ILoveLampS

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I am a 3rd year medical student rotating in WV and I am writing this on behalf of myself and a number of classmates (with input from them). So far, our clinical experiences here have been miserable, uneducational, and seemingly thrown together by our admin with little thought. My Example: On my ob-gyn rotation (I am male), I was hastily paired with a female physician for 4 weeks. Of every patient who walked in the door, 70-80% did not want me in the exam room. Of the remaining 30% who agreed, I was allowed to do ZERO pap smears, ZERO biopsies/breast exams, or ANY other procedure for that matter. During surgeries, I was afforded little autonomy, instruction, explanation, etc... most questions I asked were answered with "go read up on it." Other examples from classmates include:

Seeing only 4 or 5 patients per DAY during TEN HOUR shifts; being neglected totally by interns/preceptors who didn't even know the student was coming; being taught grossly incompetent/dangerous medicine by a physician well known to be a poor practitioner; being assigned preceptors for a specific field who are NOT even board certified in that field!

I know this may sound like a big bi*** fest, but I really want to know if students from other institutions are having such a miserable third year? If so, does your institution permit you lots of flexibility in scheduling rotations/going out of state, because ours does not. We feel like we have learned essentially NOTHING this entire year, and that if we voice any displeasure, the admin/site coordinator will crush us (they are very vindictive). If any of you have had a similar experience, did it require a lot of extra work to make up for it fourth year and internship year? Did it affect your performance on Step II?

Thanks for your input!
 

themudphud

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So here's the thing, most of your rotations will not be great. Ob/gyn is usually the worst rotation of med school. At our institution, it is hands down (at least it used to be when I took it 6 yrs ago). It is particularly tough as a male who doesn't get to do much. In any case, I would approach all of these rotations with the attitude that in 1.5 short years you will be an intern who will be expected to know these things when it comes up with one of your patients. I know it's hard to imagine now, but the panic is now setting in for me that I will have to do a month in the ED during internship next year (7 months from now) where I will be expected to do pelvic exams. If you take that approach, I think you will find your rotations at least more practical if not enjoyable.
That said, believe me that you will find an area that you enjoy. But I'll understand if you don't believe me--I didn't believe it until it happened to me. I think the key is to get exposure to varied fields of medicine. Did you enjoy the OR setting during gyn? Have you done surgery yet? Have you done internal medicine yet? Let me know if there was any clinical experience that you liked and perhaps I could direct you to an elective or clerkship.
 

smq123

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Seeing only 4 or 5 patients per DAY during TEN HOUR shifts; being neglected totally by interns/preceptors who didn't even know the student was coming; being taught grossly incompetent/dangerous medicine by a physician well known to be a poor practitioner; being assigned preceptors for a specific field who are NOT even board certified in that field!

I know this may sound like a big bi*** fest, but I really want to know if students from other institutions are having such a miserable third year?!

No. :confused: My third year was NOTHING like this. Rarely neglected, had good teaching, generally preceptors knew that I was coming and/or had a lot of experience teaching students and residents.

I've been assigned to work with NPs/PAs/CNMs as preceptors before, but they were all people who'd working in that particular field for over 10 years.

This sounds really, really bad. I'm sorry....I hope that you get a better experience as the year goes on. :(
 
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ILoveLampS

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Thanks very much to both of you for replying! MudPhud, thanks for your advice; there are a few fields that I am interested in (prior lower level experience in them as a tech). I can't really reveal too much, because I'm afraid of being identified and ceremonially castrated by our admin :scared:.

SMQ123, thanks for your input too; I am glad things are going well for you. It is nice to see that at least some places are getting it right and keeping their students at the medical forefront.

At this point, I am doing the absolute best I can by reading, shadowing, reading, watching internet procedure videos, etc... but nothing is an acceptable substitute for a good educational experience :(. I'd quite honestly rather quit medicine than enter it incompetently and risk hurting someone. I hope 4th year is better.
 

gouda

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But even if you're given the flexibility of being out of state, you have no guarantee the rotation will turn out okay in terms of a learning experience. Each rotation is a gamble, and from what it sounds like you have very little left to lose if you just perform the bare minimum required and study during the down time (you did mention step II). One thing I didn't realize about all the away rotations is how tiresome it is learning a new system (from computers to where to find food). Often all the "newness" making the rotation even more awkward than it already is, and students that do most of their sites in one area are just more adept by comparison.

If you really feel like you're missing out make sure you take the time to do the reading. At the very least you should have a sense of the time or steps it may take for simple pt care. I agree third year has many cons, but it doesn't help focusing on them.
 
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OddNath

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If you really feel like you're missing out make sure you take the time to do the reading. At the very list you should have a sense of the time or steps it may take for simple pt care. I agree third year has many cons, but it doesn't help focusing on them.
Bad rotations happen everywhere. Studying for that shelf exam is what will count on Step 2. Read cases, do lots of questions, rock the shelf...and you can basically consider the rotation a success.
 

NeuroTox

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Some of mine are turnin out like this too. I use the extra time to do questions and read. This has resulted in passing the shelf exams I've already taken as well as provided early study for Step 2. Take advantage of whatever situation you're in.
 

LadyGrey

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During surgeries, I was afforded little autonomy, instruction, explanation, etc... most questions I asked were answered with "go read up on it."

Autonomy? As a third year, in the OR? :confused:

The other ob/gyn stuff sounds more problematic -- it's ridiculous, IMHO, to come out of your third year clerkship without getting to do any pelvic exams, Pap smears, or breast exams. However, I got to do a whole lot more of that during my fourth year EM rotations, so there are other places to pick up skills that you're not getting now.
 

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It really does sound like you're getting a subpar clinical education this year, which is a shame because I think I can guess where you go to school and know the tuition there is outrageous for oos students. I'll echo the advice above about learning what you can on your own time to do as well as you can on Step 2. Also, I'm wondering if you can strategically plan your electives and away rotations next year to fill in these holes.
 

ILoveLampS

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It really does sound like you're getting a subpar clinical education this year, which is a shame because I think I can guess where you go to school and know the tuition there is outrageous for oos students. I'll echo the advice above about learning what you can on your own time to do as well as you can on Step 2. Also, I'm wondering if you can strategically plan your electives and away rotations next year to fill in these holes.


Bingo. LOL; how did you guess? :)
 

Red Beard

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I hear ya, I think 'preceptor based rotations' are way oversold. The schools make it sound like such a good deal..."its just you and the doctor. No other students, interns, or residents." I will say that yes, I have had a lot more 'hands on' than my friends doing traditional academic rotations. I got to first assist on several ob-gyn surgeries for example, caught a lot of babies....my buddy doing a GI elective got to do 4 colonoscopies today with his preceptor standing behind him. But realistically, these things are not that meaningful in the long run. In internship and residency there will be more than enough 'hands on'....what we need now is a large variety of patients, a lot of H&Ps, and a lot of opportunity to come up with a guess for A&P to be critiqued by those ahead of us. I am certainly NOT getting enough of that in my little community hospital medicine preceptorship! And frankly I am getting a little nervous about the quantum leap I will have to make to get up to speed for my sub-I and internship.
 
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Autonomy? As a third year, in the OR? :confused:

The other ob/gyn stuff sounds more problematic -- it's ridiculous, IMHO, to come out of your third year clerkship without getting to do any pelvic exams, Pap smears, or breast exams. However, I got to do a whole lot more of that during my fourth year EM rotations, so there are other places to pick up skills that you're not getting now.
I doubt s/he means autonomy in the OR, but rather in general. I felt like I had a fairly long leash on most of my rotations. When I was on surgery, I carried the consult pager when on call, and if we got a consult, I'd take the call and talk to the attending/resident. I'd ask everything I wanted to know, tell my senior that I was going to go see this consult, and I'll page him when I'm done. Then I'd go do the consult as thoroughly as I wished. When we got traumas, I had a designated role in the trauma bay - I wasn't shadowing, I was expected to do things (cut off clothes and jewelry, foley, fem stick, rectal). I rounded on my own patients in the morning by myself (someone came by after), and they'd let us do things like remove sutures, staples, etc., and we could help with bigger things like chest tubes.

I thought it was a good mix of supervision and autonomy, and I had a really good time.


As for the OP, yes, it does sound like you're having a terrible experience. I've heard a number of people from many different schools say that their OB/GYN rotation was pretty rough, but from your description of your experiences and your classmates' experiences, it's pretty reasonable for you to expect more from your school.
 

hooperg

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My Example: On my ob-gyn rotation (I am male), I was hastily paired with a female physician for 4 weeks. Of every patient who walked in the door, 70-80% did not want me in the exam room. Of the remaining 30% who agreed, I was allowed to do ZERO pap smears, ZERO biopsies/breast exams, or ANY other procedure for that matter. During surgeries, I was afforded little autonomy, instruction, explanation, etc... most questions I asked were answered with "go read up on it."

I have had a very similar experience thus far (1 week to go). I cannot imagine going into that field let alone in WV :eek:
 

Mr. Freeze

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I guess I don't really have much to add beyond what has been stated above, but I will say this: you will have the exact education you allow yourself to be given. Speak up. Tactfully. Explain to people where you think holes exist in what you are learning, and ask them how to fix it. I think people will generally be inclined to help.

I don't know if pelvics/paps are some big thing you want to do or if that was just an example, but at least at my place if you can get into an adolescent clinic you can get more pelvics than your sniffer can stand. I remember telling people "peds gyn" when they asked what I wanted to do; now I have effectively r/o that ****, joke or not...

And I dunno, but as an aside asking unsolicited questions can be real iffy, particularly if you haven't already read a little on your own. When I was on surg, if you asked a question of certain residents with anyone who outranked that resident (s), you bought yourself an automatic 3-pg report on said topic to be presented before p.m. rounds the next day. If it was legit, no, they wouldn't do that stuff, but if you asked something that should be part of your reading already, get thee to UpToDate...
 
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45408

And I dunno, but as an aside asking unsolicited questions can be real iffy, particularly if you haven't already read a little on your own. When I was on surg, if you asked a question of certain residents with anyone who outranked that resident (s), you bought yourself an automatic 3-pg report on said topic to be presented before p.m. rounds the next day. If it was legit, no, they wouldn't do that stuff, but if you asked something that should be part of your reading already, get thee to UpToDate...
If you want to avoid that sort of thing, it definitely helps if you put a conditional spin on it. Rather than asking what the indications are for operating on a small bowel obstruction (you might as well tell them you're looking for reading assignments), ask something specific, like "What was it about this patient that we decided to do X instead of Y?"

I learn well by asking questions though, and while I do read, I also like it when I'm with people who are willing to just explain. I'm on a rotation right now that's great for that sort of thing, and I feel like I'm learning a lot when they are happy to explain.
 
N

njbmd

I know this may sound like a big bi*** fest, but I really want to know if students from other institutions are having such a miserable third year? If so, does your institution permit you lots of flexibility in scheduling rotations/going out of state, because ours does not. We feel like we have learned essentially NOTHING this entire year, and that if we voice any displeasure, the admin/site coordinator will crush us (they are very vindictive). If any of you have had a similar experience, did it require a lot of extra work to make up for it fourth year and internship year? Did it affect your performance on Step II?

Thanks for your input!

First of all, my third year experience was outstanding and nothing like you describe. We had lectures, clinical sessions and loads of teaching which was nice. That was my experience.

Why was my experience outstanding? It was because those that came before me took the initiative to point out problem clerkship locations and offer suggestions. We did the same if there were any problems too. In short, if we encountered things that were counter to our learning, we were able to point these out to our clerkship directors and deans. They were very responsive when approached professionally and respectfully. I definitely think that this made a difference.

The next point is that if you have tons of time "standing around" then take stuff with you (stuff your pockets) and do some board study/shelf exam study. If your questions are not answered, the keep asking them. If you are doing third year rotations, then you should have some classes/lectures. If you don't, then you need to let your clerkship director know because lectures and presentations are the main way of learning outside of experience during third year. If you medical school is accredited, they have to meet certain standards. You may have to hold them to these standards because the things that you state above are not standard.

Lastly, if your residents are not teaching, your attendings and clerkship directors need to know. If your attending preceptors are not teaching, your clerkship director needs to know. If your clerkship director is not listening to your needs, you dean needs to know. They need specifics in black and white. You need to stand as a group united as it sounds like no one is getting the educational experience that they need. After all, you are paying for the privilege of this coursework and you need to ensure that it is quality for you. When you start paying back those loans, you need to have gotten your money's worth. It's up to you to ensure this.

They can't "crush" the entire class or even half of the class. The LCME would "crush" them. Get a copy of the LCME regulations and specifically point out where your school is not providing what you need.
 

USArmyDoc

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Third year rocks....I don't mind the hours and the studying I do. It is so much different than the first two years...first two years blow
 

meister

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This sounds like a huge issue and should definitely be raised with school administration. I don't know about you, but I am not paying $40k/year to shadow docs a few hours a day. I was doing that as a damn pre-med. You should get a few people together and start some serious complaining to get things moving. This is utterly unacceptable, and come intern year no one is going to let you get away with anything because your third year clerkship was left wanting.

Good luck.
 
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