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How to tell strength of clinical years?

Discussion in 'Pre-Medical - MD' started by snowflakes, Jan 3, 2014.

  1. snowflakes

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    Everyone emphasizes evaluating a school based on the strength of the clinical years, rather than overly focusing on the pre-clinical years.

    What are some good questions to ask current students/interviewers to get a sense of this?

    A couple of my ideas: How often do students use the simulation center? What is the typical amount of responsibility for a student in the clinic?
     
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  2. SouthernSurgeon

    Physician Lifetime Donor Verified Account 7+ Year Member

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    You have a great question. It is really hard to evaluate, often under-emphasized on the interview day, yet in my mind having gone through medical school it was the clinical years that truly made my education.

    Pre-meds unfortunately spend most of their time asking questions like "how many students per cadaver?" - a factor that will have so so so little impact on their education. The med schools encourage this though too, as most of their presentations and tours focus on the pre-clinical experience (it doesn't help that most tour guides are M1s and M2s).

    As to your ideas of questions...the first one I'd toss out the window. Every school is building some fancy multimillion dollar simulation center, but at the end of the day, simulation is not, nor should be, the focus of the clinical years. You can learn a lot of the fundamentals of interviewing patients and physical exam technique from SPs, but real learning comes from pathology and interacting with patients and a team in the hospital.

    Your second question is closer.

    Here are a few more off the top of my head I'd consider asking about (diplomatically):
    1. How many sites do students rotate at? What is the breakdown of time spent at the "mothership" (home institution) versus satellite sites? (i.e. how good/comprehensive is the home institution?)
    2. Do you have to travel out of town for any of your rotations? (i.e. am I going to have to uproot myself for 8 weeks third year because you want me to go to the middle of nowhere for my surgery rotation?)
    3. How big is the hospital? Is it a level 1 trauma center and tertiary/quaternary referral center? ( i.e. are the sickest, craziest patients in the region coming here?)
    4. How much advice do students get from their school and their peers about which rotations provide the best experience? (i.e. am I going to be coming on SDN in three years asking for advice about whether a rotation at west bumblef**k U is better than a rotation at east bumblef**k U?)
    5. What is a typical day like on the wards on IM, peds, surgery? (i.e. am I going to get murdered hours wise?)
    6. How are the clinical years graded? How many students typically get honors? ( i.e. gunners gotta gun...)
    7. Do you have any other professional students rotate with you like PA or NP? ( i.e. am I going to have some freaking NP student stealing cases/procedures/patients/attention from me?)
    8. How happy have you been with the clinical experience? Is there anything you feel like you've missed out on?
    9. Does the school have any limits on how many 4th year rotations/away rotations you can do in any one field? (i.e. if I decide I want to do derm, plastics, etc, am I gonna be able to do enough audition rotations to match?)
     
  3. Endure

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    Thank you, southernIM. This is extremely helpful and something I will be keeping in mind as I assess the value of each school.
     
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  4. RogueUnicorn

    RogueUnicorn rawr.
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    SouthernIM killed it already so there's really little to add. I hope the mods sticky this topic since it's not something most premeds and even M1s are aware of

    If you run into clinical students I'd encourage you to ask if their experience is experiential or observational; one way to actually gauge how true the answer is is to ask how comfortable they are doing histories and physicals one their own, doing their intakes, procedures, etc. If the MS3/4s say they feel confident about being interns that's probably a good sign.
     
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  5. Cyberdyne 101

    Cyberdyne 101 It's a dry heat
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    Bumping for visibility.
     
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  6. bluetovah

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    In regard to being at the home institution vs. satellite sites- recruiters seems to like to spin it as "you get to go to all these different places and work with all these different populations and it's great!" But it seems to me that it would just be a hassle to be commuting to a different place potentially every month. Anyone have opinions on pros/cons of rotations in different places?
     
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  7. LoveIR

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    I rotated at multiple sites in a 10 mile radius, and occasionally some satellite clinic 30 miles away. Yes, the commuting was a pain, especially on rotations like OB where you had to be there at 6 AM.

    The other downside is that I didn't learn the ins and outs of these different hospitals until...well near the end of med school!

    The upside is that I saw how different one hospital could be from another, and got a taste of very different patient populations.

    Overall I think it was positive, and guess what? When I start residency soon I will be rotating at multiple sites across (a new) city! Haha.
     
  8. NickNaylor

    NickNaylor Thank You for Smoking
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    Our school has this kind of setup. I actually think it's an incredible asset. We have the mothership (as @SouthernSurgeon lovingly calls it) which is predominantly poor, Medicare/Medicaid/non-insured folks with complex medical problems. On the inpatient units, most patients have either serious stuff going on or have been transferred from community hospitals for more advanced care. I think there's value to seeing these patients early in your training in that you "get used" to seeing complex patients. But these patients can be difficult to learn from because there's so much going on, and often you'll be spending a lot of time just trying to stay above water rather than really working to understand clinical medicine. We're also affiliated with a large community hospital in the suburbs which sees a completely different patient population: more affluent, generally well-insured, and simpler medically. At this hospital, you see a lot more "bread and butter" medicine, i.e., the kinds of things that you will be more likely to see outside the tertiary/quaternary medical center. In some cases this can be hugely advantageous: for example, the OBGYN experience at the mothership is pretty weak because the hospital only does high-risk obstetrics, a.k.a. "enjoy delivering the placenta." I didn't deliver a single baby solo during my three weeks on the labor and delivery floor. In contrast, the experience at the community hospital is completely different, and it's not unheard of for students to deliver 10+ babies with backup present but largely on their own. Our school is also very kind to us with respect to logistics in that we get a paid private hotel room for the duration of the time we spend up there, and you have access to unlimited cab vouchers in the event you don't have a car to get you to/from the mothership. I would have a more negative view of the experience if I was having to commute there everyday (1 hour drive one-way).

    The other thing I would add to @SouthernSurgeon's list above is to try and get a sense of what your role as an M3 is. I've read stories here that make their clerkships sound like glorified shadowing. That is not what you want. You want to have some degree of autonomy; you want to have "your own" patients that you're "responsible" for. Make no mistake, residents still see them and you still remain pretty superfluous, but the point is that you play the part and get used to being in that role.
     
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    #8 NickNaylor, Apr 11, 2015
    Last edited: Apr 11, 2015
  9. Psai

    Psai Snitches get zero vicryl
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    As was previously mentioned, simulation is probably the worst thing to happen to medical education. You need to learn things on real patients, not intubating on plastic dummies. All I can add is that your rotations depend on who you are with. If your partners suck and throw you under the bus or overshadow you, you're going to have a bad time. If your residents aren't understanding and send you home at 7pm everyday, you're going to have a bad time. If your attendings don't teach and treat you like a nuisance, you're going to have a bad time. I've had great and horrible experiences in the same rotation. It totally depends on who you're with and you won't know that until you start hearing from upperclassmen. I had a doc who would send us to see patients, didn't have us wasting time writing notes and he gave impromptu lectures in basically anything and everything that you needed to know, including things in other fields. It was a great rotation. I had a doc who made fun of me for asking if I could try to put in an IV on my anesthesia rotation. I felt horrible that day and nearly decided to switch fields
     
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  10. alpinism

    alpinism Give Em' the Jet Fuel
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    A few questions I'd also ask to 4th years:

    -What types of procedures and how many procedures did you do as a third year?
    A rough estimate for student involvement and autonomy.
    Things like intubations, lumbar punctures, suturing lacerations, joint aspirations, and delivering babies.

    -Could you enter notes and orders into patient charts?
    If not you'll be spending a lot of time sitting around watching residents write their notes.

    -How often did you have to leave the wards/OR/clinic during the day for lectures or small groups?
    This can be a huge PITA when you want to function as part of the team but you're constantly leaving for class.

    -What was your role in the OR?
    Did you get to scrub into most operations? What did you do during the operation, ex: observe, retract, assist with opening/closing, even more?

    -What was your role in the clinic?
    Did you see patients on your own first or see them with a physician?
     
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  11. bluejay456

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    Are there certain schools that are notoriously good or notoriously unpleasant for their clinical years?
     
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  12. Cyberdyne 101

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    Bumping again for visibility. See the above posts for invaluable insight regarding the clinical years and questions that should be asked during interviews and 2nd looks.

    Mods, I think you should sticky this thread.
     
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  13. RogueUnicorn

    RogueUnicorn rawr.
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    i didn't realize in the interim southernIM became southernsurgeon
     
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  14. Cyberdyne 101

    Cyberdyne 101 It's a dry heat
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    Yeah apparently, he was bored with IM and managed to secure a surgical residency late last year. I'd imagine that this is difficult to pull off. He probably had a 270 step 1 and a dozen pubs.
     
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  15. Wolf3D

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    wtfffff
    Oh, he's in the South. That must explain it :naughty:

    Actually jk changing residencies is difficult but nothing like 270 difficult especially if you don't care for big academic programs
     
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  16. Cyberdyne 101

    Cyberdyne 101 It's a dry heat
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    Lol, he didn't switch. I was joking. He just had a handle that confused the hell out of people i.e. southernIM when he's in fact a surgical resident.
     
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  17. The Knife & Gun Club

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    Great thread! Should totally be stickied. Any thoughts on going to a school that doesn't have a "mothership" at all?
     
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  18. Wolf3D

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    Pics or it didnt' happen
     
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  19. whatever5

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  20. mcworbust

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    Bumping again for visibility as this is important info for applicants as interview season begins. The clinical training is way more important than basic sciences, as everyone ultimately teaches the same stuff with small variations the first 2 years, whereas a strong M3/M4 is vital as this is where the rubber hits the road, so to speak...

    Totally agree with everything said so far, especially from @SouthernSurgeon:
    Only things I'd add is: 1) ask how much independence is granted as an M3 and M4, and if excellent performance is rewarded with more patient responsibility. 2) do people here have to study for Step 2 CS? I know I only breezed thru First Aid for Step 2 CS for about 2 days/evenings before the exam because I had great clinical training and enough responsibility (ie NOT shadowing) my M3 year that I was extremely confident going into this dumb exam. Classmates I've talked to did the same.


    I can only comment on my school (MCW), I know our clinical years are very strong, and have heard positive things about the clinical strength of MCW students from program directors in specialties at MCW as well as at outside institutions. I worked hard and was rewarded with more responsibility, allowing me to earn comments like "worked at level of an intern" as an M3. The more supervised responsibility you have, the more you'll learn and grow with support from residents/attendings, and the better it will be for clinical comments and LORs.
     
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  21. begoood95

    begoood95 The Friendly Gunner™
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    Is this stickies yet or what??

    I've looking at threads I stickied in the past for this interview season, and this particular one was great.

    I do have a question though: do our interviewers usually know all of this information? My next interviewer is an MD at the "mothership"—though I'm not certain of the extent to which he's in the program. At some institutions, I know you're allowed time with MS1/2's usually...though I can't recall any at the moment that give you time with MS3/4's (probably because they're busy, in the first place).
     
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  22. askamsky51

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    All good points...

    I would add a couple:

    1. Are there any Major residency programs your school doesn't have (ie anesthesia, emergency, ortho) -- speaking from an EM perspective, getting EM letters (ill spare the details) is 100% essential to have early in the residency application process and MUST come from a place with a residency. You can get the letters elsewhere but its 10000x easier to get the required number of LOR if you can do one of your required rotations at home. Schools lacking major programs also generally lack good exposure to the field.

    2. How flexible and easy is it to schedule "away" rotations at the end of 3rd year or beginning of 4th year? -- For some specialties (again, EM) away rotations are MANDATORY to apply. I've seen peers struggle to get rotations in early enough to get their LOR in the system before the application cycle starts.
     
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  23. Syncrohnize

    Syncrohnize PGY-1
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    This is a great question and some schools are better than others and the transparency needs to be addressed so schools can be held accountable. Some US MD schools are good (usually top schools do a good job from my experience because they don't have to worry about cramming in details into M1/2 so they can ace Step 1 since they'll match based on name brand)

    Questions you can ask:

    Subjective:
    -Describe your responsibilities as a medical student, specifically?
    -What kind of tasks are medical students assigned during their IM/Surgery clerkships?
    -How consistently are you allowed to finish your presentations?
    -How much autonomy are you given over your patients?
    -How much time to attendings spend interacting with the medical students?
    -How useful are the clerkship lectures and do students feel they help with the NBME shelf exams?
    -How confident do you feel about coming up with an assessment/plan on a patient on an internal medicine/surgery rotation. By your graduation of medical school, you should be able to do a solid job.
    -How many students in your class feel they have received effective support from a clinical mentor?

    Objective:
    -What is the student to resident (or attending or patient) ratio at a clinical site?
    -Are other students (midlevels, outside medical students, etc.) allowed to rotate at your site?
    -What is the Step 2 CK average and Step 2 CS 1st time pass rate?
    -What is the structure of the clinical clerkship leadership at the institution? Is there a centralized curriculum on each major clerkship or are a bunch of busy faculty invited with little consideration and last minute to give scatterbrained lectures with powerpoints they didn't make?
     
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    #23 Syncrohnize, Nov 6, 2018
    Last edited: Nov 8, 2018
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  24. Med Ed

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    It is. A great, almost 5-year-old, question.
     
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  25. Syncrohnize

    Syncrohnize PGY-1
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    It was a featured article that popped up on the front page...It's also a highly relevant question that I would shine light on and necro-bump even if that wasn't the case.

    The transparency of the quality of clinical education is not at all transparent and no one is held accountable for its quality. What gets students in is the perceived reputation of the school as well as the match list. I can tell you that medical students at the institution I am at right now receive a much higher quality clinical education in comparison to my home program (albeit, they may sacrifice some basic science...but that's OK because the school has the name behind it to make an average STEP 1 score mean a lot on match day).

    I hope pre-meds do a better job asking around with these questions and that a respected source in the medical community starts to take some of these factors into account because there are superficial ways to circumvent LCME guidelines which does nothing more than waste students time. Its critical that students start to think clinically from an early stage in order to be successful in residency. I've said this already in places, but more basic science material ought to be tested on the MCAT, anatomy/biochemistry ought to be trimmed down at many schools, and Step 1 needs to include management in order stress the importance of clinical science instead of learning about the tendons in the foot, DNA Zippers, Prions, and obscure vasculitides.

    For Pre-meds reading:
    I feel like a standard way schools integrate clinical science ineffectively is to stick to their old curriculum, but then add "clinical days" where students where their white coats and do doctor things for a half day. Topics are introduced, but never reinforced.

    Here is an example of effective early clinical integration at a top 20 medical school I never had the qualifications to attend. In the first year itself when a student has mastered an organ system (because hopefully the curriculum is systems-based and not normal-abnormal) students should have a graded assessment. They should watch a hospitalist/fellow take an academic history on a patient with a condition they've just learnt. Afterwards, they should then walk back quietly to their testing center where they take a computerized test which tests them on the pathophysiology of that condition and makes them formulate an assessment and plan on that patient. They should then be graded on their knowledge (50%) and also how they made their assessment/plan as well as its completeness. It is unacceptable that we are expected to do see, work up, and come up with plans as patients as residents when some medical students (at decent schools) have done nothing but watch the process. It's OK if the first few attempts are poor, but they will get better.
     
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    #25 Syncrohnize, Nov 7, 2018
    Last edited: Nov 8, 2018

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