Most Important Things When Choosing a Medical School...

[Planes2Doc]

There's an enormous disconnect between the typical SDN pre-med and the SDN medical student. As a pre-med, you're typically a perfectionist that will be very upset with anything less than an A. But what about a medical student? Believe it or not, they tend to be the opposite. Most are trying to pass and then do well on boards.

So in other words... The transition from being a top-of-your-class pre-med to medical student is enormous. So I wanted to point out a few very IMPORTANT things to consider that never gets mentioned in the pre-allopathic forum. I believe this is way more important than the "fit," school's mission, school's location, etc...

Grading System: If you go to a letter-grade school that uses A/B/C/F, you'll probably go through absolute hell. You will need to memorize the smallest of minutiae in order to get that A. Trust me, you haven't experienced anything like this in undergrad before. So what does this end up doing? It causes way more stress and makes you focus more on pointless details than getting the big picture for Step 1. I noticed that people who go to true P/F schools have time to study from board review books, and therefore technically study for the boards at the same time. People also seem less stressed and less prone to burnout. These are enormous issues in medical school.

You should: Go to a true P/F school if possible. Avoid A/B/C/F like the plague.

Mandatory Classes: In undergrad, I never ever missed a class unless I was extremely ill. When you go to class in undergrad, you probably get either oral notes or notes written on the chalkboard/white board from the professor. You write them, study them, and then take the exams. You don't really have that in medical school. Usually it's professors reading off of Powerpoint slides for hours. In other words, many medical students find classes to not only be pointless, but actually harmful. I found that I ended up doing way better when I stopped going to class. Sure it may seem counter-intuitive now, but once you get there, you'll understand. I don't think many schools have mandatory lectures (PBL is different), but I definitely feel bad for the people that do.

You should: Go to a school without mandatory lectures. If you find lectures productive, then more power to you. But it's definitely better to have a choice if you find lecture to be a waste of time.

Problem Based Learning (PBL): These are pretty much mandatory group sessions where you work on cases or something like that. If you look into the allopathic thread, you'll see that a majority of people are not fans. I realize that schools are trying to increase the relevance of pre-clinical material to clinical applications. But at the end of the day, your knowledge, especially as an MS1 is extremely limited. Therefore, for a lot of people. It's far more of a nuisance than something productive. It also doesn't really teach anything that is practical for Step 1 anyhow. If you really enjoy group work, then that's good. But for those of you that like to study yourselves, it really sucks when you're being dragged out to a mandatory class for an hour or two. A lot of schools are incorporating it, so it's kind of hard to avoid it.

You should: Make sure the school has a minimal amount of PBL sessions. Once again, it's nice to have that choice as to how you spend your time. Some people might like it, however, but generally speaking, a lot of people find it as one more annoying thing to do.

You never hear the above things being mentioned... Considering that you will invest virtually all of your time into studying, I doubt that the things most commonly mentioned here will matter. Does it really matter where your school is located if you're stuck in the library all day? Does it really matter how nice the facilities are?

I think the grading system, lecture attendance, and PBL will have the most impact on your pre-clinical education. This can mean the difference between enjoying life or going through hell. If you're going through hell, I don't think you'll care about much else. Choose wisely, and good luck!

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[Ravizzle]

Tuition and location trump these IMO.

Sent from my Galaxy S2

 

[goofball]

What about tuition, location, and match lists?

 

[nysegop]

Thanks for the tips. I bookmarked. What about USMLE and match lists?

 

[Planes2Doc]

What about tuition, location, and match lists?

Most schools are going to be expensive regardless. I realize that all people are different.

I realize that a lot of people look at match lists, but how is that going to affect YOU directly? It's probably more beneficial if you end up with higher board scores from a school with a "less impressive" list than low board scores from a school with a "more impressive" list. It's all on you. What others do makes no difference. At least that's how I see it.

I realize how people have concerns about location. Obviously this is a big one. But if you're going to be stuck in the corner of the library for hours on end (including weekends), then will it matter whether you're in the big city or the country side?

Thanks for the tips. I bookmarked. What about USMLE and match lists?

Thanks! See above for match lists. I think that people who go to true P/F schools have the opportunity to read through board review books. This will probably help them tremendously when studying for boards. At a letter-grade school, you need to nail that minutiae down if you're going to get that A. I think this will probably detract you from learning what's important. The best example of this is the anatomy courses. Gross Anatomy and Neuro have insane amount of details, yet are low yield on the boards.

 

[as1212559]

Gym?
Proximity to taco bell?
Proximity to beach?
Female to male ratio?

come on OP

 

[DrBowtie]

Most schools are going to be expensive regardless. I realize that all people are different.

I realize that a lot of people look at match lists, but how is that going to affect YOU directly? It's probably more beneficial if you end up with higher board scores from a school with a "less impressive" list than low board scores from a school with a "more impressive" list. It's all on you. What others do makes no difference. At least that's how I see it.

I realize how people have concerns about location. Obviously this is a big one. But if you're going to be stuck in the corner of the library for hours on end (including weekends), then will it matter whether you're in the big city or the country side?



Thanks! See above for match lists. I think that people who go to true P/F schools have the opportunity to read through board review books. This will probably help them tremendously when studying for boards. At a letter-grade school, you need to nail that minutiae down if you're going to get that A. I think this will probably detract you from learning what's important. The best example of this is the anatomy courses. Gross Anatomy and Neuro have insane amount of details, yet are low yield on the boards.

I suspect the OP is either MS1 or MS2 given the incredible focus on grades and board scores.

Quick points:
Grading system: True P/F UNRANKED is available only at a few schools. P/F is fairly common but they keep an internal rank for your Dean's letter which will include a specific adjective to differentiate into quartiles or quintiles. Class rank will matter for AOA. Also H/HP/P/F is pretty much A/B/C/F.

Agree that mandatory class and PBL is awful.

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

 

[Ismet]

Tuition and location trump these IMO.

Sent from my Galaxy S2

Tuition is a big factor, yes, but I would go to a slightly (relatively) more expensive school if it means P/F, non-mandatory classes, and keeping my sanity (I did choose a more expensive school for those and other reasons). Location doesn't trump these things. You really can't say what trumps what until you've experienced how pointless lectures are and how hard it can be sometimes to even score above average on exams.

 

[Planes2Doc]

Tuition is a big factor, yes, but I would go to a slightly (relatively) more expensive school if it means P/F, non-mandatory classes, and keeping my sanity (I did choose a more expensive school for those and other reasons). Location doesn't trump these things. You really can't say what trumps what until you've experienced how pointless lectures are and how hard it can be sometimes to even score above average on exams.

Indeed. If people were concerned about location, they would flock to the Caribbean. Yet Caribbean students aren't enjoying the wonderful scenery because the ones that will end up practicing here are locked up studying virtually non-stop. The same thing goes for US students. US MD and DO students probably aren't party animals living it up every weekend.

I admit I overlooked some things. But I guess it's best to get through pre-clinical years withoutbeing depressed and burned out by the end. Also in response to class rank, that isn't near the top of the list for residency placement. The USMLE trumps it all, and of course clinical grades are important as well. I wonder if the clinical sites make a difference in the end when it comes down to residency placement?

 

[Wordead]

I would put a school with big shot faculty above any of that for people trying to match into competitive specialties. Pre-clinical matters little, and even people at schools that have grades and mandatory stuff manage to do well on the boards. But even if you get a 300 Step 1, you'll get passed over by a 240 + letter from someone important in the field.

Also, ^^ AOA is important so if your school judges that based on class rank....

 

[Tots]

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

With this in mind, how does an accepted applicant go about understanding the differences in clinical years between schools? I have talked to 3rd/4th years at some schools but honestly I don't know what to look for, what is good vs what is bad.

 

[d12]

Tuition is a big factor, yes, but I would go to a slightly (relatively) more expensive school if it means P/F, non-mandatory classes, and keeping my sanity (I did choose a more expensive school for those and other reasons). Location doesn't trump these things. You really can't say what trumps what until you've experienced how pointless lectures are and how hard it can be sometimes to even score above average on exams.

I was just wondering how much of a tuition difference would ultimately sway you into going to a school that was H/P/F with mandatory lecture versus an unranked p/f school with non-mandatory? I have a feeling I'll be making this decision relatively soon and I'm trying to get a few opinions. Up to 5k/yr diff? 10k? 20k? Much appreciated!

 

[cookiemonsters]

It seems like the majority of people hate the idea of PBL, so why are more and more schools trying to make it a larger part of the curriculum? One of the places I interviewed at is a 100% PBL curriculum, which I thought was just silly.

 

[Planes2Doc]

I was just wondering how much of a tuition difference would ultimately sway you into going to a school that was H/P/F with mandatory lecture versus an unranked p/f school with non-mandatory? I have a feeling I'll be making this decision relatively soon and I'm trying to get a few opinions. Up to 5k/yr diff? 10k? 20k? Much appreciated!

You can't put a price on unranked true P/F.

 

[KnuxNole]

What is good in your clinical years: Being able to be an active member of the team. Carrying multiple patients in your ward rotations. Being able to write notes vs. writing "fake" notes that aren't checked or critiqued. If interested in surgery/OB: adequate OR exposure & L+D exposure. Although I would argue everyone should learn how to deliver a baby.

What is bad in your clinical years: Shadowing. 3rd year isn't supposed to be passive. You don't need to be working 15 hours a day but you basically need a good amount of experience so PDs won't raise their eyebrows and question if this kid can handle intern year.

Variable: Required rotations. Is there a lot of focus on rural rotations? Are sub-internships required? Are there rotations in the field you want vs. doing away rotations? The last question is probably not a good one for me to mention....since people change their mind all the time...my bad.

Scut protection. This one is hard to ask med students because they might not want to say it's that bad. There is a difference between real scut("get me coffee!" "fax 100 papers") vs. fake scut("go ask this patient XXX question" "you should go see this consult"). Yes, there was a student who rolled her eyes at seeing consults.

 

[Ismet]

I was just wondering how much of a tuition difference would ultimately sway you into going to a school that was H/P/F with mandatory lecture versus an unranked p/f school with non-mandatory? I have a feeling I'll be making this decision relatively soon and I'm trying to get a few opinions. Up to 5k/yr diff? 10k? 20k? Much appreciated!

I was offered a 10k/year scholarship at another similarly-priced school but chose my school. A lot of other factors go into a decision, Planes2Doc just wanted to point out some things that pre-meds don't realize and might not consider to be very important. I really wanted to attend Pitt, so I'm sure I would have looked past a 20k difference as well, depending on what the other school(s) were. If the difference is relatively small, like 10k or less, I'd probably go with the unranked p/f, but like I said, a lot of other factors go into it.

 

[DrBowtie]

With this in mind, how does an accepted applicant go about understanding the differences in clinical years between schools? I have talked to 3rd/4th years at some schools but honestly I don't know what to look for, what is good vs what is bad.

I'd figure out if they have multiple sites, how are they decided. For third year rotations, I'd do as many at places that have residency programs as possible, especially in fields you are interested in. Order of rotations does not matter. Grading differences are minor points and variable amongst rotations, but can be a source of frustration.

For fourth year, when does it start is important as you can fit in more audition rotations if needed the earlier fourth year begins. Also how much time off/blow off rotations are available to interview during. As things get more competitive, the # of interviews required to match will go up. # of elective months overall.

Other important things, but difficult to assess are available mentorship, important people who write strong letters, medical student involvement meaning note writing, procedures, medical decision making on sub I.

 

[Dbate]

Gym?
Proximity to taco bell?
Proximity to beach?
Female to male ratio?

come on OP

THIS.

I went to a college that was no where near walking distance to a taco bell. I will make sure I don't make the same mistake for medical school.

 

[Ismet]

It seems like the majority of people hate the idea of PBL, so why are more and more schools trying to make it a larger part of the curriculum? One of the places I interviewed at is a 100% PBL curriculum, which I thought was just silly.

I ask the same question myself. PBL can be beneficial, it just usually isn't. I usually don't mind PBL too much as often we're going over stuff from class in a clinical application, but sometimes (usually dependent on the facilitator and how much control they give us) it can feel like a waste of time. I really enjoy day 1 of PBL because it feels like we're Dr. House ...day 2 of PBL with the student presentations can get redundant very quickly.

 

[MusicJunkie]

This is awesome.

Thanks for starting this thread, OP.

I think that it would be cool to make this a list that people could add on to, as to get various opinions on the subject. Granted, everyone has a different opinion on what is, and is not, important.

I'm accepted at a school that is true P/F (no internal ranking, dean's letter only indicates that you passed), lectures are not mandatory, but there are PBL sessions twice a week (2 hrs/each). Not a terrible deal!! But I've spent some time wondering about the questions I should be asking about clinical years - as a pre-med, you just don't know what to ask when it comes to the clinical curriculum because it's such a different ball game.

 

[Planes2Doc]

This is awesome.

Thanks for starting this thread, OP.

I think that it would be cool to make this a list that people could add on to, as to get various opinions on the subject. Granted, everyone has a different opinion on what is, and is not, important.

I'm accepted at a school that is true P/F (no internal ranking, dean's letter only indicates that you passed), lectures are not mandatory, but there are PBL sessions twice a week (2 hrs/each). Not a terrible deal!! But I've spent some time wondering about the questions I should be asking about clinical years - as a pre-med, you just don't know what to ask when it comes to the clinical curriculum because it's such a different ball game.

Thanks!

Congrats on the acceptance and even with the PBL, it does sound like a very good choice. As for the clinicalcurriculum, I don't think I have ever seen anything mentioned before in pre-allo. As an MS1, I don't know much about it, and would like to learn more.

 

[Geebeejay]

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

I agree with this being the most important part, but I'm having a very difficult time gauging the differences between schools. Any tips? I am planning on shadowing at the medical schools I've been accepted to so hopefully I can get a feel of what the M3 M4 experience is like. I am hesitant to ask too many questions regarding scut/responsibilily/"shadowing" concerns due to worry of sounding like a dick.

Below is a post of mine from a previous thread listing some things I am considering while choosing between different schools. Would be nice to know if I'm on the right track here!

Other considerations: These are some of the things I've considered at least a little bit

urban vs. nonurban population

climate (i.e. a medical school in the rockies will expose you to different disease/injuries/people than a school in Florida)

primary languages of the city where the medical school is located (want to learn how to take a history using an interpreter? Might not want to go to choose U Miami over UVM then. Want to take advantage of the Italian you've spent 6 years trying to learn? Boston, Philly or St. Louis might be a better choice for you than Denver)

other specialized hospitals in the area: If there's an affiliated hospital down the street from your medical school that is a top 5 stroke center, you can bet that your university hospital will get significantly fewer stroke cases. Might not be a good choice if you want to be a neurosurgeon and you're looking forward to your neuro/nsgy rotation. Same goes for other specialties. Not sure how important this is, but worth considering.

Public vs. Private hospital

Strength of residency program (weak, frazzled, clueless residents = weak, frazzled, clueless teachers)

"Scope of Practice" of medical students - I might get some argument from this, but different medical schools afford different levels of "hands on learning". Are you going to be suturing lacs and starting ultrasound-guided lines while on the wards, or are you going to be in more of a "shadowing" role for the whole 2 years. I am under the assumption that the big academic powerhouses occasionally swing toward the latter (many reasons: more doctors, more in-house specialists, more administrative "politics", more "big-shot" doctors who do all the cool procedures themselves) while the smaller, public universities in more underserved areas may afford for some more hands-on experience.

 

[DoctwoB]

I think the OP is right on with some things, while off on others, but agree that it neglects the clinical years, which are the more important, more variable, but harder to assess part of choosing a med school. Obviously things like cost and location are important, but so individualized that I'm not including them.

Things that are important pre-clinically:

(1) Optional classes. Even if you plan on attending every class, you won't know until you've tried what method will work best for you. Having the option to not attend lecture gives you much more flexibility.

(2) How PBL is structured: This is a bit tricky, as PBL can be done both well and poorly. In general my thoughts are that going over pertinent clinical cases with faculty members is good, while assigning learning objectives and "teaching"each other through 5-10 minute powerpoint presentations is a waste of time. PBL should be about obtaining something you can't get from lecture, namely a hands on/more practical sense of how the material your learning can be applied clinically, as well as learning a more clinical "what test/imaging/treatment do you do next" approach to problems, which is tested on step1 and useful on the wards. As such, it is generally a lot more useful for more clinically relevant courses (e.g. cardiology) then it is for biochem

(3) A good syllabus for classes. My school gave us condensed syllabi for each class containing the highlights of each lecture with all the key study points and diagrams. You could study exclusively from them and do well on tests as well as get good board prep. The few classes with less useful syllabi definitely felt the lack. There are review books, but with some exceptions (e.g. BRS physiology, clinical micro made ridiculously simple), these either tend to be way too detailed or too oriented towards facts and not understanding.

Things that are less important that some tend to agonize over:
-grading system. People tend to obsess about this, but ultimately it doesn't make a huge difference. Pre-clinical grades matter very little except for AOA, which many schools keep track of anyways even if they're p/f. Regardless of grades, you need to learn the material for Step1, shelf exams, and for yourself. Yes there's a ton of minutiae, but there's a ton of minutiae on every medical exam you'll ever take. If you're someone who will go insane agonizing over getting the honors in biochemistry, then it may be important to you, but for most it shouldn't be a big issue

-People per cadaver in anatomy. In the end you'll appreciate having others dissect so you can just learn to appreciate the anatomic relationships. Some schools are even prosecting

-Early clinical exposure. As long as your school does a good job teaching you how to do an H&P, ultimately those 10 practice ones you did in 2nd year won't make a huge difference by the time you're done with 3rd year. It can help your confidence a bit come the beginning of third year though.

 

[as1212559]

-People per cadaver in anatomy. In the end you'll appreciate having others dissect so you can just learn to appreciate the anatomic relationships. Some schools are even prosecting

This x1000. Srs. Prosecting is a little lame in my opinion, but I have never heard a medical student say they wish they had more dissecting time. Don't let anyone BS you about a low student to cadaver ratio being a selling point.

 

[Planes2Doc]

This x1000. Srs. Prosecting is a little lame in my opinion, but I have never heard a medical student say they wish they had more dissecting time. Don't let anyone BS you about a low student to cadaver ratio being a selling point.

Oh my god yes!!! It sucks when you waste hours digging through fascia, when an anatomist can do it cleaner in a few minutes! Prosecting is the best thing ever.

 

[somethingdeep]

Quick points:
Grading system: True P/F UNRANKED is available only at a few schools. P/F is fairly common but they keep an internal rank for your Dean's letter which will include a specific adjective to differentiate into quartiles or quintiles. Class rank will matter for AOA. Also H/HP/P/F is pretty much A/B/C/F.

Does anyone know if there's a master list somewhere of which schools have true P/F and which have an internal ranking system?

 

[DrBowtie]

Does anyone know if there's a master list somewhere of which schools have true P/F and which have an internal ranking system?

Not sure. However, don't always trust the MS1 or MS2 giving the tour to answer this question. Some may not be aware of internal ranking systems.

 

[sazerac]

The weird thing is, if you ask a med student at a pre-clinical P/F school, they will tell you that ABCDF or the equivalent H/HP/P/CP/F schools are a living hell because you are always fighting for those last few points.

But if you talk to a student at a school that uses more than just P/F for pre-clinical years, they will assure you up and down and stamp their feet that at a multi-grade school there is no curve so everybody can get an "A" or "honors" or whatever if they want, while at those vicious P/F schools some students are guaranteed to fail every class due to the implicit curve.

Last year I went through this argument multiple times from multiple sides at multiple schools and also followed several pre-allo and allo SDN threads, and this mutual misunderstanding seems damn near universal. Everybody thinks their pre-clinical grading system is better, easier, and fairer than that other system at that other med school.

In the end I suspect both pre-clinical grading systems are fine, fair, low stress, and most importantly irrelevant to your future career.

 

[aloepathic]

I suspect the OP is either MS1 or MS2 given the incredible focus on grades and board scores.

Quick points:
Grading system: True P/F UNRANKED is available only at a few schools. P/F is fairly common but they keep an internal rank for your Dean's letter which will include a specific adjective to differentiate into quartiles or quintiles. Class rank will matter for AOA. Also H/HP/P/F is pretty much A/B/C/F.

Agree that mandatory class and PBL is awful.

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

This.

Everything about the preclinical years seems super important when you're preclinical, but other than preparing you for Step 1 and the wards, it amounts to one sentence on your Dean's letter (seriously). Hard to swallow given how tough the years can be at times, but seriously, it's 1 sentence (you get paragraphs for each clinical rotation). If having grades is going to stress you out unnecessarily, then yea, it matters. But realize that it's just you stressing yourself out, not a legitimate stressor.

I go to an H/P/F school, straight-passed every class for 2 years while learning the important stuff for Step 1, did well on that, then focused on the clinical years when it actually matters. Asked program directors at Harvard, Hopkins, Cleveland Clinic, and everywhere else I interviewed if they had any concerns or wanted to discuss my preclinical grades. Got blank looks and quotes that ranged from "why would I" to "isn't that what Step 1 is for?" Matched to my number 1 program (which is top 5) in a field with a 64% match rate.

tl;dr
preclinical grades don't matter even when they do exist, save the stress for Step 1 and years 3 and 4

 

[aloepathic]

In the end I suspect both pre-clinical grading systems are fine, fair, low stress, and most importantly irrelevant to your future career.

exactly

 

[aloepathic]

I'd figure out if they have multiple sites, how are they decided. For third year rotations, I'd do as many at places that have residency programs as possible, especially in fields you are interested in. Order of rotations does not matter. Grading differences are minor points and variable amongst rotations, but can be a source of frustration.

For fourth year, when does it start is important as you can fit in more audition rotations if needed the earlier fourth year begins. Also how much time off/blow off rotations are available to interview during. As things get more competitive, the # of interviews required to match will go up. # of elective months overall.

Other important things, but difficult to assess are available mentorship, important people who write strong letters, medical student involvement meaning note writing, procedures, medical decision making on sub I.

One thing that might be easy to assess for pre-meds is which residency programs a given medical school has. If your dream is to be rad-onc and the school doesn't have a program, it makes it harder to make connections, get good letters, and you don't have the benefit of a strong home rotation. Still possible (kid I know just matched ENT w/o a home program) but harder.

 

[Geebeejay]

Matched to my number 1 program (which is top 5) in a field with a 64% match rate.

Out of curiosity, where do we find data like this?

 

[Black Mamba24]

Out of curiosity, where do we find data like this?

What he said.

This.

Everything about the preclinical years seems super important when you're preclinical, but other than preparing you for Step 1 and the wards, it amounts to one sentence on your Dean's letter (seriously). Hard to swallow given how tough the years can be at times, but seriously, it's 1 sentence (you get paragraphs for each clinical rotation). If having grades is going to stress you out unnecessarily, then yea, it matters. But realize that it's just you stressing yourself out, not a legitimate stressor.

I go to an H/P/F school, straight-passed every class for 2 years while learning the important stuff for Step 1, did well on that, then focused on the clinical years when it actually matters. Asked program directors at Harvard, Hopkins, Cleveland Clinic, and everywhere else I interviewed if they had any concerns or wanted to discuss my preclinical grades. Got blank looks and quotes that ranged from "why would I" to "isn't that what Step 1 is for?" Matched to my number 1 program (which is top 5) in a field with a 64% match rate.

tl;dr
preclinical grades don't matter even when they do exist, save the stress for Step 1 and years 3 and 4

Also, did you get a sense of the importance of AOA from the program directors you talked to? I know this has been discussed at length on SDN so I don't want to start another debate. I just want to know your opinion on the matter since you seem to have done well in terms of securing your desired residency (presumably) w/out being AOA.

 

[yehhhboiii]

I suspect the OP is either MS1 or MS2 given the incredible focus on grades and board scores.

Quick points:
Grading system: True P/F UNRANKED is available only at a few schools. P/F is fairly common but they keep an internal rank for your Dean's letter which will include a specific adjective to differentiate into quartiles or quintiles. Class rank will matter for AOA. Also H/HP/P/F is pretty much A/B/C/F.

Agree that mandatory class and PBL is awful.

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

Well isn't it variable even within each school? You can have people in different hospitals, different departments and even different attendings at the same hospital grading differently. Also there's weighting placed on shelf exams varies.

 

[dweji16]

Is it better to go to a school that has a big teaching hospital affiliation during clinical years.... Or a school that has several locations to do your clerkships at smaller hospitals?

 

[lobo.solo]

Thanks OP and everyone else sharing your thoughts on this. Definitely an important aspect of pre-med that we don't discuss a lot; probably because we're so focused in getting in (no matter where).

 

[myPsychAlt]

Is it better to go to a school that has a big teaching hospital affiliation during clinical years.... Or a school that has several locations to do your clerkships at smaller hospitals?

do one that has BOTH. I liked the change of scenery to get out of the city to a rural hospital for a few months. Free meals and lodging to go an hour or two away.

 

[Frazier]

They may have already been mentioned above, but concerning the clinical years, some of the issues extra pertinent to me included:

Scheduled electives during 3rd year (some schools prefer to stack all electives in 4th yr).

No mandatory away rotations. (If you don't have a SO or anything tying you to a particular location, no biggie. But, for me, doing months and months of required aways was not appealing... some aways will be necessary evil if you want a competitive specialty, but if rural medicine isn't your thing...you're prob not going to be happy swallowing that pill they force in your mouth.)

Sufficient electives in a variety of specialties. You can find the listings in course catalogs. It's nice to see a variety of opportunities for the specialties that you want to explore (in opposition to just one 2 week rotation).

Length of required rotations. If I already know that surgery and obgyn isn't going to be my calling it is nice that I'll only have to deal with 6 weeks of each (instead of 8 each). Big difference? A month less of "suffering" sounds good to me!

Who is/are the attendings that offer the rotation/s in your specialties of interest? Are they bigwigs? Doing well with them could result in a solid lor.

Etc.

Edit: Perhaps none of these issues are strong enough to completely save or sink a school from my consideration, but they certainly warranted being factored into a comprehensive pro/con analysis for each school.

 

[markyb03]

I don't want to hijack this thread but I also don't feel my question warrants a new thread so please forgive me. But does the university hospital ranking where you'll be doing your rotations at matter much? If you want to go into some small competitive specialty (let's say ENT) and the univ. hospital is highly ranked in ENT, could that help in terms getting a LOR from well respected ENT docs? Would that experience rotating in that specialty or those letters be more valuable for getting an ENT residency rather than a LOR from an ENT doc not a top ranked ENT hospital?

I also agree with Blais that lots of electives time in rotations is something I'm looking at for deciding between schools

EDIT: Also this..

Is it better to go to a school that has a big teaching hospital affiliation during clinical years.... Or a school that has several locations to do your clerkships at smaller hospitals?

 

[alpinism]

With this in mind, how does an accepted applicant go about understanding the differences in clinical years between schools? I have talked to 3rd/4th years at some schools but honestly I don't know what to look for, what is good vs what is bad.

15 things to look for in 3rd year:

1) Most if not all rotations have residency programs (esp in the fields you're considering)
2) Most if not all rotations have weekly conferences and grand rounds
3) Low student to faculty ratio on rotations
4) Faculty and residents that love to teach and learn. Essentially, does the hospital have a culture of the residents/med students being there to work (bad) or being there to learn (good)? (bad = malignant)
5) Clinical faculty who are leaders in their field
6) Med students are protected from scut
7) Med students are responsible for their own patients and have a large "scope of practice." You learn best by doing, not watching. (You should be writing real SOAP notes, coming up w/ a DDx, ordering Dx tests, planning and discussing Tx options w/ your resident/attending as part of a team, and then assisting in surgery or helping to perform medical procedures)
8) Med students have a list of procedures that should be done during each rotation.
9) Med students have a list of learning objectives for each rotation
10) Med students get exposure to both university and community hospitals
11) Standardized grading rubric for rotations.
12) No limit on number of Honors given out per rotation.
13) Ability to do 3rd year electives and away rotations.
14) The hospital(s) are busy w/ lots of diverse pathology and see enough patients so you’re not just sitting around all day doing nothing.
15) The hospital(s) have a primarily low and middle income patient population that is open to letting med students take an active role in their care (many rich patients often only want to see attendings).

 

[IslandStyle808]

This tread is full of win. Thank you to all the medical students and residents who have contributed.

 

[nysegop]

15 things to look for in 3rd year:

1) Most if not all rotations have residency programs (esp in the fields you're considering)
2) Most if not all rotations have weekly conferences and grand rounds
3) Low student to faculty ratio on rotations
4) Faculty and residents that love to teach and learn. Essentially, does the hospital have a culture of the residents/med students being there to work (bad) or being there to learn (good)? (bad = malignant)
5) Clinical faculty who are leaders in their field
6) Med students are protected from scut
7) Med students are responsible for their own patients and have a large "scope of practice." You learn best by doing, not watching. (You should be writing real SOAP notes, coming up w/ a DDx, ordering Dx tests, planning and discussing Tx options w/ your resident/attending as part of a team, and then assisting in surgery or helping to perform medical procedures)
8) Med students have a list of procedures that should be done during each rotation.
9) Med students have a list of learning objectives for each rotation
10) Med students get exposure to both university and community hospitals
11) Standardized grading rubric for rotations.
12) No limit on number of Honors given out per rotation.
13) Ability to do 3rd year electives and away rotations.
14) The hospital(s) are busy w/ lots of diverse pathology and see enough patients so you’re not just sitting around all day doing nothing.
15) The hospital(s) have a primarily low and middle income patient population that is open to letting med students take an active role in their care (many rich patients often only want to see attendings).

Are these good questions to ask during an interview?

 

[prado]

Tuition and location trump these IMO.

Sent from my Galaxy S2

Are these good questions to ask during an interview?

Most of your interviews will be with an M1/2 as the M3/4s will be on rotations. So I think you're out of luck for the most part during the interview since the M1/2's don't have enough first hand experience with it.

 

[Geebeejay]

I don't want to hijack this thread but I also don't feel my question warrants a new thread so please forgive me. But does the university hospital ranking where you'll be doing your rotations at matter much? If you want to go into some small competitive specialty (let's say ENT) and the univ. hospital is highly ranked in ENT, could that help in terms getting a LOR from well respected ENT docs? Would that experience rotating in that specialty or those letters be more valuable for getting an ENT residency rather than a LOR from an ENT doc not a top ranked ENT hospital?

I also agree with Blais that lots of electives time in rotations is something I'm looking at for deciding between schools

EDIT: Also this..

I don't know the definite answer to this, but if the hospital is a top ENT hospital, you will likely be able to get letters from some pretty well-known names in the ENT field and see/do some very interesting ENT procedures that simply aren't performed at lesser-performing hospitals.

 

[Twinnering]

Just wanted to say I appreciate all of the helpful advice on this thread! I was wondering myself what to look for especially regarding the third and fourth year of med school.

 

[alpinism]

Are these good questions to ask during an interview?

Only to M3s and M4s. The admissions office personnel and M1/M2s usually know next to nothing about the clinical years.

At every school you interview, ask for contact info for multiple M4s or recent grads (interns/residents). Every admissions office should have a list or be able to get the contact info from the alumni office.

Recent grads are the best b/c they're been though the entire med school process (incl. all the rotations) and can tell you how well the school prepared them for residency.

Always try to get multiple opinions to reduce bias.

 

[aloepathic]

Are these good questions to ask during an interview?

No, wait until you get in and then ask for the contact of some MS4s who can talk to you about their clinical years

 

[mimelim]

4) Faculty and residents that love to teach and learn. Essentially, does the hospital have a culture of the residents/med students being there to work (bad) or being there to learn (good)? (bad = malignant)
6) Med students are protected from scut

You learn by doing scut. Medical students are way over protected at the cost of their education. There is a large service component of being a resident. You need to know how to work efficiently and effectively. You should not be getting coffee or going to the dry cleaners, but people drastically overestimate the importance of conferences which are in general very low yield and underestimate the in the trenches, day to day skills that people learn. Consequentially, they are effectively useless when they come ini as interns.

7) Med students are responsible for their own patients and have a large "scope of practice." You learn best by doing, not watching. (You should be writing real SOAP notes, coming up w/ a DDx, ordering Dx tests, planning and discussing Tx options w/ your resident/attending as part of a team, and then assisting in surgery or helping to perform medical procedures)

This has nothing to do with the medical school that you go to. You should be doing this on every patient that you see and certainly can do this on every patient that you see. Just because you can't actually physically leave a note in the chart doesn't mean that you can't learn from it. Nobody can bill for a medical student's SOAP note. They are completely irrelavent parts of the medical record if they make it in. The learning happens when people spend the time to think about things, not because you wrote a note. Medical students never have "their own patients". Every patient still needs to be seen by a resident and the world keeps turning when medical students aren't there. If you want to get a good education, yes, you should be an active learner. But, the school that you go to makes little to no difference on this.

8) Med students have a list of procedures that should be done during each rotation.

No, they shouldn't. People that want to learn should be able to and will. Creating a checklist so that someone can do something once or more than likely lie about doing something once doesn't help anyone.

 

[alpinism]

You learn by doing scut. Medical students are way over protected at the cost of their education. There is a large service component of being a resident. You need to know how to work efficiently and effectively. You should not be getting coffee or going to the dry cleaners, but people drastically overestimate the importance of conferences which are in general very low yield and underestimate the in the trenches, day to day skills that people learn. Consequentially, they are effectively useless when they come ini as interns.

Agreed. I would only consider the above to be scut. In addition, I don't mind grabbing a cup of coffee for a busy resident/attending while i'm down in the cafeteria. Constantly doing the job of a tech or nurse instead of learning medicine would be another form of scut.

This has nothing to do with the medical school that you go to. You should be doing this on every patient that you see and certainly can do this on every patient that you see. Just because you can't actually physically leave a note in the chart doesn't mean that you can't learn from it. Nobody can bill for a medical student's SOAP note. They are completely irrelavent parts of the medical record if they make it in. The learning happens when people spend the time to think about things, not because you wrote a note. Medical students never have "their own patients". Every patient still needs to be seen by a resident and the world keeps turning when medical students aren't there. If you want to get a good education, yes, you should be an active learner. But, the school that you go to makes little to no difference on this.

Unfortunately, there are a lot of schools where much of 3rd year amounts to mostly "glorified shadowing" (esp at DO schools). Some places don't even let you interview pts, let alone practice writing notes. A medical student's notes are for practice only, but you still have to think in order to write a good note. The point of writing notes as a med student should be have them discussed and critiqued by your resident so you can learn and improve.

Having "their own patients" refers to being responsible for a small census of patients on the ward that you help to manage from start to finish regardless of the resident or attending that is assigned to them. You see them in the morning, write notes, present on rounds, and come up w/ your own management plan. There are a number of schools that do this on rotations (Georgetown and UCLA come to mind). It mostly refers to medicine rotations, not surgery. And yes, it is the resident/attending who is ultimately responsible for the patient.

In this case, you're not just mindlessly following around a resident and watching them work all day.

No, they shouldn't. People that want to learn should be able to and will. Creating a checklist so that someone can do something once or more than likely lie about doing something once doesn't help anyone.

In a perfect world i'd agree. However, there are many students who just aren't interested in certain rotations and only want to do the bare minimum or less. Then there are others that are too shy/reserved to ask to do procedures and residents who are too busy or don't like to teach. This results in some students not getting experience in basic procedures like they should. The checklist is a sort of baseline, you can (and should) always do more. I hate hand-holding and coddling as much as the next person, but if only the outgoing and enthusiastic students get the procedures, a good chunk of every class will be under-trained as interns when patient's lives are really at stake.

 

[username456789]

I suspect the OP is either MS1 or MS2 given the incredible focus on grades and board scores.

Quick points:
Grading system: True P/F UNRANKED is available only at a few schools. P/F is fairly common but they keep an internal rank for your Dean's letter which will include a specific adjective to differentiate into quartiles or quintiles. Class rank will matter for AOA. Also H/HP/P/F is pretty much A/B/C/F.

Agree that mandatory class and PBL is awful.

OP ignores clinical years completely which is really narrow sighted as it comprises almost half of your medical education, and arguably the most important. These are also the most variable among schools. THIS is where your focus should be in picking schools.

Bingo bango bongo, this is all correct and should not be ignored.