Intern Year

[Bartelby]

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This is a wonderful thread! So full of denial and resentment, of the best sort. Reminds me what drew me to psychiatry in the first place - humans beings in all their irrationality. Now I would like to dispel a few myths.
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4) It is important to recognize medical causes of psychiatric illnesses, and recognize when a patient has a medical or neurological problem.
- For academic purposes, sure, but in real life, false. Even when a unicorn of a diagnosis comes along, like NMDA receptor encephalitis, how many neuro consult teams do you know of who will actually ACCEPT the patient on their service? If they're like the ones I'm familiar with, a psych patient is a psych patient and psych will keep the patient. I have seen acute strokes be "managed" on the psych floor with at most phone consultation from neuro. Same for chest pain. The end treatment is always exactly the same! Haldol or Zyprexa or you name it! Time and again I have seen psychiatrist deal with "medical problems" by doing what they do best, which is ordering psych meds. Raise your hand if you are a fan of benzos or clonidine for hypertension! That's only the beginning.

What? You basically start that paragraph by saying it is "false" that understanding general medicine matters in psychiatry and finish it by stating that where you practice people treat strokes and chest pain with haldol. Do you see how that does not add up? By the way, please report the attendings who are treating acute strokes with haldol, and if a neurology consultant refuses to transfer an acute stroke escalate that to your department chair or higher as your license and the patient's health are both on the line. I think what you just wrote is one of the worst things I have read on this forum.

 

[nancysinatra]

All other imgs(including euro type imgs) I would take a DO above in terms of working with

Even an Oxford or Karolinska grad? That's weird. Some of the best physicians and scientists in the world come from and/or live in Europe.

 

[nancysinatra]

What? You basically start that paragraph by saying it is "false" that understanding general medicine matters in psychiatry and finish it by stating that where you practice people treat strokes and chest pain with haldol. Do you see how that does not add up? By the way, please report the attendings who are treating acute strokes with haldol, and if a neurology consultant refuses to transfer an acute stroke escalate that to your department chair or higher as your license and the patient's health are both on the line. I think what you just wrote is one of the worst things I have read on this forum.

Yes I do realize what I said. I stand by it in principle because I did not feel like making the post even longer and filled with technical details. I was lumping several experiences into one comment and realize it could come across different from what I intended to say. However, with the acute stroke, I made numerous, and I mean numerous, phone calls, some of which involved shouting over the phone, until the patient got transferred to neuro, whose chief was very resentful because he couldn't possibly understand why the stroke patient couldn't get neuro checks and oxygen on our psych floor. By the time he got transferred, if I recall, the patient was probably out of the TPA window. This is the fault, if you ask me, of the neuro service not being very responsive to our calls. No we did not treat the strokes with Haldol. We continued to treat the psychosis with Haldol. My point is that from the patient's point of view, he's getting Haldol instead of a CT, CTA, a full neuro workup, etc. (He did get a CT, but not as quick as if he'd been in the ER. I suppose once on neuro he got the CTA, etc.) But if the same patient had been on a neuro floor, the whole approach would have been different. That was my point. The approach in psychiatry is to address the psychiatric problem and get another service to deal with the medical or neuro issue. When you are a resident and you call your psychiatry attending and describe a neurological or medical problem, in my experience they do not sit and discuss the problem in detail with a competent level of medical knowledge. They do not pull out an MS4 level of medical knowledge. In my experience they usually just said "call neuro" or "call medicine," as if those teams were really going to run and help us.

I did have one attending who was good with chest pain and knew how to read and EKG. I really liked that attending. You could discuss medicine with her. To be clear I am not saying that no psychiatrists know their medicine - I am saying that it is possible to do the vast majority of what is done in psychiatry without very up to date or strong medical knowledge.

I know of psychiatrists who claim to know ZERO medicine these days. Like, zero. They are not being hauled out and fired.

 

[nancysinatra]

Another time, I had a patient in status epileptics on the psych floor. This patient did not get IV ativan much less IV dilantin because we did not have it. We gave them IM ativan and then debated about how we would stabilize the patient for transfer to a medical floor. This discussion did not occur between myself and some psychiatry attending who had "kept up" with their neurology. It occurred between me and the neuro resident who responded to our page. I was quite thrilled to be able to use my medical knowledge to utilize the IM ativan, but the situation would have unfolded almost exactly the same without my being there. And the neuro resident seemed remarkably uninterested in my "ability to generate a differential diagnosis."

My whole point is that the people above who are saying this guy should not go into psych if he doesn't care about medicine - well, let's be honest, there are many people in our field who don't know much medicine. It's not the ideal situation, but it's acceptable to many. People are romanticizing what we do if they claim that medical diagnostic skills are "crucial" or if they make it sound like it's "scary" to contemplate a psychiatrist who can't recognize a heart murmur or workup a PE.

Meanwhile a surgeon, or an ophthalmologist, or many other specialists can be very good at their job and very successful and not know a shred of psychiatry and have the worst ability to empathize. It's probably not ideal but in the real world it's true.

 

[vistaril]

Even an Oxford or Karolinska grad? That's weird. Some of the best physicians and scientists in the world come from and/or live in Europe.

yeah but I'm never going to work with those. Far more likely to encounter American IMGS who went overseas...and not to Oxford.

 

[SteinUmStein]

No, his diagnostic skills were pretty poor, the patient almost certainly had bipolar disorder based on other provider reports and the family's report of some clear-cut past manic episodes. She was being treated with SSRIs and "psychotherapy" only (I don't know what kind of therapy and I don't think the provider knew either). Incompetence kills, regardless of the specialty. Not sure a contest between who can do the most harm to patients in a day is productive, and I'm sure EM can win that battle with one hand tied behind its back.

 

[nancysinatra]

No, his diagnostic skills were pretty poor, the patient almost certainly had bipolar disorder based on other provider reports and the family's report of some clear-cut past manic episodes. She was being treated with SSRIs and "psychotherapy" only (I don't know what kind of therapy and I don't think the provider knew either). Incompetence kills, regardless of the specialty. Not sure a contest between who can do the most harm to patients in a day is productive, and I'm sure EM can win that battle with one hand tied behind its back.

Ok well you didn't mention that there was a diagnostic error in your earlier post. You said it was the unempathic comment that was the mistake. So which one do you think it was? Was the patient in the ICU because they had been prescribed the wrong medications, or were they in the ICU because the psychiatrist was unempathic? The latter is clearly incompetent; but if it's the former, then I would argue that a lot of psychiatrists have probably made that mistake, and this guy may not be incompetent but may simply have been faced with the reality that it can be hard to tell bipolar and depression apart, especially if a patient is new, and/or won't consent to allow family to be called. Perhaps he considered bipolar, but mistekenly ruled it out. In that case he still generated a proper differential. You haven't told the whole story, but rather used bits of it to somehow challenge my claim that a person who cannot competently generate a medical differential diagnosis is not a person who should be encouraged to become a pathologist.

I was being a bit sarcastic when I invited the OP to join us in psychiatry rather than go into path. Sarcasm is occasionally used by people to make a point. It is not intended to be entirely serious. In fact the OP won't pass Step 2 if they're as bad off as they claim, so this whole discussion is moot. I was simply trying to draw attention to what I think is a basic reality - I do not think the meager amount of "differential diagnosing" that we do in psychiatry is exactly rocket science. First of all we have a very small number of conditions we see on a regular basis. Second, mistakes like the one you mentioned are so common we have probably all made them. Almost nothing actually relies upon our being extremely accurate most or all of the time.

The fact is, a lot of people in medicine, if they heard the OPs story, would say "go into psych." I'm not saying I agree, just that it's reality.

I don't know why you had to take a swipe at EM. They weren't part of this discussion. I'm not trying to start a contest to see who can do the most harm to patients. I was replying to quotes above that make psychiatry out to sound like the single most intellectually demanding field in the entire world, and imply that we make acute life and death medical decisions on a daily basis. If that's the case, why don't we have higher malpractice rates?

 

[SMC123]

I will pass step 2 thank you for words of encouragement lol

 

[nancysinatra]

I will pass step 2 thank you for words of encouragement lol

I think you were pulling everyone's leg anyway; that or you're just underconfident. I do hope you pass Step 2!

 

[shan564]

Yes I do realize what I said. I stand by it in principle because I did not feel like making the post even longer and filled with technical details. I was lumping several experiences into one comment and realize it could come across different from what I intended to say. However, with the acute stroke, I made numerous, and I mean numerous, phone calls, some of which involved shouting over the phone, until the patient got transferred to neuro, whose chief was very resentful because he couldn't possibly understand why the stroke patient couldn't get neuro checks and oxygen on our psych floor. By the time he got transferred, if I recall, the patient was probably out of the TPA window. This is the fault, if you ask me, of the neuro service not being very responsive to our calls. No we did not treat the strokes with Haldol. We continued to treat the psychosis with Haldol. My point is that from the patient's point of view, he's getting Haldol instead of a CT, CTA, a full neuro workup, etc. (He did get a CT, but not as quick as if he'd been in the ER. I suppose once on neuro he got the CTA, etc.) But if the same patient had been on a neuro floor, the whole approach would have been different. That was my point. The approach in psychiatry is to address the psychiatric problem and get another service to deal with the medical or neuro issue. When you are a resident and you call your psychiatry attending and describe a neurological or medical problem, in my experience they do not sit and discuss the problem in detail with a competent level of medical knowledge. They do not pull out an MS4 level of medical knowledge. In my experience they usually just said "call neuro" or "call medicine," as if those teams were really going to run and help us.

I did have one attending who was good with chest pain and knew how to read and EKG. I really liked that attending. You could discuss medicine with her. To be clear I am not saying that no psychiatrists know their medicine - I am saying that it is possible to do the vast majority of what is done in psychiatry without very up to date or strong medical knowledge.

I know of psychiatrists who claim to know ZERO medicine these days. Like, zero. They are not being hauled out and fired.

I think you've done a great job of summarizing why psychiatrists SHOULD know more neuro and medicine. The neuro/medicine consult teams are fed up with us because we constantly call them for minor issues, and when we actually call with a major issue, we end up with a boy-who-cried-wolf situation. If we were comfortable with basic medical management, we'd not only reduce the number of minor issues (thereby reducing the number of "cry wolf" situations), but would also know how to better understand and explain why the patient needs urgent attention from medicine/neuro. I can say with 100% certainty that I was better at this after doing some of my medicine months than I was before.

 

[Doctor Bagel]

Ok well you didn't mention that there was a diagnostic error in your earlier post. You said it was the unempathic comment that was the mistake. So which one do you think it was? Was the patient in the ICU because they had been prescribed the wrong medications, or were they in the ICU because the psychiatrist was unempathic? The latter is clearly incompetent; but if it's the former, then I would argue that a lot of psychiatrists have probably made that mistake, and this guy may not be incompetent but may simply have been faced with the reality that it can be hard to tell bipolar and depression apart, especially if a patient is new, and/or won't consent to allow family to be called. Perhaps he considered bipolar, but mistekenly ruled it out. In that case he still generated a proper differential. You haven't told the whole story, but rather used bits of it to somehow challenge my claim that a person who cannot competently generate a medical differential diagnosis is not a person who should be encouraged to become a pathologist.
QUOTE]

Or the patient has borderline personality disorder. I've come across lots of patients where people are convinced they have Bipolar Disorder, and they really truly don't. I agree that I wouldn't be so quick to label a psychiatrist is incompetent in this case without knowing more information.

I think I'm somewhere in between your argument and the other defenders of psychiatrists' knowledge of medicine and neurology. I've come to the opinion that our primary role is to know when to consult -- even with a great medicine experience as an intern, you're never going to be as up to date as someone who is actively practicing internal medicine or neurology every day.

 

[SteinUmStein]

I guess I'm still not seeing where this leads. Should psychiatrists be required to do more medicine/neuro rotations in residency, or less? Are we saying that many psychiatrists are hopeless at medicine and neuro, or that they just need more experience and training? And I'm not sure what the goal is behind wanting less competent students/residents in psychiatry, what will that gain us as a field? How will that help us help our patients?

 

[nancysinatra]

I think you've done a great job of summarizing why psychiatrists SHOULD know more neuro and medicine. The neuro/medicine consult teams are fed up with us because we constantly call them for minor issues, and when we actually call with a major issue, we end up with a boy-who-cried-wolf situation. If we were comfortable with basic medical management, we'd not only reduce the number of minor issues (thereby reducing the number of "cry wolf" situations), but would also know how to better understand and explain why the patient needs urgent attention from medicine/neuro. I can say with 100% certainty that I was better at this after doing some of my medicine months than I was before.

I absolutely totally agree with this. I have no idea why psychiatry is one of the few (only?) clinical fields where we don't do a full intern year at a minimum. My job would be so much more interesting if it involved medicine and neurology along with psychiatry. I must have spent two freaking years of residency doing inpatient psychiatry - way more than necessary, especially in this day and age where very little is actually done on inpatient other than a quick bandaid, turnaround and discharge ASAP approach. There's no lack of time to train us in medicine.

I consistently hear from patients and family members that they feel the whole medical system is way too divided up in terms of specialists who do only their one thing and are out of touch with the other areas of medicine. Totally true in my experience.

 

[nancysinatra]

I guess I'm still not seeing where this leads. Should psychiatrists be required to do more medicine/neuro rotations in residency, or less? Are we saying that many psychiatrists are hopeless at medicine and neuro, or that they just need more experience and training? And I'm not sure what the goal is behind wanting less competent students/residents in psychiatry, what will that gain us as a field? How will that help us help our patients?

I don't want less competent residents to join our field. I'm sure no one does! I was just using sarcasm to make a point, which is that standards in the real world are often not as high as the lofty statements made in this forum might lead unsuspecting med students to believe.

There are definitely many experienced psychiatrists who are hopeless at medicine and neuro, due to having forgotten it. I really doubt the APA or the ACGME or the ABPN are going to stand up in favor of changing this, because the people who probably know the least medicine (due to having forgotten it) are the ones running our field. Ask the next APA president how to work up a PE or give a differential for myasthenia gravis, and see what they say.

If I understand correctly, the last time psychiatrists are examined on neurology is in the initial ABPN exam. The recertification exams don't include neuro is my understanding. After Step 3 we are never examined in medicine. 20 or 30 years in, I'm sure people forget a lot.

 

[SteinUmStein]

I see, I misunderstood your earlier post. I wonder what would be an effective way to not only refresh basic, important medical and neuro principles but also encourage practicing psychiatrists to stay up to date on relevant new happenings in peripheral (i.e. not just psychiatry) but still important clinical fields. Simply requiring more board exams won't do it, and CME can be hit or miss... I don't know, any ideas? I feel like CME is good in theory but in practice can fall quite short of its stated goals, at least from what I've seen online and from discussions between attendings and residents.

 

[vistaril]

I think you've done a great job of summarizing why psychiatrists SHOULD know more neuro and medicine. The neuro/medicine consult teams are fed up with us because we constantly call them for minor issues, and when we actually call with a major issue, we end up with a boy-who-cried-wolf situation. .

this is you looking at it as a pgy-1 whose only real experience is of several months of inpatient psychiatry at this point.....and that's not a kock-by the time you finish training you will see this totally differently. Neurologists love to do consults. It's business. Same with internists. Being stingy and not consulting, otoh, will piss people off....

 

[nancysinatra]

this is you looking at it as a pgy-1 whose only real experience is of several months of inpatient psychiatry at this point.....and that's not a kock-by the time you finish training you will see this totally differently. Neurologists love to do consults. It's business. Same with internists. Being stingy and not consulting, otoh, will piss people off....

This is very true in the real world outside of academia. Consultants are happy for the work. I find it's a much more pleasant experience working with people who don't resent every consult request. On the other hand, it's one reason psychiatrists end up only knowing psychiatry.

 

[Euthymia]

How big of a deal is it going into a psychiatry residency without having had a real psychiatry rotation in med school? I assume being a month behind probably won't make a huge difference in the long run.

 

[hamstergang]

without having had a real psychiatry rotation in med school

What does this mean, and how would you know that you want to do psych, then?

 

[shan564]

How big of a deal is it going into a psychiatry residency without having had a real psychiatry rotation in med school? I assume being a month behind probably won't make a huge difference in the long run.

You'll be able to make up any deficiencies pretty quickly, but how can you choose a specialty without having done a real rotation in it?

 

[Euthymia]

You'll be able to make up any deficiencies pretty quickly, but how can you choose a specialty without having done a real rotation in it?

I had to pick something. It would have been the same situation regardless of specialty.

 

[notdeadyet]

I had to pick something. It would have been the same situation regardless of specialty.

Ouch...

 

[Elisabeth Kate]

I had to pick something. It would have been the same situation regardless of specialty.

This is scary. Your school owes you a refund.

 

[trustmeimlying]

I had to pick something. It would have been the same situation regardless of specialty.

What about fourth year electives/sub-i's? Does your school not give you a chance to rotate away?

 

[Euthymia]

What about fourth year electives/sub-i's? Does your school not give you a chance to rotate away?

Yeah, some students do. I applied for a bunch via vsas but didn't get any offers.

 

[Elisabeth Kate]

Yeah, some students do. I applied for a bunch via vsas but didn't get any offers.

Your school did you a HUGE disservice. If all of this is true, I think you should report them to COCA. At the very least, name them in the pre-med forums or in this thread I linked below so that other poor unsuspecting students aren't conned.

http://forums.studentdoctor.net/threads/pros-and-cons-of-your-do-school.407104/page-25

 

[rkaz]

Your school did you a HUGE disservice. If all of this is true, I think you should report them to COCA. At the very least, name them in the pre-med forums or in this thread I linked below so that other poor unsuspecting students aren't conned.

Well, hang on... I don't know if we have the whole story here. So I'd like to know more about the situation before passing judgement on the school to the extent of wanting to publicly shame them. As far as I know, medical schools don't have much input into VSAS - at least, my school didn't. It was entirely on my end to choose what sort of psych or non-psych rotations I wanted and apply to them (although my school advisor was wonderfully helpful, and assisted me with sending out supplemental information, uploading immunization documents, etc). We have no idea if part of the reason for Euthymia not getting any VSAS electives was on his/her end (of not applying to sufficient programs, not applying as soon as programs opened on VSAS, etc) or if it was on the school's end of not approving the elective through VSAS in a timely way.

HOWEVER, that being said... it IS the school's responsibility to provide an adequate 3rd year core rotation in psychiatry. We have a shelf exam in 3rd year psych, so I don't know how students can pass the exam without having the appropriate experience (as book reading goes so far, but it needs to be combined with rotation experience). If that adequate exposure to psych in fact did not happen in the 3rd year, then you are certainly correct that Euthymia was cheated out of that. No student should have to apply to specialties without having the appropriate core experience... there is a reason that these are core experiences!! They intentionally are structured to be done in 3rd year (or at the very latest, in the first month or two of 4th year) so that the student knows what they are getting into for deciding on residency.

Personally, I found my 4th year electives in psych to be very helpful complements to my 3rd year psych core rotation. I had a quasi-inpatient core experience in my 3rd year (at a crisis center with SMI population). And then I got to complement the core experience with weeks on geri inpatient psych, outpatient child psych, consult-liason inpatient and even a smear of forensic in my 4th year (which I obtained through VSAS). My school also offered me a few weeks of adult outpatient addictions. It was great, as I got to see nearly every specialty of psychiatry. Although I find it unfortunate for another applicant to not get the breadth of 4th year elective psych experience that I did, I still feel like the 3rd year core experience should be reasonably adequate to make some sort of decision on psych as a specialty. Until I know what kind of experience Euthymia did have in 3rd year, I will reserve passing judgment on whether his/her school was at fault or not.

 

[rkaz]

Euthymia has mentioned about not having had a 'real psychiatry rotation'. But I don't know what exactly that means. Some of my classmates (especially those who were not going into psych) just sat in an outpatient psychiatry clinic for 4 weeks as their psych core rotation. Does that count as not having had a real psych experience, since it wasn't inpatient with severe mental illness? Some may argue that this was in fact inadequate, and that all medical students should be required to have psych in an inpatient setting (whether or not they plan to specialize in it). Unless I know what not having had a 'real psychiatry rotation' means, I can't say whether the school did a gross injustice to the student beyond what normally goes on in other schools.

I'm not really disagreeing with anyone here (I totally get the sentiment), I just think we need more info.

 

[Elisabeth Kate]

-I wasn't talking about the VSAS incident, although the school should have done a better job of advising him about VSAS (there's no reason this poster couldn't have gotten a rotation through VSAS). I was talking about his 3rd year rotations. Also, maybe you didn't read the earlier posts in this thread, but here's what he posted on April 3rd.

I think it may be harder for a lot of MDs to get where SMC123 is coming from, but as a DO, it is very understandable to me. A lot of us go through 3rd and 4th year without ever writing notes, talking to patients, coming up with differentials, workups, or treatment plans. Some of us spend our core rotations shadowing nurses and medical assistants or quietly observing a physician from the corner. It's only natural to feel completely incompetent. The thought of being thrown into residency where we are actually responsible for doing these things is terrifying to many of us, present company included

I stand by statement. Euthymia needs to report his school and warn unsuspecting students what they're getting into. I doubt COCA would stand for a students' 3rd year rotation experience such as the above. Not writing notes? Not talking to patients? Not coming up with differentials??? That's a foreign concept to me. It makes all DO schools look bad. This school should not be accredited if they can't provide adequate clinical education and what Euthymia describes, if true, is NOT adequate by any stretch of the imagination.

 

[MLT2MT2DO]

-I wasn't talking about the VSAS incident, although the school should have done a better job of advising him about VSAS (there's no reason this poster couldn't have gotten a rotation through VSAS). I was talking about his 3rd year rotations. Also, maybe you didn't read the earlier posts in this thread, but here's what he posted on April 3rd.



I stand by statement. Euthymia needs to report his school and warn unsuspecting students what they're getting into. I doubt COCA would stand for a students' 3rd year rotation experience such as the above. Not writing notes? Not talking to patients? Not coming up with differentials??? That's a foreign concept to me. It makes all DO schools look bad. This school should not be accredited if they can't provide adequate clinical education and what Euthymia describes, if true, is NOT adequate by any stretch of the imagination.

You're delusional if you think COCA would give two flying poops about a single medical student not having to come up with talking to patients or note writing on a psych rotation. It's well known just about every DO school has good and bad rotations, it's what you get when you have physicians that are in no way connected to your school take your students.

 

[Elisabeth Kate]

You're delusional if you think COCA would give two flying poops about a single medical student not having to come up with talking to patients or note writing on a psych rotation. It's well known just about every DO school has good and bad rotations, it's what you get when you have physicians that are in no way connected to your school take your students.

One rotation, maybe. A student's entire clinical education???? Sorry, I give COCA more credit. I don't think they'd stand for it.

 

[rkaz]

I stand by statement. Euthymia needs to report his school and warn unsuspecting students what they're getting into. I doubt COCA would stand for a students' 3rd year rotation experience such as the above. Not writing notes? Not talking to patients? Not coming up with differentials??? That's a foreign concept to me. It makes all DO schools look bad. This school should not be accredited if they can't provide adequate clinical education and what Euthymia describes, if true, is NOT adequate by any stretch of the imagination.

If what happened to Euthymia is common for students at his/her school, then I share your indignation. Taking on medical students and then not providing them adequate rotations is just not okay.

I remember a story of a DO years ago who was kicked out of residency, and the person had stated that their rotations were not up to par to prepare him/her for residency, as they had all outpatient experiences. When I heard that (at the start of medical school), I became determined to seek out only the best rotations in my clerkships that would prepare me for residency, with as many ward-based rotations as possible. Most of my classmates had the same attitude, as they were also go-getters and made good rotations happen for them, as they'd always research the quality of the rotations before selecting, and choose the best of what was available. As such, when I rotated with MD students, I didn't see too much difference between them and us, as we had all been through rigorous rotations. However, for someone who took a more passive approach to rotation selection and just took what was offered, I could see how that person could get a lesser experience. I think this is unfortunate as it is a school's responsibility to make sure that no one slips through the cracks.

Unfortunately this is a part of the reason why DOs sometimes get a bad rap... as you will have fabulous DO graduates, and then on the other end of the spectrum the few who just made it through. Although this kind of variability exists within the MD student population as well (as there are both good and bad students), at least the variability shouldn't be on the part of the education that they received. As DO students, we often are in the unfortunate situation of having to fight to get the best rotations for ourselves. This may not be so much of an issue for the more established schools, or schools that have their own hospital... but for school's with not enough rotation spots for their students, they are often in a position to scramble just to find spots and thus can't always seek out the best quality.

The problem is what to do about it now. Although idealistically you might say that Euthymia should report his/her school, I don't think that he/she would have any interest in stirring up the pot now, this close to graduation. There is too much at stake, and creating any kind of issue might only open the door to his/her school attempting to retaliate. Being that he/she already has a residency in hand, and just needs to cross the graduation stage at this point, I'm sure no graduating student wants to have any issue come up now. We can only hope that he/she can be a quick learner and can compensate for any deficiencies as fast as possible after starting residency. Yes, it's not fair to have paid so much money and gotten poor education, but what else can anyone suggest?

 

[Elisabeth Kate]

I disagree. If he doesn't want to say something right this second, fine. But no way should this just be let go. The second he walks across the stage, he should have his phone in-hand ready to make a phone call. There comes a time when you don't just need to look out for yourself, but for others coming after you as well. Schools get away with this sort of thing because they count on students being too scared of retaliation to complain. The truth is, you're a customer and you're paying for an education you're not receiving. You can keep your mouth shut and let them suck you dry for something you didn't get or you can speak up and stand up for yourself and everyone coming after you.

 

[MacDonaldTriad]

Hmmm….

I may have to rethink my criticisms of academic elitism and arrogance. Maybe those snow drifts where a lot higher when I had to walk to school.

 

[Euthymia]

As far as vsas, I applied the first day it was open and used all of my tokens. Most of the places were more local and perhaps not as DO friendly. I didn't think not finding a spot via vsas was that unusual because some of my friends who had better stats only got maybe one offer themselves.

My situation is definitely not uncommon. There was recently a class Google groups discussion about our rotation sites. Some were lucky enough to be assigned to a good location and get good training. A lot of us weren't. By "not a real rotation" I mean rotations where we were assigned to shadow ancillary staff or told to enjoy our month off.

If you could file complaints anonymously, I would consider it, but it doesn't look like you can. Call me selfish, but, at this point, there is nothing for me to gain from this and potentially a lot to lose. Seems like an unfavorable risk-benefit ratio.

 

[Nasrudin]

I think if you work hard enough and learn quickly you will be able to assimilate what you need to survive as an intern. As long as you know how to write a basic note and give a presentation. I'm sure we're all starting at different levels at different aspects of what we all need to become competent at as quickly as possible.

For instance, I type like my hands are hooves. I'll be staying late to finish unless I get fast at other things. We all have deficiencies of one sort or another.

 

[Elisabeth Kate]

As far as vsas, I applied the first day it was open and used all of my tokens. Most of the places were more local and perhaps not as DO friendly. I didn't think not finding a spot via vsas was that unusual because some of my friends who had better stats only got maybe one offer themselves.

My situation is definitely not uncommon. There was recently a class Google groups discussion about our rotation sites. Some were lucky enough to be assigned to a good location and get good training. A lot of us weren't. By "not a real rotation" I mean rotations where we were assigned to shadow ancillary staff or told to enjoy our month off.

If you could file complaints anonymously, I would consider it, but it doesn't look like you can. Call me selfish, but, at this point, there is nothing for me to gain from this and potentially a lot to lose. Seems like an unfavorable risk-benefit ratio.

What about after you graduate? I just hate to see schools such as yours putting students through this. It makes all DO schools look bad and it truly cheats people out of a medical education they're paying for. As for VSAS, I wasn't under the impression that most places go by stats, esp in the psych world. I thought it was simply if they had a slot or not. First come, first serve type of thing. Am I wrong?

 

[Euthymia]

What about after you graduate? I just hate to see schools such as yours putting students through this. It makes all DO schools look bad and it truly cheats people out of a medical education they're paying for. As for VSAS, I wasn't under the impression that most places go by stats, esp in the psych world. I thought it was simply if they had a slot or not. First come, first serve type of thing. Am I wrong?

Timing is probably the biggest factor, but there is definitely more to it than that, at least for the more competitive specialties and sought after geographical locations. I know some programs straight out don't accept DO students for rotations, and I'm sure some programs screen out a lot of people based on their step 1 and CV.

 

[rkaz]

Timing is huge. I applied for VSAS in May last year, which was already quite late (as some program started opening up in March). I sent out probably 35 rotation requests (many for the same rotations for different months), and got 5 offers (all of which were in-state, as no out-of-state place offered me anything). HOWEVER, 4 of the 5 offers were at in-state hospitals affiliated with a single institution that had just opened up VSAS in May as well (as I applied to them the day it opened). Only 1 of my offers came from an institution that opened up weeks before. (By the way, not all of my VSAS rotations were in psych - I did 3 psych electives, 1 neuro, and 1 fun elective.) I did get rejected from Loma Linda due to my board scores not being high enough... but later they told me that they decided not to give rotations to any visiting students. Interestingly at the 1 place that offered me a psych rotation (not the place where I got 4/5 offers from), they rejected me for other rotations (like peds, medicine) stating my board scores did not meet their cutoff. Whatever. When it came time for residency applications, all of the programs I had done psych rotations at offered me interviews.

As far as rotations not accepted DO students, it says on the institution list if the program is accepting DO students or not - so I just applied to the ones that were, which were most of them. International students seemed more screwed than DO students, as there were less institutions accepting international folks as compared to osteopathic students (from what I observed last year).