DOnut

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Hey everyone,

I need your opinion on this.

During our 3rd year, we have the option of rotating through several of our affiliated hopsitals to complete the core rotations, or we can choose one large level 1 trauma center to complete all of our rotations for the year.

Do you think there is an advantage to rotating through several hospitals for 3rd year rotations, or would it be more advantageous to do all of my rotations at one large hospital?

I welcome all opinions!
 

edmadison

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Tough question. The real advantage of outside hospitals is that often you won't have to compete with tons of fellows, residents and fellows for the teaching and procedures. My friends who did surgery at a small community hospital had a much better experience than I. Of course the large center has a greater variety of cases. Being at the big center with the course director and his/her buddies can be good for hauling in the high grades too.

Ed
 

lowbudget

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I don't think it really matters long run but we have a similar arrangement here at UTMB-Galveston to do 3rd year rotations either in an academic hospital or in community hospitals in Austin. Here's my take:

1) Organization - the clerkship programs at the academic center is much more organized. Faculty and residents are part of the academic culture and therefore roles are defined. There are lectures tailored specifically for students in the academic center, where as the community hospital may use lectures tailored for residents and force you to go to all of them. Some community hospitals don't know what a student is capable of doing, and sometimes, you're relagated to just shadowing a doc for a long period of time. So you end up being lost. Advantage: Academic

2) Faculty exposure - this is a toss up. At the academic center, you've got faculty who theoretically can write you a rec and hook you up if you so desire, if you get to see them. You're usually part of a big resident team with a bunch of med students. At community centers, it's typically a couple of residents per team and you. Round/ward education may be better at the academic center because you see faculty, but you get more face time in community centers because you usually work one-on-one with faculty. Advantage: Tie.

3) Procedures - I agree with the above, that you don't have to compete with people to get procedures in community centers, but that you also get a variety of cases at the academic center. But one thing to consider also is that most community centers (unless it's county) have private patients, so sometimes even if you want to do procedures, you won't get a chance to because the doc will want to do it. Whereas in big academic centers, it's pretty well established that it's a teaching center and faculty lets residents run the show, and if you're an interested student, you can get in on certain procedures. Advantage: Tie.

4) Pain in the @ss - Bouncing from hospital to hospital is fun because it gives you a chance to see various settings and how different locales and institutions do things. However, you are frequently living out of a suitcase, not sleeping in your bed, driving here and there to take exams, and constantly have to make arrangements and fill out paper work just to get the proverbial "process" moving. Advantage: Academic

5) Ghetto fat b.itches - Staff around the academic centers are used to having students around and they piss on them because they can. Galveston staff are a bunch of uneducated ghetto fat b.itches who are rude and move extremely slow. They do work with their fat mouth and jabber all day with no production. It's like a McDonald's from 5th Circle of Hell. If this were a wilderness, their fat slow @sses would have been prime targets for lions, tigers, and bears long time ago. In Austin, totally different story. Community hospitals consider it a privilege to have med students visit and staff treat med students like doctors and therefore will help you out as much as they can. In Austin and in many community hospitals, students eat in the doctors lounge every day... which means free lunch. E.v.e.r.y.d.a.y. Advantage: Community

6) Party time - If your med school is southeast Buttf.uck, Texas, being able to bounce to a hospital where there's life may be good for you. In our program, Austin is a rocking town and the academic expectations are less (except for OB) so you get plenty of time to go out and play. Advantage: Community

7) Where're my boys at - when you bounce hospitals, you end up doing it by yourself. Yea, I'm sure there're people from your class who're going to be where you're at too, but it may just be 1-2-3 of them. You miss out on the big community of friends you have back in med school. Best thing to do is arrange to be in the same community hospital with your friends at a given time. But then if you go to school with a bunch of chumps, then it may be worth it to leave all of them. Advantage: Academic, unless you've got chumps.

I'm doing 2 rotations in the community hospital and the rest at the academic center and that's enough. 3rd year flies by fast so whatever advantage/disadvantage you experience is temporary at best.
 
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Seaglass

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I did half my 3rd year rotations at our academic hospital and half at an affiliated community hospital. I would say which is best is VERY ROTATION DEPENDANT!

Here's my take broken down by rotation:

Int. Med: Academic has better/more interesting patients and better teaching. Procedures are relatively scarce no matter where you go. I went with academic here and word on the street was that it was a good choice. Word: Academic

Surgery: Do you want to be a surgeon? If so then definitely academic. Actually, academic anyway because surgeons tend to be busy people and a significant # of your cases will be with private attendings who don't want you touching their patients (generally speaking of course). If you're motivated you can get your hands in some people even at your Level 1 center where the interns are stabbing each other in the back to get to the OR. Word: Academic

OB: OB care is usually regionalized now with a major OB center for every large metropolitan area now. What that means for you- Community place is likely to have as many/more and as complicated cases as your Academic center. The advantage is that there are usually fewer students and residents so that means more deliveries for you. You need to find out what the word on the street is as far as your particular options but all things being equal I'd go with the community program. Word: Community

Peds: Not usually as much volume in pt. at community but our community option had 3x as much out pt. where you see the nuts and bolts, and we had WAY MORE responsibility on the floors. I still saw Kawasaki's and the attending teaching was much more available than what my colleagues said we had at home. Word: Community

Psych: I did my psych at an In pt. sans residents. I was the resident. If you want that then great, if not then go academic. For example I had to wire the pts. for Electro-shock 3x a week early in the morning etc.

Fam Med: It's going to be the same both places. At a community program they may be more interested in you and therefore give you more interesting things to do. I did mine at a community based Res. prog. and got to cut things off people, do cryo, etc.

ICU: Not required but a popular option. More consistent experience/opportunities at academic but may hit gold at a community program. All things being equal academic pts. will be sicker and more complicated.

Gas: Since I don't want to do Gas but EM and wanted to tube a lot of people including peds I did community where I could float from room to room and tube people all day long. At home we have a "stay in the room" rule so I got way more tubes this way.

Of course if you're thinking of making it your specialty then Academic is always the way to go - those are the letters that open doors.

Hope this helps.

Casey
 

DOnut

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Originally posted by lowbudget
5) Ghetto fat b.itches

Lol :laugh: :laugh:

Thanks for the replys everyone. I would rather not bounce around from hospital to hospital. I love my apartment, and it would really take a clear advantage to make me move from this place. So I guess I'm leaning towards one spot all year.

Thanks again! Any other opinions are welcome.
 

j_sde

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just to add... agree with lovebudget, .. but

1.) family med... try to do academic. i found most of my classmates who did it at community ended up not knowing much of the evidence based medicine that is important. dont wanna diss on community fp, but alot of them just give everyone bactrim, get bunch of orders, etc... not evidence based. do it at a academic and hopefully you'll see your attending teachin/using a more ebm appraoch.


2.) peds.... academic is my preference for that too. esp if you have good teaching attendings. otherwise, community is fine since you aint gonna manage mos of the acute /zebra peds cases in acadmeic anyways, your just gonna gte a glimpse of it if your lucky.
 

doc05

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In my experience, the community hospitals are staffed by nicer, more attractive nurses.
 
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