How important is diverse pathology during clinical rotations?

[Astra]

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People seem to knock on community hospital rotations due to the lack of zebra cases. Question is, how important are these zebra cases?

Would you say getting more hands on experience outweighs seeing more diverse pathologies?

 

[Donald Juan]

It's not just about seeing zebras, it's also about seeing highly critical patients and having to manage complex situations. Many community hospitals you won't see these because they are either routed to the tertiary care center, or sent there soon after getting to the ED when they appear out of their league. For example, if you do OB at an area where they don't have a NICU, they likely try and route all their early pre term births to other hospitals that do have the care. For surgical fields, many operations just won't occur at community hospitals because there either isn't the appropriate surgeon to do it, or there isn't the ancillary staff required for the perioperative management. These things aren't zebras, they are just complex patients.

With that being said, I'm certainly not against people doing some rotations away from academia, and I know there are certainly times when people get better educational experience at a community hospital than they do at the academic one. It's still good to see that higher level of care for a good portion (if not the majority) of your training.

 

[Trefoil]

People seem to knock on community hospital rotations due to the lack of zebra cases. Question is, how important are these zebra cases?

Would you say getting more hands on experience outweighs seeing more diverse pathologies?

It also depends on what stage of your training you are at. You have to first become used to routine cases before you can worry about Zebras. Zebras are interesting, but they will not be the bulk of your practice. Additionally, some community hospitals have similar capabilities to academic centers. You can receive a similar education, and often, you will actually be next in line to do a procedure or be a first assist in a surgery. In academic programs, there is a resident or a fellow above you who will get all of the hands on experience. That being said, there is more formal education at academic centers with lectures and residents who can teach you. I have found that my DO counterparts, who do a majority of rotations at community hospitals, have a lot more hands on practical experience. On the other hand, they really love all the teaching that goes on at academic centers. There are obviously pros and cons to both systems.

 

[ChrisMack390]

FWIW, a lot of my friends further along in med school preferred their rotations at community hospitals because they felt that they got to do a lot more procedures and such because of fewer students/residents/fellows and less red tape.

 

[Taddy Mason]

You may get to do more at community hospitals, but seeing and participating, to whatever degree, in the management of zebras and more complex cases in person is much better for learning and retaining the path, management, etc. than just reading about it IMO. I say this as someone who opted to go to a community med school v. an academic one because I thought getting to do more v. seeing more pathology would be better. Now I’m starting to feel the other way…the grass is always greener I guess…

 

[chizledfrmstone]

You may get to do more at community hospitals, but seeing and participating, to whatever degree, in the management of zebras and more complex cases in person is much better for learning and retaining the path, management, etc. than just reading about it IMO. I say this as someone who opted to go to a community med school v. an academic one because I thought getting to do more v. seeing more pathology would be better. Now I’m starting to feel the other way…the grass is always greener I guess…

What do you mean by community medical school?

 

[TooMuchResearch]

People seem to knock on community hospital rotations due to the lack of zebra cases. Question is, how important are these zebra cases?

Would you say getting more hands on experience outweighs seeing more diverse pathologies?

You want good pathology in school but also bread and butter and hands on.

Not all "community" hospitals are the same. The range from rural hospitals that have to transfer any sick patients, to rural/suburban hospitals that might be able to manage many routine sick patients but transfer more complex ones or those on ventilators to suburban/urban non-university tertiary referral centers that receive all those sick patients.

 

[Taddy Mason]

What do you mean by community medical school?

There are 10-11 US MD schools that don't have affiliated academic teaching hospitals and 3rd and 4th rotations are done at community hospitals. They’re usually referred to as community, or community affiliated/associated schools.

 

[chizledfrmstone]

There are 10-11 US MD schools that don't have affiliated academic teaching hospitals and 3rd and 4th rotations are done at community hospitals. They’re usually referred to as community, or community affiliated/associated schools.

Oh wow, didn't know that. Where can I find a list of these schools?

 

[Taddy Mason]

Oh wow, didn't know that. Where can I find a list of these schools?

According to the blog of the Dean of my school there are actually 28 (I could have sworn he said 10-11 previously). Regardless, I know he listed all the US community-based med schools in a post 1-2 years ago. I’ll have to do some digging for the specific post that lists the schools, but I’ll post it as soon as I find because I can only remember 2 other schools off the top of my head.

 

[ChordaEpiphany]

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[Daodejing]

To this question, I answer 'meh' and remember some advice.

"Med school is where you learn how to learn. Your PGY years are where you learn what to do with all that learning and grow into that long white coat."

 

[sliceofbread136]

Never understood why people trip over themselves to try and get involved with procedures during medical school. Always seemed like the lowest level of learning to me, and you'll pick up the ones that are actually important to you in residency fairly easily (I'm obviously non-surgical minded)

I also think med student autonomy is a laughable concept. You know incredibly little, why in the world would you have autonomy? Your job is see a patient, come up with a plan and learn from the mistakes in said plan

 

[Hangry]

FWIW, a lot of my friends further along in med school preferred their rotations at community hospitals because they felt that they got to do a lot more procedures and such because of fewer students/residents/fellows and less red tape.

Meh, this is the sort of thing that sounds sexy as a premed or preclinical, but many of us think this is an issue of trying to run before you can crawl. Trying to learn 1:1 from an attending is difficult, a lot of what they do/think is second nature at that point and unless they go way out of their way to explain every little thing to you it will be tough to follow along with their reasoning. They are often pressured to be very time-efficient and have forgotten what it was like to be a student/your level of knowledge, so it can be tougher for them to both have the time to teach you and to know what sort of material is appropriate for your level.

When you have residents, they are still learning as well, so things move less efficiently on a service but you get to see more of the "sausage being made" as the residents work through their decision making on rounds. You have people just above you on the totem pole that remember what it is like to be a student and can guide you in those next few steps you will be making with each successive year of experience.

Finally, and arguably most important, is that the EVERY residency spot is at a place where there is well..a residency program. If you do all your training in a preceptor model you will have no idea how a residency service is supposed to run and will have a very steep learning curve to start your intern year, on top of all the usual intern learning that happens.