Originally posted by 12R34Y:
I hope that someone can please calm my fears about a possibly substandard clinical education at osteopathic schools. Please explain to me the difference between the preceptor based and the other. thanks a ton.
I don't think that you have to worry. Basically, it is very fashionable for medical students (both DO and MD) to complain about their rotations, their interns, and/or their attendings. You have to be skeptical about what you hear and keep in mind everyone's experience is a little different.
Every medical school has good and bad rotations for a variety of reasons. And, you can't please everyone all the time. Every student learns differently and every student expects something different from a rotation given their interests, motivation, and work ethic. Sometimes you get attendings who like to teach, other times you don't. Sometimes you get a rotation that's *SO* heavy on the didactics it's like being back in the classroom, other times you're running your butt off doing scut work all the do'da'day.
In general, there are preceptor-based rotations (where you follow one doc in his office, on his rounds, at the hospital, to the post office, and to his kid's softball game...) and ward-based or service-based rotations where you're "clerking" (hence the term "clerkship") for a team usually comprised of an attending, a resident, and a chain-smoking, coffee-guzzling haven't-slept-in-12-days intern. Each kind of rotation is organized differently. Students benefit from exposure to both.
The ward-based rotation is the traditional medical education experience that comes to most people's mind where the responsibilities are usually very sharply delineated and hierarachal. The student gets to hospital at 5:30AM, does pre-rounds on the patients assigned to him or the whole service, goes to morning report, checks with the intern (who usually dumps more work on him/her), and then rounds later with the resident and attending. The student presents each patient ("Mrs. Smith is a 65 y.o. African-American woman who blah blah blah with blah blah and so on and so on...") The intern chimes in with the latest change in therapy, the resident posits some very intriguing and somewhat esoteric question, there ensues plenty of pimping all around, delegation of new tasks, the attending signs the chart and off to the next patient...
The preceptor-based rotation can vary widely in scope, responsibility, and academic instruction. Sometimes you just follow around some grumpy attending who lets you do nothing, ocassionally drops some clinical pearl with half-hearted disgust and usually just responds to every question with "look it up." Other times, you show up and meet the doc's staff who hand you a chart, smile and say, "Dr so and so is late this morning, he said to get started, his first patient is in room 3." Some preceptors are on the ball and have compiled a list of articles they want you to read, set aside a specific amount of time per week to discuss specific educational issues, etc. Others barely realize you're there...
There are pluses and minuses to each kind of rotation not to mention the huge individual variation from attending to attending. The traditional ward-based rotation, which used to be the dominant model of clinical medical education worldwide, is comforting in its clear expectations and roles, but can get mind-numbing once you finally "catch-on" to the system. The preceptor-based rotation can be a wonderful mentoring, nurturing experience or a trial-by-fire hell.
Likely, regardless of where you decide to attend medical school you'll have plenty of experience with both kinds of rotations, good and bad. My personal opinion is that it should be 60/40 in favor of outpatient, preceptor-based learning. Others will disagree. I just think that more and more medicine is being "turfed" to the outpatient setting and only sickest of the sickest get into the hospital these days---usually endstage or near endstage disease. The days are long gone when patients were admitted to the hospital to be "worked-up." Now, cardiologists will do just about everything except actually cath the patient right there in the waiting room.