How would you change the med school curriculum so that it actually makes sense?

[W19]

The VA in my username is for Virginia - was in undergrad there when I joined SDN.

I graduated med school in 2010, so not all that long ago. If what you say is true - no notes, no orders, essentially shadowing then that is very concerning.

I was able to write note in only 3 rotations (inpatient IM, Peds and FM)... For surgery, we wrote the notes and showed it to the attending and he corrected them... 6 wks ObGyn, 2wks Neuro, 6 wks psych were all shadowing... Things have changed since you left because of new medicare/insurance rules (according to my school).

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[Jabbed]

The VA in my username is for Virginia - was in undergrad there when I joined SDN.

I graduated med school in 2010, so not all that long ago. If what you say is true - no notes, no orders, essentially shadowing then that is very concerning.

Please see comments above before reiterating how "not broken" the current system is.

 

[VA Hopeful Dr]

Please see comments above before reiterating how "not broken" the current system is.

See that's insane.

I have students in my clinic. They see every patient alone, check out to me, we go in together, then they write a note that goes into the chart. I write an addendum. Heck I let one do a knee injection and another did two shave biopsies. I didn't realize I was that special.

This isn't an insurance/CMS thing, I know that. It might be a liability insurance thing but I doubt even that.

 

[Jabbed]

See that's insane.

I have students in my clinic. They see every patient alone, check out to me, we go in together, then they write a note that goes into the chart. I write an addendum.

This isn't an insurance/CMS thing, I know that. It might be a liability insurance thing but I doubt even that.

"Student notes aren't billable"-- no idea if that's true or not, but it's what I hear. Maybe it would be a bigger issue, but (as I've been told more than once) "you are only going to be on service for 4 weeks anyway, and your EMR access doesn't even start until next week so don't worry about it".

And, very honestly, I applaud you for being an awesome preceptor. But please stop encouraging people to drink the Kool-Aid.

 

[VA Hopeful Dr]

"Student notes aren't billable"-- no idea if that's true or not, but it's what I hear. Maybe it would be a bigger issue, but (as I've been told more than once) "you are only going to be on service for 4 weeks anyway, and your EMR access doesn't even start until next week so don't worry about it".

And, very honestly, I applaud you for being an awesome preceptor. But please stop telling encouraging people to drink Goro's Kool-Aid.

Student notes aren't billable, that's true. But it doesn't hurt anything to let y'all write them and then have a resident/attending go back and write a billable one. That's what we did when I was in school.

 

[W19]

Student notes aren't billable, that's true. But it doesn't hurt anything to let y'all write them and then have a resident/attending go back and write a billable one. That's what we did when I was in school.

Now it's more like you are in the way of residents/attending doing their job...

 

[VA Hopeful Dr]

Now it's more like you are in the way of residents/attending doing their job...

Well and in truth, you are. But that's the nature of the beast - and academic attendings and residents at programs with students should be aware of that.

 

[W19]

Well and in truth, you are. But that's the nature of the beast - and academic attendings and residents at programs with students should be aware of that.

Can you answer that since you are a FM doc? Why do we need a FM rotation when ~90% of it is IM all over again, ~9% is peds and the other ~1% GYN?

 

[VA Hopeful Dr]

Can you answer that since you are a FM doc? Why do we need a FM rotation when ~90% of it is IM all over again, ~9% is peds and the other ~1% GYN?

Because, at least at my school, it the only time we got any outpatient adult medicine. IM was entirely inpatient. Plus, most of the FM inpatients were clinic continuity patients while IM was almost entirely unassigned patients.

 

[W19]

Because, at least at my school, it the only time we got any outpatient adult medicine. IM was entirely inpatient. Plus, most of the FM inpatients were clinic continuity patients while IM was almost entirely unassigned patients.

Oh Ok... IM is different here... 6wks inpatient and 4 wks outpatient. FM is 3/3 in/outpatient...

 

[Stagg737]

I was able to write note in only 3 rotations (inpatient IM, Peds and FM)... For surgery, we wrote the notes and showed it to the attending and he corrected them... 6 wks ObGyn, 2wks Neuro, 6 wks psych were all shadowing... Things have changed since you left because of new medicare/insurance rules (according to my school).

Shadowing psych sounds absolutely miserable. If that had been my rotation, I'd probably have hated it and not chosen to attempt pursuing psych. Fortunately we were treated like interns on my core rotation and were expected to interview all new patients, chart, pre-round on all our old patients, write progress notes, and on the second half of the rotation make diagnoses and treatment plans (obviously then to be reviewed by the attending). At least with neuro and OB/Gyn you'd get to see some procedures and visualize some of the thought process. Trying to learn the thought process of psych by just watching/listening to an interview seems like an awful rotation.

See that's insane.

I have students in my clinic. They see every patient alone, check out to me, we go in together, then they write a note that goes into the chart. I write an addendum. Heck I let one do a knee injection and another did two shave biopsies. I didn't realize I was that special.

This isn't an insurance/CMS thing, I know that. It might be a liability insurance thing but I doubt even that.

It varied for me as well. My psych and FM rotations I was basically treated like an intern (even though FM was at an outpatient clinic). For surgery I got to first assist almost daily, sometimes multiple times per day, and was expected to round, take call, and call the attending when something didn't seem right. Peds and IM I'd go in and see the patient first, get the history and perform a physical, then go back in with the attending. Didn't round on peds (outpatient again) and rounding on IM was minimal because I was the only student on that rotation (was my rural rotation). OB/Gyn we got to first assist on a few surgeries, but beyond that it was mostly shadowing because the hospital the rotation was at didn't allow students to access patient information.

I'm at a DO school, so our rotations could vary a lot, but at my school how much students got to do on rotations was completely based on the policy of whatever hospital they were rotating at, or if it was at a private clinic the attending's discretion. I can't speak to what other schools do, but after hearing about rotations from friends at other schools as well as on here it seems like I got to do a lot more than many of my peers.

 

[WingedOx]

I was able to write note in only 3 rotations (inpatient IM, Peds and FM)... For surgery, we wrote the notes and showed it to the attending and he corrected them... 6 wks ObGyn, 2wks Neuro, 6 wks psych were all shadowing... Things have changed since you left because of new medicare/insurance rules (according to my school).

This isn't even close to being true, and any issues with this are due to problems with individual preceptors, and not "the system".

 

[W19]

This isn't even close to being true, and any issues with this are due to problems with individual preceptors, and not "the system".

Well, they lied to us...