M4s trying to match...what would you have done differently?

[ihazquestionz]

Until you get that malignant attending who says he's going to fail 1/4 of the kids on the team bc he recently got a divorce but is tenured so there's nothing the admin can do about it.

Can't tell if I'm happy or sad about knowing now.



#AOAorkillyourself.



Until you get sick and half to miss half a rotation but still want to graduate on time.



Doctors get sick days too.

Did you read my posts? I was specific that appeals should be granted in extreme situations. Missing half a rotation for "sick" days while going to the library to study or getting research done instead or hanging out with friends-this is unacceptable. I've taken a couple sick days (thanks peds for the wonderful GI bugs). This is human and normal. Our school has enough flexible time that if you genuinely get seriously sick and need to take time off, you still have months where you can make up the rotation and graduate on time. Some of my classmates who failed first year were able to repeat it and still graduate on time. So, for the specific case I described at my institution, your arguments don't apply.

EDIT: My sarcasm filter is dysfunctional right now so I can't tell if you're trolling or not.

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[Osteoth]

Did you read my posts? I was specific that appeals should be granted in extreme situations. Missing half a rotation for "sick" days while going to the library to study or getting research done instead or hanging out with friends-this is unacceptable. I've taken a couple sick days (thanks peds for the wonderful GI bugs). This is human and normal. Our school has enough flexible time that if you genuinely get seriously sick and need to take time off, you still have months where you can make up the rotation and graduate on time. Some of my classmates who failed first year were able to repeat it and still graduate on time. So, for the specific case I described at my institution, your arguments don't apply.

EDIT: My sarcasm filter is dysfunctional right now so I can't tell if you're trolling or not.

Yeah I read it but I missed the part in parenthesis where you address malignancy. I'm sorry.

It seems as though your institution is exceedingly flexible with the time allotted to meet required rotation time. You are very fortunate to attend such a school, as I know several others where the aforementioned situations would not apply. In your situation I understand your point of view, but like I mentioned from my knowledge (n=~7) there are quite a few places where it is significantly more difficult to repeat blocks or even years and still graduate on time.

The issue from an organizational point of view is how to differentiate real vs. fake reports of sickness, family problems etc. On one hand you want to give students ample opportunities to take care of personal concerns, but you also don't want to make it too easy on them to the point where the system is heavily abused. I saw someone posted about their school requiring them to get a doctor's note if they miss time, but the issue with that becomes when a kid who's been working 5A-8P for a month straight on his surgery rotation gets a bad case of pneumonia, and while driving to the doctor to get a note his febrile, sleep lacking, drug-influenced self crashes his car and he dies. Then the organization looks like ****. Its a tough balance.

 

[ihazquestionz]

Yeah I read it but I missed the part in parenthesis where you address malignancy. I'm sorry.

It seems as though your institution is exceedingly flexible with the time allotted to meet required rotation time. You are very fortunate to attend such a school, as I know several others where the aforementioned situations would not apply. In your situation I understand your point of view, but like I mentioned from my knowledge (n=~7) there are quite a few places where it is significantly more difficult to repeat blocks or even years and still graduate on time.

The issue from an organizational point of view is how to differentiate real vs. fake reports of sickness, family problems etc. On one hand you want to give students ample opportunities to take care of personal concerns, but you also don't want to make it too easy on them to the point where the system is heavily abused. I saw someone posted about their school requiring them to get a doctor's note if they miss time, but the issue with that becomes when a kid who's been working 5A-8P for a month straight on his surgery rotation gets a bad case of pneumonia, and while driving to the doctor to get a note his febrile, sleep lacking, drug-influenced self crashes his car and he dies. Then the organization looks like ****. Its a tough balance.

Yes definitely. We have a ton of built in research time, which is used when students have to repeat blocks for whatever reason.

Agreed-when I got sick on peds I went to work anyways and got chewed out by the resident for being irresponsible and putting kids at risk and got kicked out of the hospital with a warning that I would get reported for lack of professionalism if I showed up again until I was afebrile and my GI was more stable haha. We aren't required to have doctor's notes, which is helpful when a student needs a "mental health day" which we are encouraged to take if we feel burnt out.

I do think, however, that it should raise a red flag to the school when there are repeated absences. In that case, the deans should become involved to tease out if the student is genuinely sick or if he/she is abusing the system.

Everytime I look away from this thread I think of something else I would have done differently lol.

 

[Osteoth]

Yes definitely. We have a ton of built in research time, which is used when students have to repeat blocks for whatever reason.

Agreed-when I got sick on peds I went to work anyways and got chewed out by the resident for being irresponsible and putting kids at risk and got kicked out of the hospital with a warning that I would get reported for lack of professionalism if I showed up again until I was afebrile and my GI was more stable haha. We aren't required to have doctor's notes, which is helpful when a student needs a "mental health day" which we are encouraged to take if we feel burnt out.

I do think, however, that it should raise a red flag to the school when there are repeated absences. In that case, the deans should become involved to tease out if the student is genuinely sick or if he/she is abusing the system.

Everytime I look away from this thread I think of something else I would have done differently lol.

I mean thats the thing though right, how can you accurately determine that? If it came to a point where punishments were being handed out for said behavior, it might encourage students who see other kids that are "sick" to rat each other out, which seems to be the exact sort of hyper-competitive, aggressive behavior that medical schools and medicine in general is trying to weed out.

 

[Lil'Sebastian]

I wouldn't have gone to a DO school.

 

[Redpancreas]

Agreed. Unfortunately not how it works out for us. Student gets a low clinical grade --> whines and complains and appeals --> continues to whine and complain to administration --> gets either an automatic honors bump or is required to write a 1-2 page essay on a topic from the rotation and gets honors.

It's honestly an infuriating process and hurts students who are amazing clinically and have a harder time with exams. One of my good friends was paired with a med student who slacked off (actually said he was sick half the the ENTIRE rotation). She was always there and was deeply involved in the team's workflow. She was asked to help on the night before the shelf because the intern was overwhelmed and a patient ran off the floor under the intern's care. Patient was found unconscious and not breathing in another area of the hospital at like 3 am and she had to help with the code blue and the aftermath. I was on night float on a different service (my shelf wasn't until a month later) and heard the code blues called. The code blue team went to the wrong location and the med student literally saved this man's life by herself while the intern ran around the hospital trying to find the code blue team. School didn't let her reschedule her shelf. Other student made honors cut off, she missed the honors cutoff by 2 points. Other student ended up honoring the rotation, she did not. Other student ended up with AOA, she missed AOA by one honors grade. Which student do you think is more competent and which student do you want on your team taking care of you or your loved ones? Not to mention, the girl in this case is hugely involved in the school in really impressive ways whereas the guy has been #ortho from day one and has only focused on honoring rotations, being condescending, and successfully getting younger med students to do all his chart review so that he could nag more first author publications.

The answer might be obvious to us. However, when residency programs look at the two students, which student is more likely to get an interview? Which student is given more opportunities? This is my issue with the system. The way we select our future leaders in medicine and healthcare is so flawed.

I think this is a load of baloney. There's no way to determine if a student is amazing clinically unless you give them the responsibility of actually caring for a patient independently and seeing how well they do. If you did, they'd all fail. Until then, all you're assessing is a student's confidence and likeability. I see too many students realize this early on and project insane levels of confidence which screws it up for everyone. It's misleading to residents when they try to see what students know and it seems like we know stuff we don't.

I do agree that taking days off for non-illness/emergent reasons is unacceptable too though. The most important thing is to be there and learn how residents work so you can strive to do what they do one day. At our school, some CDs haven't gotten smart about it and only hand HP if a student meets a certain mark on both their assessments. If you scored below average on the shelf, but were told you performed at the level of an attending and are in the top 1% of your class, I think those subjective comments deserve to be checked.

 

[Osteoth]

I wouldn't have gone to a DO school.

Expand?

 

[Milotic]

I think this is a load of baloney. There's no way to determine if a student is amazing clinically unless you give them the responsibility of actually caring for a patient independently and seeing how well they do. If you did, they'd all fail. Until then, all you're assessing is a student's confidence and likeability. I see too many students realize this early on and project insane levels of confidence which screws it up for everyone. It's misleading to residents when they try to see what students know and it seems like we know stuff we don't.

I do agree that taking days off for non-illness/emergent reasons is unacceptable too though. The most important thing is to be there and learn how residents work so you can strive to do what they do one day. At our school, some CDs haven't gotten smart about it and only hand HP if a student meets a certain mark on both their assessments. If you scored below average on the shelf, but were told you performed at the level of an attending and are in the top 1% of your class, I think those subjective comments deserve to be checked.

This topic blows up all the time on the clinical rotations forum. If you aren't as naturally bright as your classmates and require more time to study, try to just leave the floors ASAP so you can study for the shelf to get your honors. I realized how to play that game and I am thankful I did. It's a horrible system but as long as there are shelves, some of us need to study literally 2x more than others off the floors to get that honors.

 

[ihazquestionz]

I think this is a load of baloney. There's no way to determine if a student is amazing clinically unless you give them the responsibility of actually caring for a patient independently and seeing how well they do. If you did, they'd all fail. Until then, all you're assessing is a student's confidence and likeability. I see too many students realize this early on and project insane levels of confidence which screws it up for everyone. It's misleading to residents when they try to see what students know and it seems like we know stuff we don't.

I would agree with the confidence factor though-I have been on teams where students have acted like they know everything when they don't, which not only makes everyone else look bad but also takes away a learning opportunity for everyone. But what's wrong with being likable? A lot of the good feedback I got was that I'm a good team player and well liked by everyone. I think it's good to not be toxic and ruin everyone's life haha. Likability alone should not translate into honors IMO. That's not cool.

On our medicine rotation we are given almost full autonomy (our orders are all checked), so attendings use that as part of our patient management assessment for grades. That being said, the point of us being students is that we are in training and are not perfect. Our attendings were fair in the sense as long as we thought about and had decent reasoning for why we did something, they didn't destroy us and told us why we were wrong. It's part of the learning process. Eagerness to learn and taking initiative in researching management, presenting on rounds with the latest literature, etc were looked upon favorably.

Whatever, these are just rambling reflections of a 4th year nervously awaiting interviews.

 

[Stagg737]

I refuse to believe that one can miss half a rotation and still get honors

Maybe not half a rotation, but I know people who were "sick" for the last 3-4 days of their rotation right before the shelf and instead just went and studied. Not exactly fair when some people are busting their butts the entire rotation while others slack off and then get honors.

Anyway, was just using this case as an example. It's the most extreme example I know but lots of people at my institution get "sick" right before shelves for 3-4 days or "sick" once a week. People need to suck it up and realize that being in the hospital and taking care of people is part of the package of getting an MD and staying an MD. There are alternative careers for those who like to "work from home."

End rant.

It's not part of the package, it IS the package. If you don't want to take care of people or don't enjoy the work you're doing you shouldn't be going into medicine.

Do you really believe that? Doesn't matter how you feel about that orthopod if he's the only one in the county doing hips.

Absolutely, I've had attendings say they won't refer their patients to certain physicians because of problems with them clinically. If they're the only orthopod in the county doing hips then I'll recommend someone from another county if I don't think they're clinically sound or aren't adequate. I also had my surgery attendings say that it pays to be polite and work with FM and IM docs because they're the ones referring you patients. It pays (literally) to play nice.

I think this is a load of baloney. There's no way to determine if a student is amazing clinically unless you give them the responsibility of actually caring for a patient independently and seeing how well they do. If you did, they'd all fail. Until then, all you're assessing is a student's confidence and likeability. I see too many students realize this early on and project insane levels of confidence which screws it up for everyone. It's misleading to residents when they try to see what students know and it seems like we know stuff we don't.

I do agree that taking days off for non-illness/emergent reasons is unacceptable too though. The most important thing is to be there and learn how residents work so you can strive to do what they do one day. At our school, some CDs haven't gotten smart about it and only hand HP if a student meets a certain mark on both their assessments. If you scored below average on the shelf, but were told you performed at the level of an attending and are in the top 1% of your class, I think those subjective comments deserve to be checked.

Sure there are, and one of them is to give them responsibility over a patient like you said. Another is to have the do H&Ps and see how their assessment stacks up to reality. Another is to ask them to create a treatment plan and see how valid it is. It's much more than just confidence and likeability. Imo, more rotations should be like sub-i's where students are given more responsibility in the last few weeks of the rotation to see how they perform. If residents suck at judging a student's clinical abilities, they shouldn't be evaluating the students.

If the student sucks and isn't good at this stuff just give them a pass. If they perform above what's expected and can handle many situations independently or with minimal supervision then give them honor. If they completely slack off, don't do their work, or just make excuses so they can go study or do something else, then either fail them or pass them and give them terrible evals (like they should). I'm totally fine with shelf exams being a portion of the grade (even a significant portion), but I think there should be far more that goes into the clinical grade than just that.

 

[Mad Jack]

Expand?

inb4 no explanation is provided

 

[Lil'Sebastian]

Expand?

Forget the lack of clinical facutly in years 1 and 2, forget the abandonment of EBM for the sake of OMM, forget the crumbling AOA programs (4 ruled ineligible for the match in last week by my count), forget the ridiculousness of COMLEX, forget not having a "home program." I regret going to a DO school because of the amount of program directors that would quit their job before having a DO in their intern class. All of the test scores, letters of rec, research projects and away rotations are made meaningless by the 2 letters that will come after my name.

 

[Redpancreas]

I would agree with the confidence factor though-I have been on teams where students have acted like they know everything when they don't, which not only makes everyone else look bad but also takes away a learning opportunity for everyone. But what's wrong with being likable? A lot of the good feedback I got was that I'm a good team player and well liked by everyone. I think it's good to not be toxic and ruin everyone's life haha. Likability alone should not translate into honors IMO. That's not cool.

On our medicine rotation we are given almost full autonomy (our orders are all checked), so attendings use that as part of our patient management assessment for grades. That being said, the point of us being students is that we are in training and are not perfect. Our attendings were fair in the sense as long as we thought about and had decent reasoning for why we did something, they didn't destroy us and told us why we were wrong. It's part of the learning process. Eagerness to learn and taking initiative in researching management, presenting on rounds with the latest literature, etc were looked upon favorably.

Whatever, these are just rambling reflections of a 4th year nervously awaiting interviews.

Nothing wrong with being likable, until the one being assessed knows he or she's being assessed on being likable.Wow...Well good for you if that's true then because that's what an intern's supposed to be doing where I work.

 

[el_duderino]

Forget the lack of clinical facutly in years 1 and 2, forget the abandonment of EBM for the sake of OMM, forget the crumbling AOA programs (4 ruled ineligible for the match in last week by my count), forget the ridiculousness of COMLEX, forget not having a "home program." I regret going to a DO school because of the amount of program directors that would quit their job before having a DO in their intern class. All of the test scores, letters of rec, research projects and away rotations are made meaningless by the 2 letters that will come after my name.

That's shocking and awful. I'd love to see "DO" and AACOM just go away and most/all of the DO schools get merged into AAMC/MD. Might be hard or impossible for a lot of DO schools to meet the LCME requirements though.

 

[SpartanWolverine]

That's shocking and awful. I'd love to see "DO" and AACOM just go away and most/all of the DO schools get merged into AAMC/MD. Might be hard or impossible for a lot of DO schools to meet the LCME requirements though.

They shouldn't exist if they can't meet basic standards for US medical education.

Forget the lack of clinical facutly in years 1 and 2, forget the abandonment of EBM for the sake of OMM, forget the crumbling AOA programs (4 ruled ineligible for the match in last week by my count), forget the ridiculousness of COMLEX, forget not having a "home program." I regret going to a DO school because of the amount of program directors that would quit their job before having a DO in their intern class. All of the test scores, letters of rec, research projects and away rotations are made meaningless by the 2 letters that will come after my name.

Sorry you feel this way. Agree that OMM is garbage. Like my thoughts on DO schools not being able to meet LCME requirements, residency programs should also not exist if they're not up to standards. COMLEX sucks, but that's why many of us also take the USMLE. I have only met a couple of elitist program directors that don't like DOs and the vast majority say that if you're competitive from a USMLE/letters/research standpoint you're fine. Disagree that good scores, letters, research, and away rotations mean nothing. I've been very happy with the response to my ERAS application so far. The field is essentially moving in the right direction and the two letters after your name mean a lot less than you suggest.

 

[el_duderino]

They shouldn't exist if they can't meet basic standards for US medical education.

We'll all the DO physicians I've met have been perfectly competent, so I don't think it's a matter of the schools not meeting basic standards. There's a lot you give up by going DO, but I don't want to imply the schools are substandard. It would also not be politically viable for LCME to relax or remove certain standards in order to absorb DO programs. There's no easy answer.

 

[Stagg737]

Forget the lack of clinical facutly in years 1 and 2, forget the abandonment of EBM for the sake of OMM, forget the crumbling AOA programs (4 ruled ineligible for the match in last week by my count), forget the ridiculousness of COMLEX, forget not having a "home program." I regret going to a DO school because of the amount of program directors that would quit their job before having a DO in their intern class. All of the test scores, letters of rec, research projects and away rotations are made meaningless by the 2 letters that will come after my name.

Some of those are valid points, but I think some of those are very, very school dependent. Almost all of my faculty second year were MDs/DOs and several from first year were as well. OMM was definitely not emphasized very heavily at my school and other than some of the more commonly used modalities in several fields (like techniques PTs use), OMM was mostly taught for the boards. Validity of AOA programs won't matter in a couple years, so your wish is granted there. COMLEX complaint is valid. I actually am glad I didn't have a home program, as I got to experience what services in several hospitals, both community and academic were like. I've got to see and learn some things that friends at other med schools were and some still are clueless about. I also think your point about the letters after your name is a semi-valid point. A lot of PDs don't care at all, and I'd guess that the issue will continue to diminish as the two degrees become more melded, but the bias is still there and until it's gone it's at least worth mentioning.

Nothing wrong with being likable, until the one being assessed knows he or she's being assessed on being likable.Wow...Well good for you if that's true then because that's what an intern's supposed to be doing where I work.

That's how several of my rotations were as well. I think students should have to have at least a short period of that on each rotation (other than surgery for obvious reasons) so they can experience what it's like to actually work in that field instead of just shadowing with a few responsibilities.

They shouldn't exist if they can't meet basic standards for US medical education.

Sorry you feel this way. Agree that OMM is garbage. Like my thoughts on DO schools not being able to meet LCME requirements, residency programs should also not exist if they're not up to standards. COMLEX sucks, but that's why many of us also take the USMLE. I have only met a couple of elitist program directors that don't like DOs and the vast majority say that if you're competitive from a USMLE/letters/research standpoint you're fine. Disagree that good scores, letters, research, and away rotations mean nothing. I've been very happy with the response to my ERAS application so far. The field is essentially moving in the right direction and the two letters after your name mean a lot less than you suggest.

Agree with (almost) all of this. I've also been very pleasantly surprised by how well my application has been received this cycle, including getting interviews at a few academic programs that I thought were only reaches.

 

[IslandStyle808]

Some of those are valid points, but I think some of those are very, very school dependent. Almost all of my faculty second year were MDs/DOs and several from first year were as well. OMM was definitely not emphasized very heavily at my school and other than some of the more commonly used modalities in several fields (like techniques PTs use), OMM was mostly taught for the boards. Validity of AOA programs won't matter in a couple years, so your wish is granted there. COMLEX complaint is valid. I actually am glad I didn't have a home program, as I got to experience what services in several hospitals, both community and academic were like. I've got to see and learn some things that friends at other med schools were and some still are clueless about. I also think your point about the letters after your name is a semi-valid point. A lot of PDs don't care at all, and I'd guess that the issue will continue to diminish as the two degrees become more melded, but the bias is still there and until it's gone it's at least worth mentioning.

I think all of what he is mentioning is "besides the point" issues. It is not like the majority of schools are like that, but more than enough to be upset about. I feel like the clinical faculty at my school are trying to turn 2nd year into a pre-3rd year experience, instead of focusing on pathophysiology and building a foundation they are too focused on memorizing long lists differentials and risk factors. Yes, its important to know but for all those risk factors/differential their is a science behind it that should be explained. We don't really have clinical faculty who are used to teach things at the basic science level. So there are problems like this also.

I don't think the turning of AOA residencies into ACGME will wipe out all the bad things away. A bad program will be know as a bad program whether AOA or ACGME. It does raise the floor (I acknowledge this), but we also have to remember there are bad ACGME programs also.

While its great that you had a good learning experience from your aways, but it still better to have a home program. A home program wants to see you succeed and can help you in your goals. Its still a risk to do away rotations, especially when you have a stellar application (then again this depends on the specialty). You have no idea if it will work out well with the program and if they will give you a good letter of recommendation. Even with a home program, it doesn't mean you cannot explore other hospital after you sent your match list (unless I'm mistaken).

I doubt a lot of PDs care about the DO status. However, when you are aiming for the top it is when the letters start become more of a hinderance.

 

[Osteoth]

Forget the lack of clinical facutly in years 1 and 2, forget the abandonment of EBM for the sake of OMM, forget the crumbling AOA programs (4 ruled ineligible for the match in last week by my count), forget the ridiculousness of COMLEX, forget not having a "home program." I regret going to a DO school because of the amount of program directors that would quit their job before having a DO in their intern class. All of the test scores, letters of rec, research projects and away rotations are made meaningless by the 2 letters that will come after my name.

Why is COMLEX so bad?

What specialty are you applying into?

 

[DBV]

Spend more than 1.5 days studying for CS

That is significantly more time than I spent. Hope I get a P on the 11th

 

[Stagg737]

I think all of what he is mentioning is "besides the point" issues. It is not like the majority of schools are like that, but more than enough to be upset about. I feel like the clinical faculty at my school are trying to turn 2nd year into a pre-3rd year experience, instead of focusing on pathophysiology and building a foundation they are too focused on memorizing long lists differentials and risk factors. Yes, its important to know but for all those risk factors/differential their is a science behind it that should be explained. We don't really have clinical faculty who are used to teach things at the basic science level. So there are problems like this also.

I don't think the turning of AOA residencies into ACGME will wipe out all the bad things away. A bad program will be know as a bad program whether AOA or ACGME. It does raise the floor (I acknowledge this), but we also have to remember there are bad ACGME programs also.

While its great that you had a good learning experience from your aways, but it still better to have a home program. A home program wants to see you succeed and can help you in your goals. Its still a risk to do away rotations, especially when you have a stellar application (then again this depends on the specialty). You have no idea if it will work out well with the program and if they will give you a good letter of recommendation. Even with a home program, it doesn't mean you cannot explore other hospital after you sent your match list (unless I'm mistaken).

I doubt a lot of PDs care about the DO status. However, when you are aiming for the top it is when the letters start become more of a hinderance.

Your description of your second year curriculum sounds pretty terrible. Maybe my school is just better than most DO schools, which I doubt but idk.

Unifying AOA and ACGME residencies isn't just to eliminate programs which are substandard, it also starts to eliminate differences which cause bias between the two degrees. Even if there are still DO and MD schools, at least no one can say the DO got a Post-grad education that wasn't up to the national standards.

How does a home program help in your goals more than a "core sight" which is what we have. I do understand that there's pluses to being at an academic hospital like greater research opportunities, attendings who are (hopefully) more focused on teaching, and more academic cases. However, if your core site includes academic hospitals you still have access to that and experience that while also getting an opportunity to work in community hospitals, where some of the highest acuity patients in the city are more likely to go.