kills any chance they have of matching at the program when they see how terrible they are. we have had lots of complaints from residents about visiting students this year and the complaints are almost always about DO students, particularly from lesser known schools.

be realistic about your competitiveness and the strength of your interpersonal and clinical skills. if these are strong and you can do an away early and get a strong letter of recommendation from faculty at a reputable place this will help you everywhere as one of the major disadvantages if many DO students seem to apply with letters from docs in straw huts or something and it becomes hard to know how to gauge that. be sure that your clerkships have given you enough experience so you can hold you own and understand the conventions in medicine, particularly at teaching hospitals. Also from what I've seen osteopathic applicants who have had successful careers/life experiences in other fields (particularly if relevant) tend to do better and be take more seriously than those coming straight from undergrad.

no one cares about your preclinical grades but hopefully that will translate into a strong step 1 score. showing a strong commitment to psychiatry and other distinguishing things will also contribute to being more loved.

 

[Doctor Bagel]

there are some excellent osteopathic applicants out there but the large proportion of the ones applying for psychiatry are just terrible and doing an away only further kills any chance they have of matching at the program when they see how terrible they are.

Really? A large proportion are actually terrible? Im having trouble believing that.

 

[FlowRate]

Really? A large proportion are actually terrible? Im having trouble believing that.

I'd wager it might be a regional thing--people coming from the shady ones that accept people with 2.5/25, where they barely provide any clinical training and it's usually in random individual outpatient clinics. (This is what I've heard about places like Touro NV)

 

[splik]

Really? A large proportion are actually terrible? Im having trouble believing that.

im not really in a position to say what proportion but yes we've seen many terrible students from certain osteopathic schools.

 

[surfguy84]

ucsd tends to take a fair few DOs and ucsf has taken a few DOs in the past a least. i am not sure any of these places except UCLA has a clear anti-DO bias. the reality is many DO schools are proliferating that no one has heard of, medical school of attendance does matter to programs as it speaks the the general caliber of the applicant, and the quality of education at many DO schools leaves a lot to be desired. further DO students may not have appropriate letters of recommendation and tend to not be as well advised on the application process that disadvantages them. some don't even give clerkship grades and the quality of the clerkships at some places certainly raises eyebrows.

there are some excellent osteopathic applicants out there but the large proportion of the ones applying for psychiatry are just terrible and doing an away only further kills any chance they have of matching at the program when they see how terrible they are. we have had lots of complaints from residents about visiting students this year and the complaints are almost always about DO students, particularly from lesser known schools.

be realistic about your competitiveness and the strength of your interpersonal and clinical skills. if these are strong and you can do an away early and get a strong letter of recommendation from faculty at a reputable place this will help you everywhere as one of the major disadvantages if many DO students seem to apply with letters from docs in straw huts or something and it becomes hard to know how to gauge that. be sure that your clerkships have given you enough experience so you can hold you own and understand the conventions in medicine, particularly at teaching hospitals. Also from what I've seen osteopathic applicants who have had successful careers/life experiences in other fields (particularly if relevant) tend to do better and be take more seriously than those coming straight from undergrad.

no one cares about your preclinical grades but hopefully that will translate into a strong step 1 score. showing a strong commitment to psychiatry and other distinguishing things will also contribute to being more loved.

Thanks for taking the time to write all of that; really appreciate your advice. For what it's worth I'm a non-trad with probably one of the most unique prior careers/life stories around..hopefully that'll help. I also go to one of the CA osteopathic schools. Do you think this would make a big impact in matching out here?

 

[kirkirkir]

im not really in a position to say what proportion but yes we've seen many terrible students from certain osteopathic schools.

Which schools have not so terrible students?

 

[Dharma]

ucsd tends to take a fair few DOs and ucsf has taken a few DOs in the past a least. i am not sure any of these places except UCLA has a clear anti-DO bias. the reality is many DO schools are proliferating that no one has heard of, medical school of attendance does matter to programs as it speaks the the general caliber of the applicant, and the quality of education at many DO schools leaves a lot to be desired. further DO students may not have appropriate letters of recommendation and tend to not be as well advised on the application process that disadvantages them. some don't even give clerkship grades and the quality of the clerkships at some places certainly raises eyebrows.

there are some excellent osteopathic applicants out there but the large proportion of the ones applying for psychiatry are just terrible and doing an away only further kills any chance they have of matching at the program when they see how terrible they are. we have had lots of complaints from residents about visiting students this year and the complaints are almost always about DO students, particularly from lesser known schools.

be realistic about your competitiveness and the strength of your interpersonal and clinical skills. if these are strong and you can do an away early and get a strong letter of recommendation from faculty at a reputable place this will help you everywhere as one of the major disadvantages if many DO students seem to apply with letters from docs in straw huts or something and it becomes hard to know how to gauge that. be sure that your clerkships have given you enough experience so you can hold you own and understand the conventions in medicine, particularly at teaching hospitals. Also from what I've seen osteopathic applicants who have had successful careers/life experiences in other fields (particularly if relevant) tend to do better and be take more seriously than those coming straight from undergrad.

no one cares about your preclinical grades but hopefully that will translate into a strong step 1 score. showing a strong commitment to psychiatry and other distinguishing things will also contribute to being more loved.

The large proportion of the DO students applying psychiatry are "just terrible." ???Come on! Ridiculous. Your assumptions regarding the quality of DO education are a bit skewed as well. While there are some situations that can be described by your semi-rant, most are not.

 

[Wilf]

The large proportion of the DO students applying psychiatry are "just terrible." ???Come on! Ridiculous. Your assumptions regarding the quality of DO education are a bit skewed as well. While there are some situations that can be described by your semi-rant, most are not.

His post was not as ridiculous as you make it seem. Even a lot of the MD applicants to psychiatry aren't that great unfortunately.

 

[MLT2MT2DO]

His post was not as ridiculous as you make it seem. Even a lot of the MD applicants to psychiatry aren't that great unfortunately.

It's the way she singled out DOs. Being a foreign grad I figure splik would have been a little more careful with her words, especially since they actually carry some weight around here.

Lately spliks posts have went from very informative to well, overly opinionated jibberish.

 

[Dharma]

His post was not as ridiculous as you make it seem. Even a lot of the MD applicants to psychiatry aren't that great unfortunately.

Didn't see any mention of that in her post. Her word is strong around here, so I'm calling out the hyperbolic rhetoric in attempt to prevent its perpetuation.

 

[splik]

Lately spliks posts have went from very informative to well, overly opinionated jibberish.

my posts have always been overly opinionated and ive never claimed otherwise. i do think it is unfair to denounce anything that you disagree with as "jibberish" though.

 

[splik]

Thanks for taking the time to write all of that; really appreciate your advice. For what it's worth I'm a non-trad with probably one of the most unique prior careers/life stories around..hopefully that'll help. I also go to one of the CA osteopathic schools. Do you think this would make a big impact in matching out here?

yes, at least in as much as it would be much harder if you didn't go to school in cali. This is mainly because the hospitals in CA are more likely to be familiar with the CA osteopathic schools and so would make it easier. I really dont think it is as hard to get into a cali program beyond ucsf, ucla, stanford as has been claimed. even people who have failed their boards multiple times manage to match into half-decent programs in california (i know at least one example of this). making a good impression doing an away rotation early, and forming a more enduring relationship with a psychiatrist who is willing to champion your case will help alot.

 

[Shikima]

Couldn't DO's just use the force to mind manipulate PD's into accepting them?

 

[Nymphicus]

I've seen a couple DO's at my interviews, including UCSD. However, it seemed they had all done aways at the program

 

[OldPsychDoc]

Couldn't DO's just use the force to mind manipulate PD's into accepting them?

These are not the DOs I'm looking for.

 

[MacDonaldTriad]

Knowing someone can do the job is worth a thousand references and letter grades. Interviewing rotators isn’t just “courtesy”.

This MD vs DO bias discussion is better characterized by some bottom line duck tests. The first two preclinical years are more similar than different no matter where you go to school. If you are a good student at a so so school, you would be only slightly better off at a top school. Just because the guy who wrote the book is teaching you doesn’t mean he or she is a good teacher.

It is the clinical experiences that make the difference between schools in my opinion. If your mentors are just physicians, but not physician educators, that is not good. If there are no interns, residents or fellows around to take advantage of the clinical teaching, that is not a good sign. You can do well with individualized teaching between just a student and a practitioner, but this person better have a passion for teaching and a good amount of time dedicated to it.

Clinical rotations need to give students enough responsibility to test their clinical decision making. This has to be well monitored, but we all learn through our mistakes and walking around watching doesn’t teach much and it evaluates even less. “I think I’ll give this student honors, they did a fine job at appearing interested in what I was doing….” If you want to know if your education measures up, these things are much more important than which degree you get.

Then there is garbage in, garbage out, or more positively; talent in talent out. Cream will raise to the top and the better the material that goes into a program, the better the quality of the product that comes out. There are some fantastic students in average schools, but very few average students in the best schools. So which school you come from does mean something. I didn’t say all Ivy league graduates are good or all of the bad medical students come from the worst schools it isn’t nearly that absolute, but it isn’t irrelevant either.

I would take the top students from the bottom schools every time as compared to the bottom students from the best schools, but all things being equal, your school is relevant.

 

[MacDonaldTriad]

These are not the DOs I'm looking for.

I have a DO-R2, is that close enough?

 

[surfguy84]

I've seen a couple DO's at my interviews, including UCSD. However, it seemed they had all done aways at the program

Is it quite difficult to land an away at UCSD, for instance? Any idea about other programs in CA?

 

[temoojin]

im not really in a position to say what proportion but yes we've seen many terrible students from certain osteopathic schools.

So this is not just for splik because I've seen similar sentiments elsewhere on the site, but could someone list off some "good" DO schools vs. "bad"? I ask as a current osteopathic student, hoping I don't come from a "bad" school.

 

[Dharma]

^ really not necessary. Plenty of fodder for this in the pre-allo/osteo and student forums.

 

[MLT2MT2DO]

my posts have always been overly opinionated and ive never claimed otherwise. i do think it is unfair to denounce anything that you disagree with as "jibberish" though.

I agree on both fronts. I guess I've just seen a lot more "off the cuff" opinions with little basis, lately.

I'm more of a fan of your earlier work, that appeared to be a little more grounded with evidence.

 

[notdeadyet]

So this is not just for splik because I've seen similar sentiments elsewhere on the site, but could someone list off some "good" DO schools vs. "bad"? I ask as a current osteopathic student, hoping I don't come from a "bad" school.

In general (so caution), schools that have their own hospitals for their training tend to be viewed as better. Schools that have a school for first and second year classes then have "relationships" with a long list of sites around the country for clinical training are viewed less favorably.

This tends to get proven out, in my experience. Some of the latter batch of schools seem to have pretty poor advising, which makes sense if the school doesn't have actual clinical departments operating. I've worked with some osteopaths that went to programs that ran their home hospitals and their training and chops seemed indistinguishable from allopathy (plus the kung fu that is OMM, of course).

Also, for many folks, the new and for-profit osteopathic schools are viewed less favorably, for now. I say for now because as newer programs mature, they may develop a good reputation (and get past the fact that new programs of any kind tend to be less selective than others until they gather some moss). For the for-profit schools, they may be viewed more favorably with time as folks get used to the idea of for-profit medical education. I personally doubt that will happen, as for-profit education, if anything, is getting dinged more and more as exploitive, shady, and just bad juju.

Most of all, good vs bad programs tend to be a matter of geography. The further folks are from a osteopathic school, the more polarized (and potentially stereotypic) views will be.

Time will tell. Osteopaths have done an excellent job of producing excellent, well-trained, and hard working clinicians that have overcome the "what's a DO?" Thing and proven themselves interchangeable with MDs. But I personally think the DO thing is at a tipping point: there is the potential that schools will be allowed to proliferate (particularly with the for profit model) and you would see more and more programs with lower and lower admission standards with higher and higher tuition. I would hate for this to happen, as it could potentially start to undo a lot of great work osteopathy has done over the past couple of decades.

 

[SomeDoc]

Good discussion, though at times misinformed with good intentions, and in need of a few facts. The climate of medical, and graduate medical education is changing for both the LCME and AOA

1) GME is merging into one entity, the ACGME, which will accredit programs for both MD's and DO's
2) The LCME removed Standard IS-2, nullifying the not-for-profit requirement for accreditation of new schools. LCME has provisionally accredited a for-profit institution, ironically in the state of CA (fitting for this thread). Several others have been under proposal since 2013. See https://www.lcme.org/2013-new-and_revised-standards-summary.pdf
3) For-profit medical education is not going anywhere, and will likely grow.
4) There are no for-profit DO "schools". There is one in CO. The number will likely increase.

 

[notdeadyet]

The LCME has already provisionally accredited a for-profit institution, ironically in the state of CA (fitting for this thread). Several others have been under proposal since 2013.

Are you talking about Cal Med? They must have changed things up a bit. At my last read, it was going to be not-for-profit, a la LLU. And UC Riverside. Those are just the ones I'm thinking of in California. When did Cal Med change the plan to for-profit? Or are you referring to another school?

.
4) There are no for-profit DO "schools". There is one in CO. The number will likely increase.

What about Burrell College College of Osteopathic medicine in New Mexico?

 

[MLT2MT2DO]

The vast majority of DO schools are going to be viewed as poor. With the exception of probably North Texas, OSU, and MSU. These are academic and have their own hospitals.

Even these you'll have a bias against you being a DO, but more so if you don't.

With that said your 3rd and 4th year education may be lackluster but this is where you can start setting yourself apart with aways and show that you aren't just another average student from Kmart osteopathic school of cranial discombobulation.

If you're headed to a DO school worry less how your school is viewed and worry more about you as an individual since you actually have control over the latter.

 

[MacDonaldTriad]

And, since medical school slots are growing and graduate medical education isn’t, face your demons and show some capacity for radical acceptance. If you are worried that the schools that are willing to accept you will not open the doors you need open after 4 years and a few hundred thousand, change directions or go to grad school and try again. I hate seeing us become like psychology as we now allow for profit education. So many sad educational dead end stories. The only way to prevent people from getting burned is to keep the front end more selective. If you work hard enough to circumvent this selective process, don’t be surprised with your result. 🙁

 

[Doctor Bagel]

The vast majority of DO schools are going to be viewed as poor. With the exception of probably North Texas, OSU, and MSU. These are academic and have their own hospitals.

Exactly -- most DO schools, even ones that are thought of as being the "better" ones don't have their own hospitals. My residency program had taken people from places like Des Moines and Kirksville, and I think knew those schools were OK. They had no clue that say, OSU, was considered to be a stronger DO school.

 

[MLT2MT2DO]

Exactly -- most DO schools, even ones that are thought of as being the "better" ones don't have their own hospitals. My residency program had taken people from places like Des Moines and Kirksville, and I think knew those schools were OK. They had no clue that say, OSU, was considered to be a stronger DO school.

Your current PD seems to also do a much better job at assessing individuals as just that. As opposed to trying to make his current resident website look overly purty with fancy school names.

 

[675015]

Your current PD seems to also do a much better job at assessing individuals as just that. As opposed to trying to make his current resident website look overly purty with fancy school names.

You can make comments like "overly purty" all you want but the point is, how are these PDs supposed to assess individuals? A standardized test like USMLE? Because then it will be all foreign grads? Clinical grades and letters of rec? That's where part of the bias comes in. If your rotations are at random clinics with doctors who aren't trained to be teachers but just to allow shadowers, those letters are worthless. There's no accountability. So it's difficult to figure out who's a good candidate vs who's not. But most good programs have a glut of passable MD candidates so it's not worth the time to nitpick and guess who will be a good DO "individual"... And voilà... A DO bias is born.

 

[Dharma]

You can make comments like "overly purty" all you want but the point is, how are these PDs supposed to assess individuals? A standardized test like USMLE? Because then it will be all foreign grads? Clinical grades and letters of rec? That's where part of the bias comes in. If your rotations are at random clinics with doctors who aren't trained to be teachers but just to allow shadowers, those letters are worthless. There's no accountability. So it's difficult to figure out who's a good candidate vs who's not. But most good programs have a glut of passable MD candidates so it's not worth the time to nitpick and guess who will be a good DO "individual"... And voilà... A DO bias is born.

Gross generalizations and assumptions you make here. Are you DO student?

 

[MLT2MT2DO]

You can make comments like "overly purty" all you want but the point is, how are these PDs supposed to assess individuals? A standardized test like USMLE? Because then it will be all foreign grads? Clinical grades and letters of rec? That's where part of the bias comes in. If your rotations are at random clinics with doctors who aren't trained to be teachers but just to allow shadowers, those letters are worthless. There's no accountability. So it's difficult to figure out who's a good candidate vs who's not. But most good programs have a glut of passable MD candidates so it's not worth the time to nitpick and guess who will be a good DO "individual"... And voilà... A DO bias is born.

Considering the PD would be a psychiatrist I don't think I'm asking too much to have someone assess a candidate based on their individuality and dismiss their biases at the interview door.

Fair warning, I'm an idealist, so I usually give people too much credit.

I'm also mostly referencing the fact that the bias is still prevalent after the interview. I can somewhat see your point when it comes to extending interviews. Though giving an interview to an MD that has multiple retakes of the USMLE vs a DO who scored a 250+ I'll never understand.

 

[notdeadyet]

Considering the PD would be a psychiatrist I don't think I'm asking too much to have someone assess a candidate based on their individuality and dismiss their biases at the interview door.

This is part of the problem, though. Dismissing "bias" at the interview door grossly over-inflates the information you glean from an interview.

An interview, after all is said and done, tells you one thing: how well someone interviews. It's a very specific skill. People who are good at it (and you can work at being good at it) can grok what you are looking for and give you the impression that they are that.

So dimissing your "bias" at the door for the interview can lead to just ditching one bias for another. The interview-bias is even more popular, because despite evidence to the contrary, psychiatrists like to think they can tell when people are being authentic more than most (and evidence suggests otherwise).

Though giving an interview to an MD that has multiple retakes of the USMLE vs a DO who scored a 250+ I'll never understand.

I don't think too many decent residency programs will do this. You might see this in the non-decent programs that are desperate to up their MD count, but most places would jump at the DO.

 

[notdeadyet]

It all matters to most sound allopathic residencies:

• Step 1. It's just a standardized test (personally I loath them) but you need a quantitiative measure by which to judge. It's also a divining rod of sorts for a degree of fund of knowlege and how seriously they take a big day of consequence. There is always the Step 2 as a safety chute for the "I had the flu" crew.
• Clinical grades. Not just how many honors, but which ones did you honor and what percentage honored? What are the comments about your performance? Folks who struggle and excel in clerkships are likely to do the same during clinical training. Some programs may care about pre-clinical grades, but I don't personally know of any (see Step 1).
• Letter of Recommendations. This is where MD students often have a leg up on folks from some osteopathic programs. You can get good letters from folks who know you for a total of 30 days, but better letters come from folks who've known you longer. The strong letters that really have impact are from the psychiatry faculty member who saw you on a rotation (or two or three), knows you from interactions with PsychSIG, worked with you volunteering in a student-run clinic, and has gotten input from other faculty who've worked with you whose opinions he or she respects and can write deeper than just "NDY showed up daily x30 and rarely cried." These letters are certainly possible for osteopathic students, but harder if their clinical training is scattered around the country.
• Reputation of medical school. This isn't the end-all/be-all but it matters. Schools with strong reputations tended to get that reputation by producing good quality clinicians. That helps separate the wheat from the chaff. Great psych programs regularly take folks from not top tier medical schools (there are way more seats at top psych residencies than there are applicants going into psych from top tier medical schools), but the stronger the reputation of the medical school, the more likely an applicant is to have had a wide breadth of clinical opportunities. Top 10% medical school = leg-up, 80% of the schools = no penalty, 10% bottom of the heap medical school = more careful scrutiny of the application.
• Awards/Articles/Attaboys. Publications show a deeper interest/understanding. Fellowships and honors that folks compete for nationally show nationally-ranked performance. AOA shows that you've been judged one of the best your program has to offer.
• Interview. Probably overly valued by many psychiatry residencies, imho. Like I said above, an interview serves to demonstrate how good an interviewer you are. There's some cross-over: if someone can't socially engage, isn't articulate, and can't handle a conversation on the fly, they are more likely to struggle with some portions of a psych residency. But interviews are helpful for the PD, faculty, and the resident interviewers in answering their burning questions: is this person going to be the train wreck that occupies 70% of my time, what is this person going to be like working under stress at 2 a.m. when I'm covering, and will this person share a joke/laugh/beer with me (respectively).

 

[promotemma]

Knowing someone can do the job is worth a thousand references and letter grades. Interviewing rotators isn’t just “courtesy”.



It is the clinical experiences that make the difference between schools in my opinion. If your mentors are just physicians, but not physician educators, that is not good. If there are no interns, residents or fellows around to take advantage of the clinical teaching, that is not a good sign. You can do well with individualized teaching between just a student and a practitioner, but this person better have a passion for teaching and a good amount of time dedicated to it.

Clinical rotations need to give students enough responsibility to test their clinical decision making. This has to be well monitored, but we all learn through our mistakes and walking around watching doesn’t teach much and it evaluates even less. “I think I’ll give this student honors, they did a fine job at appearing interested in what I was doing….”


]\.

You are describing my exact clinical experience. While there does seem to me exceptions to the rule, I think the rule is that DO's have less consistency in the quality of their clinical experience.

 

[MacDonaldTriad]

Yep, and very little convention between rotations on what constitutes an honors performance, a near honors performance, or a pass. DO grades have very little validity unfortunately, and this does not work to their advantage.

 

[Dharma]

Yep, and very little convention between rotations on what constitutes an honors performance, a near honors performance, or a pass. DO grades have very little validity unfortunately, and this does not work to their advantage.

Is this simply based on the fact that DO schools are not attached to major academic hospitals? This does not entail a lack of quality education on a daily basis though. N= 1, but most of my rotations have been with teams of residents, daily rounds, morning reports, grand rounds, regular didactics, etc. And more often than not, I was not a flower-on-the-wall, but expected to play a role as a contributor to the team which allowed for a good deal of hands-on experience along with a nice dose of accountability. Were they at hospitals that many would recognize by name? For the most part, no. That does not detract from the quality of education, although I understand why name-brand institutions have a 1-up in terms of validity.

The subjectivity regarding grades is across the board though, regardless of degree, and this in and of itself puts the validity of all grades into question.

 

[notdeadyet]

Is this simply based on the fact that DO schools are not attached to major academic hospitals? This does not entail a lack of quality education on a daily basis though. N= 1, but most of my rotations have been with teams of residents, daily rounds, morning reports, grand rounds, regular didactics, etc. And more often than not, I was not a flower-on-the-wall, but expected to play a role as a contributor to the team which allowed for a good deal of hands-on experience along with a nice dose of accountability. Were they at hospitals that many would recognize by name? For the most part, no. That does not detract from the quality of education, although I understand why name-brand institutions have a 1-up in terms of validity.

It sounds like you've been getting a quality education, both in terms of the how the rotations are run and how you are participating. Congratulations!

In my eyes, it's not the issue of name-brand institutions that can hurt DOs. Part of it is the actual environment, as MacDonaltTriad alluded to above (good teachers tend to congregate in environments in which they teach). But it is also the consistency of the rotations. When an individual does a majority of their rotations at a home hospital, there tends to be a much more consistent academic standard than when someone is sprinkled around the country for their clinical years. The latter can also be troubling because while some folks may have your experience at some sites, often a visiting medical student is not held to the same standards as a home student (it's hard... we really have little idea about their level of training and not much time to spend with them to learn). So the clinical evaluations of DO students that rotate through different non-home hospitals can be less helpful.

And none of this touches on the "tourist effect" in which there is a large and necessary amount of time spent on acclimating to a new environment (who is who, what is where, standards for charting, etc.). All of that time detracts from patient care and education, which weakens the experience. But that's another kettle of fish.

The subjectivity regarding grades is across the board though, regardless of degree, and this in and of itself puts the validity of all grades into question.

That's why medical schools work hard to reduce the subjectivity. It doesn't eliminate it entirey: evaluations will always be subjective. But having a home institution with home medical students allows programs to create standards, apply them, and collaborate with other departments to keep them across the medical center. That is lost when folks rotate at random electives in random spots. That's why programs tend not to care about 4th year rotation grades.

 

[Dharma]

It sounds like you've been getting a quality education, both in terms of the how the rotations are run and how you are participating. Congratulations!

In my eyes, it's not the issue of name-brand institutions that can hurt DOs. Part of it is the actual environment, as MacDonaltTriad alluded to above (good teachers tend to congregate in environments in which they teach). But it is also the consistency of the rotations. When an individual does a majority of their rotations at a home hospital, there tends to be a much more consistent academic standard than when someone is sprinkled around the country for their clinical years. The latter can also be troubling because while some folks may have your experience at some sites, often a visiting medical student is not held to the same standards as a home student (it's hard... we really have little idea about their level of training and not much time to spend with them to learn). So the clinical evaluations of DO students that rotate through different non-home hospitals can be less helpful.

And none of this touches on the "tourist effect" in which there is a large and necessary amount of time spent on acclimating to a new environment (who is who, what is where, standards for charting, etc.). All of that time detracts from patient care and education, which weakens the experience. But that's another kettle of fish.

That's why medical schools work hard to reduce the subjectivity. It doesn't eliminate it entirey: evaluations will always be subjective. But having a home institution with home medical students allows programs to create standards, apply them, and collaborate with other departments to keep them across the medical center. That is lost when folks rotate at random electives in random spots. That's why programs tend not to care about 4th year rotation grades.

Good points. That said, the notion that a majority of DO rotations are scattered throughout the country is not entirely accurate yet continually perpetuated in multiple threads here on SDN. The bouncing from place to place that many speak of is not necessarily the norm, although it happens more than it should. Most of the schools have core rotations sites that are not random and quite established.

I agree that this isn't the case across the board, and generally speaking, MD schools will have a more reliable set-up.

 

[MLT2MT2DO]

It sounds like you've been getting a quality education, both in terms of the how the rotations are run and how you are participating. Congratulations!

In my eyes, it's not the issue of name-brand institutions that can hurt DOs. Part of it is the actual environment, as MacDonaltTriad alluded to above (good teachers tend to congregate in environments in which they teach). But it is also the consistency of the rotations. When an individual does a majority of their rotations at a home hospital, there tends to be a much more consistent academic standard than when someone is sprinkled around the country for their clinical years. The latter can also be troubling because while some folks may have your experience at some sites, often a visiting medical student is not held to the same standards as a home student (it's hard... we really have little idea about their level of training and not much time to spend with them to learn). So the clinical evaluations of DO students that rotate through different non-home hospitals can be less helpful.

And none of this touches on the "tourist effect" in which there is a large and necessary amount of time spent on acclimating to a new environment (who is who, what is where, standards for charting, etc.). All of that time detracts from patient care and education, which weakens the experience. But that's another kettle of fish.

That's why medical schools work hard to reduce the subjectivity. It doesn't eliminate it entirey: evaluations will always be subjective. But having a home institution with home medical students allows programs to create standards, apply them, and collaborate with other departments to keep them across the medical center. That is lost when folks rotate at random electives in random spots. That's why programs tend not to care about 4th year rotation grades.

You do realize the huge influx of new MD schools even those like 10 years old are getting very similar clinic year experience as DOs, right? There was quite a lot of overlap between my schools rotations and Florida State Universities.

 

[notdeadyet]

That said, the notion that a majority of DO rotations are scattered throughout the country is not entirely accurate yet continually perpetuated in multiple threads here on SDN. The bouncing from place to place that many speak of is not necessarily the norm, although it happens more than it should. Most of the schools have core rotations sites that are not random and quite established.

I didn't mean to imply that it's the norm nationally. Just that it is the norm at some DO programs. If I made it sound like I was saying it was the universal experience among DOs, I apologize. Not my intent.

 

[notdeadyet]

You do realize the huge influx of new MD schools even those like 10 years old are getting very similar clinic year experience as DOs, right? There was quite a lot of overlap between my schools rotations and Florida State Universities.

I do. FSU is a great example of one taking after the DO model. MD programs are now authorized to be for-profit (although I don't know of any example) as well.

This new shift isn't being done for reasons of training, it's being done for reasons of cost (which I presume is the same reasons that the DO programs using that model did so). My prediction is that if you graphed out the cost of attendance at programs built on that model vs. the ones built on the traditional MD model, you'll fine the latter is cheaper cost-of-attendance.

The model that many DO programs have (and some of the newer MD programs seem to be taking steps to embrace) is financially savvy if pedagogically suspect. You avoid the capital and operating cost of a hospital and just form "partnerships" with a string of different providers and services, jack up the tuition, and target folks who lack other opportunities to become a doctor who are willing to tolerate that combination of training/tuition.

This proliferation happened with law schools what 40 years ago? Now when someone says they went to law school, it doesn't mean a whole lot. You have to ask "where?" to get an idea of whether or not they had chops and/or have any particular legal skill. My hope is that this doesn't happen with medical schools, because the potential is that (like law school graduates) you will have folks unable to use their MD/DO degree very well. The difference is that our choke point will be residency. GME has not been increasing in size at the rates that UME has. We have wiggle room with the fact that we have a whole lot of slots filled by offshore and overseas students, but that will only go so far.

Interesting times. If this trend continues, where you went to medical school will have more impact on residency selection than it does now, because it will just exacerbate the same issue we have today with determining level of training.

 

[MacDonaldTriad]

I think I'll start a University of Phoenix Medical School. I wish I could have taken anatomy online.

 

[notdeadyet]

I think I'll start a University of Phoenix Medical School. I wish I could have taken anatomy online.

"Are you an unlucky college student?... Call in the next five minutes and get a copy of Netter's FREE!"

 

[Nymphicus]

I think I'll start a University of Phoenix Medical School. I wish I could have taken anatomy online.

Anatomy And Physiology II – nsci281 (4 credits)
http://www.phoenix.edu/courses/nsci281.html