Med student dilemma: hospital exposure vs. study time!

[Agreeable_Moose_7234]

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Hi! My school has ties with several hospitals, and I'm in the process of ranking my preferences. I'd love to get some input on my options.

Here is my dilemma:

• prioritize more time in hospital (eg. more work hours) vs more study time for shelf exams and Step 2, considering step 2 will likely replace step 1
• letters of recommendation from more established hospitals with more trailblazers in the field (eg. Henry Ford)
• Clinical evaluations, which seem to be more lenient at Ascension

I'm still undecided on my specialty, leaning towards potentially going into primary care. Already have a long-term research project (was hoping for a short-term one). I don't have any strong mentor relationships (yet) in the primary care field I may want to go in. Any advice?

	Henry Ford	Detroit Med Center (DMC)	Ascension St John
Type	Academic hospital with name-recognition	Academic-ish, for profit	Community hospital
Environment	More networking, mentorship opportunities with leaders in various fields	Serves the city of Detroit, deals with high acuity patients	inpatient: medium acuity; outpatient: wealthy suburb patients
Residency program reputation + education initiatives	Highest	Medium	Lowest
Research	Numerous research opportunities	Less research	Little to none
Work hours	Longest	Medium	Lowest- very flexible
Financial status of hospital	Great- they're buying up everyone!	Unstable, understaffed	OK- will be merging with Henry Ford
Clinical evaluations	Harsher	Harsher	Nicer and more lenient

Would appreciate any thoughts or advice on how to weigh these options. Thanks!

 

[voxveritatisetlucis]

Always go where you can get the best grades

 

[PathNeuroIMorFM]

Ascension and it's not even close.

The most important thing is clinical evals/grades and Step 2 score. It sounds like Ascension offers the best of those two. 3rd year letters are less important and your best letters will come during 4th year. Where they come from is less important than their content most of the time.

I did spend most of 3rd year in a hospital that sounds similar to DMC and it was an experience. I mostly liked it, other students mostly hated it. I think the hospitals serving low income populations are the most fun and interesting from a student perspective, but that's an unpopular opinion.

 

[operaman]

Ascension. No question. Hit the easy button. Look great on paper.

 

[LunaOri]

3rd year at Ascension. Wait until 4th year electives to branch out, so you can target specific clerkships that will ne beneficial to you.

 

[bGMx]

Ascension. Easy.

 

[mistafab]

I disagree with the above.

Your interest is in primary care. Your exposure to good clinical training during MS3 will set you up for success in your career, and your general skills. Your clinical training is more important in becoming a good doctor than your score on step 2 going up 5 points.

People that phone it in in medical school show up in residency and suck. Then they get trained in their own specialty (at least decently) and remain garbage in everything they ignored in med school. This may not matter much to a hand surgeon. However, to someone considering primary care, your grades don't really matter THAT much in the grand scheme of things... but your training will have a big impact on your future skills and will directly impact your patient care.

So I vote wherever you think the actual TRAINING is the best per your colleagues, regardless of the scores or reputation.

 

[PathNeuroIMorFM]

I disagree with the above.

Your interest is in primary care. Your exposure to good clinical training during MS3 will set you up for success in your career, and your general skills. Your clinical training is more important in becoming a good doctor than your score on step 2 going up 5 points.

People that phone it in in medical school show up in residency and suck. Then they get trained in their own specialty (at least decently) and remain garbage in everything they ignored in med school. This may not matter much to a hand surgeon. However, to someone considering primary care, your grades don't really matter THAT much in the grand scheme of things... but your training will have a big impact on your future skills and will directly impact your patient care.

So I vote wherever you think the actual TRAINING is the best per your colleagues, regardless of the scores or reputation.

Ability as a physician depends far more on your training in residency than clinical training in med school. More time in the hospital and harsher evals does not equate to better training. It means supervisors who don't know when to dismiss you.

Ability to get into a good residency (or the residency of ones choice) will depend more on clinical evals and step scores.

People that phone it in in med school are probably just people who phone it in in many aspects of life.

 

[mistafab]

Ability as a physician depends far more on your training in residency than clinical training in med school. More time in the hospital and harsher evals does not equate to better training. It means supervisors who don't know when to dismiss you.

Ability to get into a good residency (or the residency of ones choice) will depend more on clinical evals and step scores.

People that phone it in in med school are probably just people who phone it in in many aspects of life.

I agree somewhat with what you are saying. However I would double down that training in medical school has a big effect on skills/knowledge that carry into residency. In FM, for example, med school may be the only formative training the OP gets in neuro or psych from a neurologist or psychiatrist. If they phone it in on these rotations, or go to places where they just shadow and get dismissed early, they may or may not get additional training in these areas during residency. That carryover will alter their prescribing/referral patterns as an attending, and their comfort level in their clinic.

I can easily tell applicants who come in and were trained well vs not trained well. You can't always tell who got good grades or not. If OP actually wants to become a better doctor (some are okay not doing that), then the quality of the training is more important than the grades and more important than the score - so long as the latter doesn't tank their career. In the end, an FM applicant having a P in psych or neuro rather than a HP is not a big deal. And a 245 is not that much different from a 250. But the actual clinical knowledge learned may be vastly different between sites and does make their clinical practice better.

 

[AnonymousDoctorGuyPerson]

3rd year it's best to focus on bread and butter cases anyways, you won't be lacking those at Ascension.

Doing well on shelf exams, and thus also on Step 2, are going to open up more doors for residency. I went to my program's easiest hospital, I didn't feel left behind when I did aways at "top programs" and I got to use 4th year to focus on learning more clinically focused skills.

 

[JBM16BYU]

If you were interested in a particular subspecialty for residency, I would recommend a place that (A) has that residency and (B) has research opportunities. What seems to matter most nowadays for residency applications are: Step 2 score, Step 1 pass on first try, not having a red flag or failure from clinical evaluations, good letters of recommendation research/publications/presentations. Other things are talking points and help develop you as a person, but securing interviews at residency programs depend on the former. If interested in primary care, which you mention you are, getting a good clinical training during medical school might supersede the research part a little.