Ortho "ask me anything" thread

[NurWollen]

Ha! You posted this as I was writing the same thing!

So you were there too huh?

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[abolt18]

So you were there too huh?

Yeah it was a pretty awesome conference! It really helped me solidify my desire to go into medicine. Many great mentors there.

 

[Orthojoe]

Your experiences with discrimination against your degree are certainly disheartening. I think you did a better job keeping your cool than most.

And I have to ask...why do you think a DO makes a better orthopod than an MD. Them's fightin' words.

DISCLAIMER: these are my opinions based on my experiences. It doesnt make it right or wrong. It's gathered from rotating at 2 allopathic ortho and 6 osteo ortho. I also asked anesthesiologist/nursing staff/scrub techs etc questions between the two because I felt I had the stats to go either allo or osteo ortho. I wanted to know which one would provide to me the best opportunity. This only applies to ortho (maybe). Please dont post back attacking this post - well you can, but look we all get it, this is a generalization post.

"Why I think Ortho DO creates better surgeons that Ortho MD programs - INITIALLY"

One of the things I learned real quickly during my third year is that no matter how much you study, memorize, watch, discuss and read--- hands on learning is the best. You truly dont know how to manage a DKA patient until you have a DKA patient, you dont really know how to manage an ASA overdose or run a code until you actually do both. Experiential learning is hands and foot the best.

this can be applied, obviously, to the concept of a surgeon. This is why these programs are 5 years long. To get your hands on experiences in as many types of surgeries as possible (side note - I think ortho has the most variability in surgical operations and you need to know a gazillion times more anatomy).

What I observed, learned and discussed was that in allopathic program academia tends to be hugely emphasize in comparison to osetopathic program. Dont get me wrong, both push knowledge like crazy,, however allopathic programs take the cake. Great for medicine and other primary care fields where knowledge is king - but NOT so in the surgical world.

Allopathic programs sacrifice surgical experiences for knowledge/research. Interns rarely see the inside of the OR and when they do, its to hold retractors, prep patients and close. You end up doing the scut work (work that no one wants and really should be left up to the nurses or ancillary staff) Yes you can learn during during the operation by observing but its totally different then when you actually hold the knife (or scope or whatever). I found that in most cases it wasn't until late third year/fourth year that the residents got to do many of the surgeries from close to close. At one program I observed a third year being taught how to do a distal radius, one of the most common operations in ortho. I was shocked because I actually had done a distal radius close to close with a hand surgeon and knew the steps,anatomy,etc better. I watched a third year at a prestigious allopathic ortho program open only once and the rest was just closing in a 4 weeks time.

However they could tell you all the osteoprogenitor cells and what factors stimulated osteoclast growth and what's the new trials on bone growth factors, etc, etc I also discovered that MD programs have some huge surgical names to work with - ones who pioneered new procedures/research. cool right... well in most cases do you think these hot shot surgeons with huge reputations are going to hand the knife over to a second or third, maybe even fourth year resident.. It didnt happen and in fact I watched in most cases the residents get grilled/fired and roasted during the procedures with questions that have no bearing on surgery (Like, why is this instrument called the kelly forceps, who was the guy and what did he do- the resident didnt know and was shunned the rest of the operation.. happened at Mayo)

Now compare that do osteopathic programs which tend to be more smaller community based programs. In most instances as an intern there was plenty of OR time, and in fact the 4-5 year residents were expected to be the teachers for them on simple procedures. I saw second years roding femurs/tibias, placing screws, working one on one with an attending. Often third years were open to close. fifth years ran their own room (attending pops head in to start procedure for legal reasons then leaves). So the surgical experience and opportunities to operate were placed in a much higher emphasis. The surgical skills therefore, as a fifth year, were much more developed than in the allopathic programs.

I asked so many anesthesiologist about the difference in skills between allo and ortho residents -- they are the eyes in every OR. they almost always said the osteopathic residents are way more autonomous and have better surgical skills. they stated the third years were 1-2 years behind in surgical skills and in some extreme cases stated that they couldn't believe how little the senior residents operated.

i believe due to this, I would prefer to have a DO surgeon right out of residency operate on me as compared to a new MD surgeon. I'm not sure if this gap disappears after 5-10 years as an attending but its a major factor of why I DID NOT choose to participate in the MD match for ortho. I chose to match into a DO program because from day one I will be handed the knife, per say. Academics can always be learned on your own. I want to have the opportunity to be put in front of a patient, given the knife and guided as much as possible from day one.

by the way - the program I matched into I feel is the best osteo ortho program (Modesto California). just an amazing group of docs, case load and case variability. If you guys make it that far- make sure to come rotate. I'll be a senior resident, just mention this post and I'll make sure you get handed the knife, drill, saw or whatever.

 

[Orthojoe]

Love Elder Nelson! He came and spoke at a pre-med conference at UVU about 2 yrs ago and it was an awesome experience! Where'd you do your undergrad? Did you find that the Micro major (though 6 years removed) was beneficial in a good amount of classes during school? I'm a Micro major about to graduate from Weber State.

undergrad at a few colleges because I thought I could play baseball.. I initially started at RICKS.. for those of you who know that school, it shows my antiquity but ended up at BYU.

Micro was fine and helped in a few areas. but I also took a few additional classes that made a huge difference such as biochemistry (I know some med schools are requiring it now as a pre-recc), anatomy, physiology -- those made a bigger differences,huge difference

 

[DrBumblebee]

Orthojoe -

It's been said to do the residency where you wanna practice in the future.

Since you'll be doing your orthopaedic surgery residency at Modesto, CA:

1) How do you think about the job opportunities in Northern & Southern California after residency? Do you have to do your job search in other regions?
2) Does your program promise to help you in your job search efforts in the future?
3) How is the networking of osteopathic surgeons in California?

 

[backsideattack1]

However they could tell you all the osteoprogenitor cells and what factors stimulated osteoclast growth and what's the new trials on bone growth factors, etc, etc I also discovered that MD programs have some huge surgical names to work with - ones who pioneered new procedures/research. cool right... well in most cases do you think these hot shot surgeons with huge reputations are going to hand the knife over to a second or third, maybe even fourth year resident.. It didnt happen and in fact I watched in most cases the residents get grilled/fired and roasted during the procedures with questions that have no bearing on surgery (Like, why is this instrument called the kelly forceps, who was the guy and what did he do- the resident didnt know and was shunned the rest of the operation.. happened at Mayo)

Now compare that do osteopathic programs which tend to be more smaller community based programs. In most instances as an intern there was plenty of OR time, and in fact the 4-5 year residents were expected to be the teachers for them on simple procedures. I saw second years roding femurs/tibias, placing screws, working one on one with an attending. Often third years were open to close. fifth years ran their own room (attending pops head in to start procedure for legal reasons then leaves). So the surgical experience and opportunities to operate were placed in a much higher emphasis. The surgical skills therefore, as a fifth year, were much more developed than in the allopathic programs.

I asked so many anesthesiologist about the difference in skills between allo and ortho residents -- they are the eyes in every OR. they almost always said the osteopathic residents are way more autonomous and have better surgical skills. they stated the third years were 1-2 years behind in surgical skills and in some extreme cases stated that they couldn't believe how little the senior residents operated.

i believe due to this, I would prefer to have a DO surgeon right out of residency operate on me as compared to a new MD surgeon. I'm not sure if this gap disappears after 5-10 years as an attending but its a major factor of why I DID NOT choose to participate in the MD match for ortho. I chose to match into a DO program because from day one I will be handed the knife, per say. Academics can always be learned on your own. I want to have the opportunity to be put in front of a patient, given the knife and guided as much as possible from day one.

by the way - the program I matched into I feel is the best osteo ortho program (Modesto California). just an amazing group of docs, case load and case variability. If you guys make it that far- make sure to come rotate. I'll be a senior resident, just mention this post and I'll make sure you get handed the knife, drill, saw or whatever.

I noticed this as well while I was shadowing in all the surgical specialties. The osteopathic hospital let the brand new residents take part, while the fellows of the prestigious allo heavy hospital ended up holding things and completing less tasks. I wonder though, does it make it harder to complete a fellowship coming from an osteopathic hospital? I am sure it does. I really enjoyed hearing that the osteopathic surgery PDs were still highly biased toward taking osteopathic residents because they felt the same things that you just stated.

 

[Sam212]

Allopathic programs sacrifice surgical experiences for knowledge/research. Interns rarely see the inside of the OR and when they do, its to hold retractors, prep patients and close. You end up doing the scut work (work that no one wants and really should be left up to the nurses or ancillary staff) Yes you can learn during during the operation by observing but its totally different then when you actually hold the knife (or scope or whatever). I found that in most cases it wasn't until late third year/fourth year that the residents got to do many of the surgeries from close to close. At one program I observed a third year being taught how to do a distal radius, one of the most common operations in ortho. I was shocked because I actually had done a distal radius close to close with a hand surgeon and knew the steps,anatomy,etc better. I watched a third year at a prestigious allopathic ortho program open only once and the rest was just closing in a 4 weeks time.

Not saying you're misrepresenting, but I would say this is an exaggeration as I checked out 7 DO programs and never did anything skin to skin. In fact most PGY2s didn't do cases skin to skin, even distal radius, attendings/senior residents always took charge.

 

[Orthojoe]

Not saying you're misrepresenting, but I would say this is an exaggeration as I checked out 7 DO programs and never did anything skin to skin. In fact most PGY2s didn't do cases skin to skin, even distal radius, attendings/senior residents always took charge.

understandable. No resident, just me and the hand surgeon,

lets see, after having a 15 minute conversation of the steps,structures, etc before the case we scrubbed in and the scapel was handed to me, i made the skin incision, dissected out nerves/vessels under direct supervision of attending (obviously he was directing me!), protected these structures, reflected PQ to expose fracture site ----- here attending took over to gain provisional fixation and plate placement --- handed drill to me, i placed all screws --- attending took over to close fascial layers -- I closed skin. Of course he was giving me step by step instructions, guided my hand, checked with flouro, etc. It was last case of the day, last week of my 4 week rotation.

This was more than what a PGY-3 at a very reputable allopathic program did in four weeks. I saw him make one skin incision, remove two screws, and close. that was my point. But i guess you were right, I didnt do every step.

In osteopathic programs I saw three PGY2's do skin to skin on multiple cases -- but most commonly femoral neck fractures. I saw quite a few PGY3-4 do some large trauma cases skin to skin (AGAIN attending was there guiding and directing). I saw three PGY-5s run their own room for the whole day doing scopes (knee and shoulders), total knees, distal radius, femur and tibial fractures, femoral neck fractures, AKA. etc. WHILE guiding and directing PGY2-3. Attendings had complete confidence in these seniors. I was impressed with some of these seniors that I felt they were better than some other attendings I rotated with.

Maybe I just happened to luck out on my audition rotations to find programs like this. But I've heard many many of my friends say the same thing.

 

[Orthojoe]

Orthojoe -

It's been said to do the residency where you wanna practice in the future.

Since you'll be doing your orthopaedic surgery residency at Modesto, CA:

1) How do you think about the job opportunities in Northern & Southern California after residency? Do you have to do your job search in other regions?
2) Does your program promise to help you in your job search efforts in the future?
3) How is the networking of osteopathic surgeons in California?

good questions man! I am impressed. I did my homework as well. I spoke with the hospital administrator and the director of a conglomerate of community programs thats sole goal is to entice physicians to practice in their county. They specifically polled the county and determined that orthopedics was the greatest need - thus why they began an orthopedic residency (in hopes a few residents will stay). So I believe the opportunity, should I choose, will be there whether in private practice or through hospital employment. california's taxes (states personal income tax just jumped to 13%) and environment has made it difficult to entice physicians into the central california area.

Didnt ask about job placement help, mainly because I have two friends who are head hunters for docs. I would use them.

Not sure about the osteopathic community in california.

 

[Orthojoe]

I noticed this as well while I was shadowing in all the surgical specialties. The osteopathic hospital let the brand new residents take part, while the fellows of the prestigious allo heavy hospital ended up holding things and completing less tasks. I wonder though, does it make it harder to complete a fellowship coming from an osteopathic hospital? I am sure it does. I really enjoyed hearing that the osteopathic surgery PDs were still highly biased toward taking osteopathic residents because they felt the same things that you just stated.

thanks for the confirmation - even a pre-medical student recognizes the difference.

I am not sure about the fellowships. I was only exposed to two fellows, both in trauma, one osteopathic and one allopathic. I didnt get to know them enough to determine their skill sets. usually when the fellow showed up, it bumped the medical students because now you had the attending, fellow, PGY4/5 and ad PGY2/3 all scrubbed in. I ended up hitting the floor with the intern.

This is also one reason I chose not to do an residency with a built in associated fellowship - which many allopathic programs are. I know I'll run into fellows on my peds and trauma rotations but general, joints, sports, hand, foot/ankle I wont because those are done at my core hospital.

 

[Sam212]

understandable. No resident, just me and the hand surgeon,

lets see, after having a 15 minute conversation of the steps,structures, etc before the case we scrubbed in and the scapel was handed to me, i made the skin incision, dissected out nerves/vessels under direct supervision of attending (obviously he was directing me!), protected these structures, reflected PQ to expose fracture site ----- here attending took over to gain provisional fixation and plate placement --- handed drill to me, i placed all screws --- attending took over to close fascial layers -- I closed skin. Of course he was giving me step by step instructions, guided my hand, checked with flouro, etc. It was last case of the day, last week of my 4 week rotation.

This was more than what a PGY-3 at a very reputable allopathic program did in four weeks. I saw him make one skin incision, remove two screws, and close. that was my point. But i guess you were right, I didnt do every step.

In osteopathic programs I saw three PGY2's do skin to skin on multiple cases -- but most commonly femoral neck fractures. I saw quite a few PGY3-4 do some large trauma cases skin to skin (AGAIN attending was there guiding and directing). I saw three PGY-5s run their own room for the whole day doing scopes (knee and shoulders), total knees, distal radius, femur and tibial fractures, femoral neck fractures, AKA. etc. WHILE guiding and directing PGY2-3. Attendings had complete confidence in these seniors. I was impressed with some of these seniors that I felt they were better than some other attendings I rotated with.

Maybe I just happened to luck out on my audition rotations to find programs like this. But I've heard many many of my friends say the same thing.

When you said skin to skin, I thought you did everything with no attending intervention, only supervision. I would say the amount of autonomy you got is a rarity for a medical student in any program. I did remove a 1/3 tubular plate but it was way too easy so he let me do it.

I agree that DO programs operate early and hence you're well trained. Every program I went to, the seniors were running their own room. PGY4s were almost running their own room.

As for PGY2s, they did CMNs/Distal Radius/Tibial Nails/Femoral nails/Perc Pinning/some hand stuff/knee scopes until they screwed up and then a senior/attending intervened. I did see a pgy2 do the whole humeral plate skin to skin, but he was a gen surg resident before so his skills were really good. Never saw any PGY2 do hemis or totals, they would do some cuts/reaming but never skin to skin. Same thing with shoulder scopes unless it was SAD.

I guess what I am saying is that yeah we operate early and often but it's not universal among all DO programs and it varies depending on a resident's skill.

 

[Wozo30]

I'll preface with I did not do a rotation at an allo program. From what I have heard through friends in general surgery residencies and some allo programs, in general but not across the board, DO residents get more surgical exposure than do MD counterparts. Autonomy varied from place to place where I went so its not all inclusive that PGY3 will run their own room, but probably more likely. Academically it's known that MD residencies focus much more on basic science, just check out their curriculums online and you'll find a month dedicated to it during intern year. Just an anecdote but while at one program I was on call with a PGY2 and we covered with a newly minted doc that just finished his foot and ankle fellowship at Johns Hopkins. It was a septic hip, used posterior approach and was all over the place...took over an hour just to get the approach and even as a student I could tell it wasn't going well. She had some post op issues with her sciatic nerve that resolved. Afterwards the resident said that I as a student probably could have done a better job. Now while I know that's not true, it just illustrated that this physician wasn't comfortable with a simple procedure that I had seen either one of the chiefs instruct the PGY2/3 on how to do. Again just one experience and most other anecdotal stories will come from the side it benefits but I think you'll have a hard time finding many MD programs where their residents have done 3000+ cases.

 

[Wozo30]

When you said skin to skin, I thought you did everything with no attending intervention, only supervision. I would say the amount of autonomy you got is a rarity for a medical student in any program.

I was lucky enough at one program to get to do a carpal tunnel release skin to skin with the chief walking me through the procedure, attending wasn't even in the room. He said a chief had done it for him and he always liked to return the favor for med students.

 

[abolt18]

undergrad at a few colleges because I thought I could play baseball.. I initially started at RICKS.. for those of you who know that school, it shows my antiquity but ended up at BYU.

Micro was fine and helped in a few areas. but I also took a few additional classes that made a huge difference such as biochemistry (I know some med schools are requiring it now as a pre-recc), anatomy, physiology -- those made a bigger differences,huge difference

Haha yeah my brother went to Ricks for a year so I can definitely see the age gap haha. I've taken all the required micro courses but I've taken as electives anatomy, advanced anatomy (teach the anatomy lab and perform dissections), physiology, biochem, genetics and a few others. Hopefully these will allow me to focus on things I'm less familiar with when school starts.

Being a family man, would you have any tips for what worked best for you as far as time management and spending time with the fam. I'm married with a 6 month old. Probably going to start trying for another in the next year or so. A friend of mine always gets up at 4:30am, studies, works out, studies more, eats lunch, studies, etc. comes home at 6pm ever night except the weeks before their block exams. Sounds awesome to me but I don't know if I could do the 4:30 every day haha. What did you do to make sure to give yourself time with your family in the first two years of school?

 

[NurWollen]

Haha yeah my brother went to Ricks for a year so I can definitely see the age gap haha. I've taken all the required micro courses but I've taken as electives anatomy, advanced anatomy (teach the anatomy lab and perform dissections), physiology, biochem, genetics and a few others. Hopefully these will allow me to focus on things I'm less familiar with when school starts.

Being a family man, would you have any tips for what worked best for you as far as time management and spending time with the fam. I'm married with a 6 month old. Probably going to start trying for another in the next year or so. A friend of mine always gets up at 4:30am, studies, works out, studies more, eats lunch, studies, etc. comes home at 6pm ever night except the weeks before their block exams. Sounds awesome to me but I don't know if I could do the 4:30 every day haha. What did you do to make sure to give yourself time with your family in the first two years of school?

I would also love to hear some advice on this. Also Orthojoe, have you been back to Rexburg since you went to Ricks? I bet you wouldn't even recognize the place.

 

[Orthojoe]

Haha yeah my brother went to Ricks for a year so I can definitely see the age gap haha. I've taken all the required micro courses but I've taken as electives anatomy, advanced anatomy (teach the anatomy lab and perform dissections), physiology, biochem, genetics and a few others. Hopefully these will allow me to focus on things I'm less familiar with when school starts.

Being a family man, would you have any tips for what worked best for you as far as time management and spending time with the fam. I'm married with a 6 month old. Probably going to start trying for another in the next year or so. A friend of mine always gets up at 4:30am, studies, works out, studies more, eats lunch, studies, etc. comes home at 6pm ever night except the weeks before their block exams. Sounds awesome to me but I don't know if I could do the 4:30 every day haha. What did you do to make sure to give yourself time with your family in the first two years of school?

havent been back to rexburg since 1996. someday maybe -

I was a father of two with one on the way when I matriculated to med school (leaving with four, what can i say, my wife thinks I'm hot!).

first and foremost my priority is and will always be my family. This means that I did NOT have many friends in my class and it means I did NOT join many study groups and during clinical rotations I didnt go out with the residents after work... my time away from school/studies were with my family. I rarely did anything just for me, and I chose and learned that my relaxation/get away was my family.. and when I did something for myself I had made sure my father priorities were done first.

So things that helped --

(1) we got a home close to school so my wife could bring the kids to lunch. I ate lunch with them most days. then played around the school grounds, volleyball court, gym -- AZCOM actually has a great gym facility,basketball court and volleyball courts. We did this on rotations as well

(2) I enrolled my wife into studying and helping me. we would cuddle in bed and she would quiz me with flash cards, test materials, etc. To add a little incentive I would rub her back while she did this. Some of my funniest memories of med school was listening to my wife butcher medical lingo - and then on sunday have conversations with her friends at church where she would act like she knew all this medical material. It made me smile and laugh. Really this was huge for me. My wife bought into the idea that we were going to medical school together and when I did well, she did well. We would celebrate with a mcdonalds ice cream or something when I aced a test. Basically my wife really earned a medical degree with me. She probably could run circles around some medical students. shes kind of a "dumb blonde" personality so if my wife can do it, anyones can.

(3) As i mentioned before I am a firm believer that focused studying beats volume studying anyday (see previous posts). I would set at time to study for 1 hour, super focus, learn, read and when the timer goes off I would stop for 30 minutes, go play with my kids, help with dinner -- timer goes off after 30 minutes I would go back to studying. using visual cues (markers, underlining, circling, staring) are part of this super focused learning. There are a few books out there on this process.

(4) I avoided lectures at all costs. These eat up so much time. I wanted to learn at my pace. So I would record lectures and listen to them at 1.6X speed, go over notes a week in advance so that all i would do was listen to the spots of the lecture I needed a little help with. I believe the lecture format is an old model that should be changed.

(5) study groups - i mentioned this before.. i wanted to learn at my own pace and often times study groups end up having long conversations NOT about school, or someone is struggling to understand which holds back the learning. This sounds kind of selfish but its the reality of study groups. I didnt have the time or luxury to participate.

(6) SLEEP!! important to me. I never pulled all nighters (only when on call). I felt they do more damage than good - eating into the next day as well. If i needed an all nighter its becasue I didnt learn the material appropriately the first time. Studying for a test for me was a simple review of material I already understood. Memorizing this information does take time. But going into a study session for a test, understanding the concepts, made memorizing easy.

(7) date night with wife - invaluable for maintaining a solid relationship. at least once a week. finding a group of 3or 4 families and then rotating babysitting is the best way. All the kids would be dropped off for 2.5 hours to one family already haven had dinner. Therefore we had one crazy saturday for 2.5 hours but then free babysitter 3 saturdays of the month. we have a large backyard with a huge play set so we just sent the kids outside with cupcakes or something.. whallo! our 2.5 hours were up in no time.

(8) I love the motto "adjust and continue" - if something didnt work or a study session was bad I would quickly identify why then adjust. Example.. I learned quickly that studying at home during the day (8-5) was pretty detrimental because "dad was home!" or my wife would ask for my help -- so I stayed at school until 5ish studying at the library. sometimes I would come home earlier but not if I knew I needed to get good studying in.

(9) We taught our kids that when dad is in the office - its "do not disturb".. basically we also had to buy a lock for the door so that I could study. I could do this and not feel guilty because I knew in an hour from going in, I'd be out to play or help around the house.

(10) - lastly (sorry for those who are not religious or spiritual).. my wife and I are committed physically, emotionally and spiritually. We committed that nothing would stand in our way of having a solid and close family dedicated to GOD and providing an awesome life for them. I understood that in the grand scheme of things my family is more important and if my grades slipped (NOT because I didnt try but because a family priority came up or church responsibility) then so be it. I believe because I put my family and god first i was blessed. yes there were days I wasnt around for my kids and days I couldnt "fulfill" my church responsibilities myself (i just asked for help though). But overall we followed my family's motto "Do your best and let God do the rest" (yes pretty cheezy but good none the less -- it sounds better when a chorus of a 7 year old girl, a 5 and a 3 year old boy are saying it at night after our family prayers)

thats all i can think of right now.

 

[abolt18]

Wow thank you for that! I will definitely have my wife read this post this evening. I look forward to the challenge of finding what works best for my family.

 

[NurWollen]

wow thank you for that! I will definitely have my wife read this post this evening. I look forward to the challenge of finding what works best for my family.

+1

 

[DrBumblebee]

Orthojoe -

What's the main reason that the day starts too early for surgeons, like around 4:00am in the morning? Does it have anything to do with catching up with the patient's Circadian rhythm?

 

[abolt18]

Orthojoe -

What's the main reason that the day starts too early for surgeons, like around 4:00am in the morning? Does it have anything to do with catching up with the patient's Circadian rhythm?

Doesn't 4:00am already mean "in the morning?"

 

[Orthojoe]

Orthojoe -

What's the main reason that the day starts too early for surgeons, like around 4:00am in the morning? Does it have anything to do with catching up with the patient's Circadian rhythm?

starting the day at 4:00am as a surgeon is a legend/myth and not the norm. You only start that early consistently if (1) you are a resident/medical student or (2) you've been on call. I dont know of any attending that starts that early.

as a resident/medical student you need to round before the attending. so if the attending has a 7:00 OR case (which is pretty much standard time for a good surgeon) then resident will round 5-5:30 so that they can then round with attending about 6-6:30 depending on how big their census is.

so as a medical studnet you need to pre-round before the residents at 4:30 ish, then you round with the residents, then round with attending.. thus why the early morning start.

Now if you are on call that's a completely different story.

 

[chiddler]

Orthojoe: I'm still a little nervous about picking LA for rotations. How do I find out which location is good? I know you said you're not sure about LA specifically, but do you have any suggestions on how I can find out?

Don't care where I go. Just picked it because familiarity with area.

 

[NurWollen]

Orthojoe, at what point during do you learn what is expected of you as a 3rd year med student? Do you just show up being ready for anything? For example, a couple of posts ago you mentioned that you needed to do rounds before rounding with the residents. How did you know what time you needed to be there? How did you know when to show up on your first day? How do you know what to do when you round by yourself? Do you just learn on the go, looking clueless on your first rotations? I'm not trying to sound lazy, and I'm not trying to see how little I can get away with on rotations. It just seems like there is such a huge difference between pre clinicals and clinical years, I'm just wondering how you know where to start when 3rd year begins.

 

[Orthojoe]

Orthojoe: I'm still a little nervous about picking LA for rotations. How do I find out which location is good? I know you said you're not sure about LA specifically, but do you have any suggestions on how I can find out?

Don't care where I go. Just picked it because familiarity with area.

are you in AZ? if so PM me and lets meet at the school and I will help you go through the selection process.

If not does the school give you access to their online preceptor evaluations? thats where I would start, looking to see what type of physicians and hospitals you have access too. I know when we recently went through they were having some issues with LA and accreditation/approval of rotation sites. Im assuming they have solved them.

 

[Orthojoe]

Orthojoe, at what point during do you learn what is expected of you as a 3rd year med student? Do you just show up being ready for anything? For example, a couple of posts ago you mentioned that you needed to do rounds before rounding with the residents. How did you know what time you needed to be there? How did you know when to show up on your first day? How do you know what to do when you round by yourself? Do you just learn on the go, looking clueless on your first rotations? I'm not trying to sound lazy, and I'm not trying to see how little I can get away with on rotations. It just seems like there is such a huge difference between pre clinicals and clinical years, I'm just wondering how you know where to start when 3rd year begins.

I called the program two weeks before I was to start the rotation, asking about dress code, white coat, tie, when and where to show up first day. I also made sure I was badged before I started the rotation. That way I hit the ground running and didn't leave in the middle of the first day to get my hospital badge.

But your first day most of these questions will be answered. You will learn quickly at every rotation (well hopefully) what is expected and what each physician/attending lets you do. Some rotations are outpatient and some inpatient, so the expectation is completely different.

typically I was assigned 3-4 patients for me to round on when inpatient. I would show up early, get their vitals, ins and outs, read new results of labs, etc - then go to the floor and ask the patients nurse if there was any overnight events and how the patient was doing (the time was dependent on how complex and how many patients I had, it got shorter and shorter as I became more experienced). Then i would examine the patient and ask questions pertaining to their illness. -- then input this into note format so that I could report it to the residents.

some residents don't like you to round or write notes, some do. It all depend on the resident and your abilities. My first clinical rotation was inpatient IM. by the third day I had been assigned 4 patients and saw them myself, then at morning rounds with the residents and staff I reported on those patients. Each day I was given more and more autonomy as I showed competence. If we were slow, I would hit the floor and round again on my patients to check up on them in the afternoon. I would also keep abreast of my patients labs so that I could report them to resident when they came in.

so in a nut shell you really wont know what to expect until you show up the first day and feel out your expectations.. then work hard and try to be involved as much as possible.

 

[Silent Cool]

OJ,

What were your stats: gpa, mcat, and step 1

thanx

 

[Dreamstoo]

I have noticed that for what I'm interested in (sports medicine orthopedics), PCOM has an orthopedic program where you can be completed with your residency and fellowship (in near by hospitals) within 5 years. How does this compare to a MD's route for sports medicine orhtopedics? I'm a pre med and I don't know much about the process of how residencies/fellowships work. I know however that a DO has the option to apply to MDs if he or she has taken the USMLEs.

 

[DrEnderW]

I have noticed that for what I'm interested in (sports medicine orthopedics), PCOM has an orthopedic program where you can be completed with your residency and fellowship (in near by hospitals) within 5 years. How does this compare to a MD's route for sports medicine orhtopedics? I'm a pre med and I don't know much about the process of how residencies/fellowships work. I know however that a DO has the option to apply to MDs if he or she has taken the USMLEs.

You have the option to apply to an MD residency, that is correct. However, this forgoes your ability to match DO ortho.

Most people do not take this gamble, as between 1-6 DOs match ACGME a year. To match as a DO, you'd have to have stellar stats, LOR, research, and often inside connections above that of the majority of MDs matching ortho. Additionally, you will have to overcome the serious anti-DO bias surgical program directors hold. For that reason, most competitive DOs will go the AOA route and not take that gamble, but exceptions happen every year. Unlike the other specialties such as IM, FM, psych, PM&R, peds etc, the ACGME surgery world is not DO friendly in any way. AOA ortho is incredibly competitive as well and is an amazing opportunity if you match.

 

[Dr Dazzle]

You have the option to apply to an MD residency, that is correct. However, this forgoes your ability to match DO ortho.

Most people do not take this gamble, as between 1-6 DOs match ACGME a year. To match as a DO, you'd have to have stellar stats, LOR, research, and often inside connections above that of the majority of MDs matching ortho. Additionally, you will have to overcome the serious anti-DO bias surgical program directors hold. For that reason, most competitive DOs will go the AOA route and not take that gamble, but exceptions happen every year. Unlike the other specialties such as IM, FM, psych, PM&R, peds etc, the ACGME surgery world is not DO friendly in any way. AOA ortho is incredibly competitive as well and is an amazing opportunity if you match.

Are the chances to match AOA ortho for DOs proportional to chances for matching ACGME ortho for MDs?

 

[DrEnderW]

Are the chances to match AOA ortho for DOs proportional to chances for matching ACGME ortho for MDs?

Good question. They are slightly lower for DOs but very similar - I forget the exact numbers off hand. I'll try to remember to post them later when I have a chance. There are way less AOA spots, but there are also way less applicants making the ratio similar.

 

[DrEnderW]

So that data I have is for 2011 because that is the easier info to find on the AOA side...

AOA Ortho match rate: 57%

ACGME Ortho match rate: 68%

There's a little more disparity than I remembered. However, I think there are more AOA positions available now if I am reading the recent AOA release of residency positions available. I think it may be in the low 60s (around 64%) now, but I am not 100% sure on this.

You can check out this link:

http://opportunities.osteopathic.or...essionid=f030b8ab5a50d101fef8581c691444b15726

On either side, ortho is incredibly competitive.

 

[cliquesh]

In 2011 there were 86 AOA orthopedic spots and 4228 graduates. In 2013 there 100 orthopedic spots and 4913 graduates.

 

[DrEnderW]

In 2011 there were 86 AOA orthopedic spots and 4228 graduates. In 2013 there 100 orthopedic spots and 4913 graduates.

Thanks for that - I thought I saw there was an increase in spots. I suppose one has to assume that with an increased number of students, there would be a corresponding increase in the amount of #1 choice ortho applicants as well. At least ortho has been adding spots unlike some of the other surg subspecialties.

 

[Dr Dazzle]

Thanks for that - I thought I saw there was an increase in spots. I suppose one has to assume that with an increased number of students, there would be a corresponding increase in the amount of #1 choice ortho applicants as well. At least ortho has been adding spots unlike some of the other surg subspecialties.

Yeah, it's unfortunate that there just aren't enough spots on AOA side for all graduating DOs. Very concerning if ACGME changes it's policies towards DOs. Already DOs are limited to mostly primary care type things on the ACGME side with comlex.

 

[DrEnderW]

Yeah, it's unfortunate that there just aren't enough spots on AOA side for all graduating DOs. Very concerning if ACGME changes it's policies towards DOs. Already DOs are limited to mostly primary care type things on the ACGME side with comlex.

This is cause for concern but I don't think the AOA would let that happen. It would end the DO degree - they would take a residency merger deal long before that. There aren't even close to enough spots for DOs in AOA residencies.

For the COMLEX part, I personally would not accept COMLEX scores if I was an ACGME program director. If DOs want to match ACGME, they should conform to their rules and take their examination. I don't think that's unreasonable at all.

 

[Frankminguel]

Howdy!


So right now, I'm finished with my first year at a medical school which still uses the ABCDF system and I'very gotten mostly Bs, 1 As, and one C for the year. I know what to do next year to do better and I believe that I will start racking up honors soon enough, but how much of a chance will I have to matching in Ortho assuming everything else is stellar?