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How to tell strength of clinical years?

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

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  1. snowflakes

    snowflakes 2+ Year Member

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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?
     
    crossled likes this.
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  3. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 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?)
     
  4. Endure

    Endure 2+ Year Member

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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.
     
    emilym likes this.
  5. RogueUnicorn

    RogueUnicorn rawr. 7+ Year Member

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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.
     
    Cyberdyne 101 likes this.
  6. Cyberdyne 101

    Cyberdyne 101 It's a dry heat Gold Donor 2+ Year Member

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    Bumping for visibility.
     
  7. bluetovah

    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?
     
  8. LoveIR

    LoveIR 2+ Year Member

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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.
     
  9. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    I don't think there is a single perfect solution.

    I do think that schools try to spin it as a positive in cases where it's really a huge PITA and indicative of lacking options at the home site.

    I also think that the more satellite locations you offer, the harder it is to quality control the rotation.

    The obvious benefit to rotating elsewhere is seeing a different system (I did an away rotation in a very different hospital in a very different part of the country as an M4 for precisely this reason). The downsides are more variable quality and logistical difficulties.
     
  10. NickNaylor

    NickNaylor Thank You for Smoking Lifetime Donor 7+ Year Member

    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.
     
    Last edited: Apr 11, 2015
  11. Psai

    Psai Account on Hold Account on Hold 2+ Year Member

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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
     
  12. alpinism

    alpinism Give Em' the Jet Fuel 5+ Year Member

    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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  13. bluejay456

    bluejay456 2+ Year Member

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    Are there certain schools that are notoriously good or notoriously unpleasant for their clinical years?
     
    Ryuichi and singergirl18 like this.
  14. Cyberdyne 101

    Cyberdyne 101 It's a dry heat Gold Donor 2+ Year Member

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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.
     
  15. RogueUnicorn

    RogueUnicorn rawr. 7+ Year Member

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    i didn't realize in the interim southernIM became southernsurgeon
     
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  16. Cyberdyne 101

    Cyberdyne 101 It's a dry heat Gold Donor 2+ Year Member

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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.
     
  17. Wolf3D

    Wolf3D

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    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
     
  18. Cyberdyne 101

    Cyberdyne 101 It's a dry heat Gold Donor 2+ Year Member

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

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Significant disadvantage
     
  21. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Yeah huh! And it was a 275, duh.
     
  22. Wolf3D

    Wolf3D

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    Pics or it didnt' happen
     
    The Knife & Gun Club likes this.
  23. whatever5

    whatever5 2+ Year Member

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