I need advice... and hurry!

[Fif the Great]

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Hurry before this gets moved to the Tomb of the Unknown SDN Threads, AKA the 3rd and 4th Year Rotations forums. I posted this about 7 months ago and only got a few responses... so I was wondering if anyone could enlighten me a little more.

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At the school I attend (WVU) we have the option of choosing another part of the state in which to do our clinical years, as opposed to simply remaining at the campus hospital in Morgantown. The area I would be going roughly sends 10-12 students a year there out of a class size of roughly 100. The following are my opinion of the pros and cons of going there versus staying at the university hospital.

Pros:

1. Faculty to student ratio is pretty high.

2. There are very few residents and 3rd/4th years to compete with for "learning" experiences. Most of the time, it's just you and the attending physician. (NOTE: one of the responses from the previous time I posted this said that not having residents is a BAD thing because they do a lot of the "teaching")

3. A lot of personal space. The university is building a brand new education center (a couple thousand square feet) at the site that will house a 200 seat auditorium and our own personal "office space." My class would be the first third year class to occupy it.

4. Most likely would get a good dean's letter for residency. I actually know the deans at the other division better than I do my deans at the regular campus. Plus, a lot of one on one time with the deans since I wouldn't be competing with roughly 65 other students.

5. One of the hospitals is a VA hospital. This is a good thing, right?

Cons:

1. Not a lot of exposure to specialty medicine. Sure the basics are there, but fuggedabout neurosurgery, any significant ortho, and other specialties. Those types of things are usually transferred to the main university hospital (about a two and a half hour drive).

2. Lots of self motivation/responsibility is required. Now while this may not be viewed as a con, you really can't have days where you just veg out and let the 10 residents and 5 other students take up your slack. You have to be up on your game every day.

3. Only a Level 3 trauma center. Level 1 at the university hospital. The really gory stuff is airlifted to the ED in Morgantown.

4. Peer support. I mean what, only 9 other med students there (19 if you count the 4th years)?

5. Transportation expense and time. The division I'm going to utilizes 3 different hospitals, located about 5-15 miles from one another.

Stuff that may be a pro or con:

1. This is pretty IMPORTANT, if you respond to nothing else, please let me know what you think about this approach to the clinical years.

My division differs in their approach of the 3rd year versus the university hospital based approach. Rather than have rotations broken up into discrete 8 week blocks, they utilize a longitudinal approach. We will spend a day (or two) a week in surgery, a day in OB, a day in family med, etc, over the course of approximately a 24 week period. Any opinions?

2. It's viewed as a "community based approach to learning." Meaning you don't spend a lot of time in a tertiary care setting, rather you'd be with established physicians at their place, so to speak. They trump it up by saying residency programs look highly upon that type of approach since it will "better prepare you for the rigors of residency." I'm not too sure.

3. The "n" factor.

Not enough step 2 scores to draw a legitimate conclusion about this approach. We'll supposedly know more next year after the 3rd years from this year take step 2. A grand total of 2 graduates have come from the division I am going to (they only took 2 the first year they started this), so the "n" is non-existant at this point.

So please, any thoughts anyone may have on this would be greatly appreciated. Mainly I'm worried about my options when trying to get into a specialty residency (not derm or ortho or anything, just not IM or FM). I honestly don't think I'd suffer either way I went, but just wanted some other objective opinions on it. Sorry this post is so long, but if you made it this far, I thank you for the effort. 😀

 

[tigress]

That longitudinal approach sounds like it may make it difficult for you to really learn any field in depth. But you'd have to discuss it with people who have done it to really get a feel for how it works, because it's certainly unusual. To me that would be the biggest caveat about going there. Otherwise it sounds like you're really interested in that location.

(take this with a grain of salt; I am a lowly pre-med; but my husband and bro-in-law are med students so I know what their experiences have been like 🙂 )

 

[Fif the Great]

Hey thanks. And there is no such thing as a "lowly pre-med", we all were there at one time or another. I agree the longitudinal approach is different. It remains to be seen how it turns out. They say one good thing about it is follow up. If a patient has a chronic condition, you are able to actually see how different treatments affect the disease, what complications may come about, etc. over the course of 24 weeks, rather just 8 weeks.

Thanks for the opinion.

 

[Wednesday]

I think it sounds bad. The good thing about having rotations in blocks is that you spend 6 or 8 or 12 weeks as a surgeon (for example). You immerse yourself in surgeon speak. You study surgery. You attend grand rounds. You hang out with surgeons, find out how often they eat, find out how much they sleep, laugh at their surgeon jokes, become a part of their team, etc. You try to teach yourself how a surgeon thinks so that even if you never set foot in another OR after that, you will be able to communicate with the surgeons you come into contact with in the future. It's a chance to try on a specialty and see how it fits. Once you're done with surgery, you get a chance to try on internal medicine for a while. You won't get any of that if you're doing it one day a week.

Additionally you're just going to be a random med student. No one will remember your name, because you're not really on their team, you're just passing through. Being one on one with the attendings could go either way. If all of the attendings like to teach, it would probably be great (many fourth year rotations are just you and the attending). The good thing about residents is that they sometimes can give you tips to shine for the attending. They also do a lot of the teaching in most programs, but perhaps this would be different if there weren't any residents.

Probably the best people to ask about the experience are the fourth years who are at that site now. They will be the most informed about the strengths and weaknesses of the program.

Finally, you said you were interested in specializing (but I'm confused about what sub-specialty). Do you do all your fourth year rotations there too? If you can do fourth year at the university hospital, that might be better. It sounds like this tract is set up for FP almost (especially the every day is different stuff part). Probably doesn't matter as a third year, but it would matter as a fourth year. BTW, most deans letters are fairly standardized. It's recommendation letters that are more personal and from what I've heard, they aren't really weighted heavily in the application since they all say just about the same thing (unless the person writing it is a mover and shaker in the field, but it sounds like that may not be the case with the attendings you would be working with).

Bottom line: if you're already there, ask the fourth years what they wish they'd done differently so you can get the most out of the experience. Otherwise, ask they if they'd do it again. Good luck with third year!

 

[Fif the Great]

Thanks for the response, Wednesday.

I'm actually not over there yet, I'm still in the 2nd year, contemplating my decision. That was an interesting take on the longitudinal approach, and honestly, I haven't been sold on that part of the program since choosing to do my clinical years there. It also seems kinda bad to have to take 4 shelf exams in December as opposed to taking one after each 8 week block.

As far as the fourth year rotations go, you are basically free to go wherever you want. You can return to the main campus, go to an additional state campus, or go elsewhere in the US, depending on what specialty you are interested in. From what I hear, you don't do much of the fourth year on site at the satellite campus I am going to. Also, my interests as of right now are EM and Anesthesia. Of course those are subject to change.

Thanks again for the advice!

 

[Fif the Great]

Bump

 

[RustNeverSleeps]

A little bit of feedback about your query (numbers don't correspond to your numbers because I am sick and too lazy at the moment!)...

1. Working with attendings only is not all it's cracked up to be. I had one rotation at a psychiatric hospital in which we worked only with attendings, and it was one of my poorest learning experiences. Obviously you can't generalize from this one experience, but don't assume that higher status equals better. I often enjoyed working with residents -- most/many want to teach you, and because I am closer in age to residents than attendings, it is more natural to have a camraderie.

2. I may have missed this, but what are you interested in for a career? If you want to pursue general IM, general surgery, or FP, maybe going to the away hospital won't be so bad. On the other hand, at a major academic medical center, you are exposed to things (both cases and specialities) that you may never see again. This makes for excellent learning opportunities, but may also lead you to consider new specialties career-wise.

3. To me, the longitudinal schedule sounds absolutely terrible. As someone above mentioned, having a solid block of weeks in a rotation really immerses you in that specialty, allowing you to pick up the culture and to provide continuity of care for patients. In addition, such a schedule would really cause problems with your sleep, as the major rotations all have different hours. If it were me, I would avoid this away thing just because of the schedule.

 

[Sureshot83]

Just throwing in my two cents -

If you are seriously interested in EM, shouldn't you stay in the city with the level 1 trauma center rather than the level 3?

Also, my interests as of right now are EM and Anesthesia. Of course those are subject to change.

 

[Fif the Great]

Just throwing in my two cents -

If you are seriously interested in EM, shouldn't you stay in the city with the level 1 trauma center rather than the level 3?

I suppose, but again, it's only for the 3rd year of med school. 4th year is virtually wherever you want it to be (none of the 4th year rotations are required to be at the away hospital), including the option of returning to the main campus.

I just recently had a meeting with the deans over there and they added some things I thought may be good. All of the teaching physicians are screened by a committee for competency in their ability to teach, not just babysit. They also said that the longitudinal approach allows you one half-day a week to gain experience anywhere you'd like. i.e. if you're interested in Anesthesia, you can go spend that one-half day in that department, etc. Another thing is that a current third year already has over 80 first assists in surgery (not sure what kind exactly), so first hand exposure is readily available.

Also, has anyone out there ever done this longitudinal approach before? I could ask current third years but I'm too lazy to find out who they are and would rather just ask here. 😉

Thanks again for all the feedback, although none of it in my favor... 😀

 

[Samoa]

The argument that the longitudinal approach better prepares you for residency is complete cr@p. Residencies are structured in blocks, exactly like the 3rd & 4th year curriculum at most schools. The only difference is that all the blocks are somehow tied to whatever field you've chosen. Yes, you have clinic days, but that's maybe once or twice a week, superimposed on whatever block you happen to be doing that month (cards, EM, acute care, ICU, whatever).

Also, I'll pass along some advice I was given about the issue of hands-on rotations vs. tertiary care settings: You will learn how to do the work in your specialty when you do residency. So you want the best residency you can get, so you can get the best training possible. 3rd year is for making the connections that will help you get a good residency, for being immersed in different fields sequentially so that you can understand the life you'd lead in that specialty, for exposure to the breadth and depth of medical specialties available to you, and for acquiring fundamental skills needed in the majority of specialties. It is not for learning how to operate.

It sounds to me like that longitudinal setup cheats you out of nearly all of those things. So unless you want to go into family medicine, or practice IM in a rural and underserved area, it sounds like a bad choice.

 

[RustNeverSleeps]

I suppose, but again, it's only for the 3rd year of med school. 4th year is virtually wherever you want it to be (none of the 4th year rotations are required to be at the away hospital), including the option of returning to the main campus.

I just recently had a meeting with the deans over there and they added some things I thought may be good. All of the teaching physicians are screened by a committee for competency in their ability to teach, not just babysit. They also said that the longitudinal approach allows you one half-day a week to gain experience anywhere you'd like. i.e. if you're interested in Anesthesia, you can go spend that one-half day in that department, etc. Another thing is that a current third year already has over 80 first assists in surgery (not sure what kind exactly), so first hand exposure is readily available.

Also, has anyone out there ever done this longitudinal approach before? I could ask current third years but I'm too lazy to find out who they are and would rather just ask here. 😉

Thanks again for all the feedback, although none of it in my favor... 😀

It sounds like you have an idea of what you want to do and are looking for people to agree with your choice. 😛 I think that nobody has said it is a good idea is notable. Not to pile on, but in response to your post:

1. Assisting in a lot of surgeries is not necessarily impressive. What if they were 80 appendectomies? There is not that much learning in that. What is important to consider is it not just the quantity of opportunities, but the quality. At an academic medical center, you will get to see so much more in terms of surgery (and everything) than at this remote site. As someone who has not yet done his clinical year, you might not appreciate this, but trust me, it's important. As an example, I am not going into surgery, but I will always remember the time I got to assist on a heart surgery on a little baby. Things like this and other highly specialized procedures you will not get to see at smaller med centers.

2. I still think that you might be over-emphasizing the importance of working with attendings only. I did this as well before I started my clinical year. In a normal academic setting, you get to work with both attendings and residents, which many people enjoy.

3. You mentioned that the deans had good things to say about the alternate program -- isn't in their best interest to say such things? They have a secondary option that is far less appealing to most people (as you can see from the response to your question). It is probably in their interests to talk up the program so they can interest students in signing up for it.

 

[Fif the Great]

It sounds like you have an idea of what you want to do and are looking for people to agree with your choice. 😛 I think that nobody has said it is a good idea is notable.

OK, ok, I admit it, I am fishing for those "I think it was a good choice!!" responses, but apparently they aren't coming. 🙄

It has been a predicament, you guys have definitely provided a lot of good (and strong) opinions on this subject. I want as many options open to me when it comes time to apply to residencies... and apparently many of you think I would be selling myself short by going to the alternate site. As of right now, the decision is out of my hands... I have to find someone to switch with to attend the main campus. I don't know if that is going to happen. I may just have to write a strongly worded letter to the dean and demand to be placed in the main campus program...